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Borentain S, Desai P, Fu DJ, Nancy Chen L, Lane R, Mathews M, Canuso CM. Commentary on Cochrane review: "Ketamine and other glutamate receptor modulators for depression in adults with unipolar major depressive disorder". J Psychopharmacol 2023; 37:836-844. [PMID: 36218274 PMCID: PMC10399093 DOI: 10.1177/02698811221123046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Cochrane recently published a review of esketamine and other glutamate receptor modulators in depression. AIM To address the limitations of the review, analyses of esketamine data were conducted to provide additional perspective to the reviewers' interpretation of their findings. METHODS Response rate, remission rate, and change from baseline in Montgomery-Åsberg Depression Rating Scale (MADRS) total score were determined using data from all esketamine phase 2/3 registration studies of treatment-resistant depression (TRD) and, separately, all esketamine phase 2/3 registration studies of major depressive disorder (MDD) and active suicidal ideation with intent. Outcomes were assessed at all timepoints (i.e., 24 h, 72 h (MDD with active suicidal intent only), and 1, 2, and 4 weeks). Enrollment criteria of the TRD studies were different than those of the studies of MDD and active suicidal ideation with intent, resulting in differences in patients' clinical characteristics and depression severity between the cohorts. Thus, we did not compare results between these cohorts (as was done in the Cochrane review). RESULTS/OUTCOMES In the combined TRD studies, a statistically significant between-group difference favored esketamine plus antidepressant over antidepressant plus placebo at 24 h (based on response, remission, and change in MADRS score), 1 week (change in MADRS score), 2 weeks (response and change in MADRS score), and 4 weeks (response, remission, and change in MADRS score). In the combined studies of MDD and active suicidal ideation with intent, the between-group difference was statistically different, favoring esketamine plus standard-of-care over placebo plus standard-of-care, at 24 h (response, remission, and change in MADRS score), 72 h and 1 week (change in MADRS score), 2 weeks (response), and 4 weeks (response, remission, and change in MADRS score). For both study types, the between-group difference in outcomes was not statistically significant at the other timepoints. CONCLUSIONS/INTERPRETATION Esketamine improves response, remission, and depressive symptoms as early as 24 h post-first dose among patients with TRD and among patients with MDD and active suicidal ideation with intent.
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Affiliation(s)
| | - Pooja Desai
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Dong-Jing Fu
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Li Nancy Chen
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Rosanne Lane
- Janssen Research & Development, LLC, Titusville, NJ, USA
| | - Maju Mathews
- Janssen Research & Development, LLC, Titusville, NJ, USA
- Perception Neuroscience, New York, NY, USA (current employment)
| | - Carla M Canuso
- Janssen Research & Development, LLC, Titusville, NJ, USA
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Menon V, Kar SK, Marthoenis M, Arafat SY, Sharma G, Kaliamoorthy C, Ransing R, Mukherjee S, Pattnaik JI, Shirahatti NB, Varadharajan N, Padhy SK. Is there any link between celebrity suicide and further suicidal behaviour in India? Int J Soc Psychiatry 2021; 67:453-460. [PMID: 33028142 DOI: 10.1177/0020764020964531] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Little is known about the factors that determine vulnerability to subsequent suicide in the community following a celebrity suicide. Our objective was to investigate the link between an alleged celebrity suicide and further suicidal behaviour in the community in India. METHODS Relevant news articles that reported suicidal behaviour in the population were retrieved from online news portals of regional and English language newspapers in the immediate month following the actor's death. A deductive analysis of the retrieved suicide news articles was carried out using a pre-designed data extraction form. RESULTS A total of 1160 relevant news articles were identified from the local language (n = 985) and English (n = 175) newspapers. For a sizeable percentage of these reports (n = 65, 5.6%), the media reported links with celebrity suicide. Odds of subsequent suicide among young (Odds Ratios [OR] - 9.24), female (OR - 1.94), unemployed (OR - 7.26), those without precipitating life events (OR - 2.94) or mental illness (OR - 1.69) were higher among those with link to celebrity suicide; likewise, odds of death by hanging (OR - 49.84) and leaving a suicide note (OR - 2.03) were higher among those linked to celebrity suicide. English newspapers (OR - 4.23) were more likely to report events linked to celebrity suicide than local language newspapers. CONCLUSION Persons who died by suicide by hanging after a celebrity suicide are more likely to be young, female, unemployed, have a mental disorder or precipitating life events. Suicide prevention efforts must focus on this group and prevent the same method of suicide like that of the celebrity.
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Affiliation(s)
- Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Pondicherry, India
| | - Sujita Kumar Kar
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Marthoenis Marthoenis
- Department of Psychiatry and Mental Health Nursing, Universitas Syiah Kuala, Banda Aceh, Aceh, Indonesia
| | - Sm Yasir Arafat
- Department of Psychiatry, Enam Medical College and Hospital, Dhaka, Bangladesh
| | - Ginni Sharma
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Charanya Kaliamoorthy
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Pondicherry, India
| | - Ramdas Ransing
- Department of Psychiatry, BKL Walalwalkar Rural Medical College, Ratnagiri, Maharashtra, India
| | - Srijeeta Mukherjee
- Department of Psychiatry, MKCG Medical College, Brahmapur, Odisha, India
| | | | - Nikhilesh B Shirahatti
- Department of Psychiatry, King George's Medical University, Lucknow, Uttar Pradesh, India
| | - Natarajan Varadharajan
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, Pondicherry, India
| | - Susanta Kumar Padhy
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Priilaid D, Hall D. Price preferences reveal asymmetric price effect—A preliminary study. J SENS STUD 2021. [DOI: 10.1111/joss.12665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- David Priilaid
- Applied Management University of Cape Town Rondebosch South Africa
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4
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Worthley A, Simonyan K. Suicidal Ideations and Attempts in Patients With Isolated Dystonia. Neurology 2021; 96:e1551-e1560. [PMID: 33504639 DOI: 10.1212/wnl.0000000000011596] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 12/07/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the hypothesis that individuals with isolated dystonia are at an increased risk for suicidal behavior, we administered an anonymous electronic survey to patients with dystonia, asking them about their history of suicidal ideations and suicide attempt. METHODS A total of 542 patients with dystonia completed an online 97-question survey, which captured the demographics of suicidal behavior and major psychiatric disorders. Statistical analyses examined the prevalence of suicidal behavior in patients with dystonia compared to the prevalence of suicidal ideations and attempt in the general global population and assessed the significance of risk associations between suicidality and psychiatric history in these patients. RESULTS Overall, 32.3% of patients with isolated dystonia reported a lifetime history of suicidal behavior, which was significantly different from the reported rates of suicidal ideation (9.2%) and attempt (2.7%) in the general global population. The prevalence of suicidality was higher in patients with multifocal/segmental and generalized forms of dystonia (range of 46%-50%) compared to patients with focal dystonias (range of 26.1%-33.3%). The highest suicidal ideation-to-attempt ratio of 4:1 was found in patients with generalized dystonia. Suicidality in patients with focal dystonia was significantly associated with history of depression and anxiety disorders. CONCLUSION Patients with isolated dystonia have an increased, albeit unrecognized, prevalence of suicidal behavior compared to the general global population. Screening for suicidal risk should be incorporated as part of the clinical evaluation of patients with dystonia to prevent their suicide-induced injury and death.
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Affiliation(s)
- Alexis Worthley
- From the Department of Otolaryngology-Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston
| | - Kristina Simonyan
- From the Department of Otolaryngology-Head and Neck Surgery (A.W., K.S.), Massachusetts Eye and Ear; Department of Otolaryngology-Head and Neck Surgery (K.S.), Harvard Medical School; and Department of Neurology (K.S.), Massachusetts General Hospital, Boston.
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5
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Suicidality in Chronic Illness: An Overview of Cognitive–Affective and Interpersonal Factors. J Clin Psychol Med Settings 2020; 28:137-148. [DOI: 10.1007/s10880-020-09749-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2020] [Indexed: 12/18/2022]
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Ryan EP, Oquendo MA. Suicide Risk Assessment and Prevention: Challenges and Opportunities. FOCUS: JOURNAL OF LIFE LONG LEARNING IN PSYCHIATRY 2020; 18:88-99. [PMID: 33162846 DOI: 10.1176/appi.focus.20200011] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Despite increased access to mental health care for the previously uninsured and expanding evidence-based treatments for mood, anxiety, psychotic, and substance use disorders, suicide is on the rise in the United States. Since 1999, the age-adjusted suicide rate in the United States has increased 33%, from 10.5 per 100,000 standard population to 14.0. As of yet, there are no clinically available biomarkers, laboratory tests, or imaging to assist in diagnosis or the identification of the suicidal individual. Suicide risk assessment remains a high-stakes component of the psychiatric evaluation and can lead to overly restrictive management in the name of prevention or to inadequate intervention because of poor appreciation of the severity of risk. This article focuses primarily on suicide risk assessment and management as a critical first step to prevention, given the fact that more research is needed to identify precision treatments and effective suicide prevention strategies. Suicide risk assessment provides the clinical psychiatrist with an opportunity for therapeutic engagement with the ultimate goals of relieving suffering and preventing suicide.
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Affiliation(s)
- Eileen P Ryan
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus (Ryan); and Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oquendo)
| | - Maria A Oquendo
- Department of Psychiatry and Behavioral Health, Ohio State University College of Medicine, Columbus (Ryan); and Perelman School of Medicine, University of Pennsylvania, Philadelphia (Oquendo)
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Holma KM, Holma I, Ketokivi M, Oquendo MA, Isometsä E. The Relationship Between Smoking and Suicidal Behavior in Psychiatric Patients with Major Depressive Disorder. Arch Suicide Res 2019; 23:590-604. [PMID: 29883280 DOI: 10.1080/13811118.2018.1480986] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Smoking is frequently associated with suicidal behavior, but also with confounding other risk factors. We investigated whether smoking independently predicts suicidal ideation, attempts (SAs), or modifies risk of SAs during major depressive episodes (MDEs). In the Vantaa Depression Study (VDS), a 5-year prospective study of psychiatric patients (N = 269) with major depressive disorder (MDD), we investigated the association of suicidal ideation and smoking, and smoking as an independent risk factor for SAs in 2-level analyses of risk during MDEs. Smoking was not significantly associated with suicidal ideation, nor SAs after controlling for confounding factors, and no evidence of a significant effect during MDEs was found. Smoking was neither significantly associated with suicidal ideation, nor predicted suicide attempts.
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Affiliation(s)
- K Mikael Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Mental Health and Substance Abuse, City of Helsinki, Social Services and Health Care , Helsinki , Finland
| | - Irina Holma
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
| | - Mikko Ketokivi
- Operations and Technology Department, IE Business School , Madrid , Spain
| | - Maria A Oquendo
- Perelman School of Medicine, University of Pennsylvania , Philadelphia , PA , USA
| | - Erkki Isometsä
- Mental Health Unit , National Institute for Health and Welfare , Helsinki , Finland.,Department of Psychiatry, University of Helsinki and Helsinki University Hospital , Helsinki , Finland
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Porta-Sales J, Crespo I, Monforte-Royo C, Marín M, Abenia-Chavarria S, Balaguer A. The clinical evaluation of the wish to hasten death is not upsetting for advanced cancer patients: A cross-sectional study. Palliat Med 2019; 33:570-577. [PMID: 30688146 DOI: 10.1177/0269216318824526] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND An important concern of healthcare professionals when exploring the wish to hasten death with patients is the risk of causing them some type of distress. AIM To assess the opinion of hospitalized patients with advanced cancer about the proactive assessment of the wish to hasten death. DESIGN Descriptive, cross-sectional study. SETTING/PARTICIPANTS We assessed 193 advanced cancer patients admitted to an oncology ward for the wish to hasten death using a semi-structured clinical interview. After the assessment the participants were surveyed to determine whether they found the interview upsetting and, if so to what extent, and also their opinion regarding the assessment's importance. RESULTS The wish to hasten death was reported by 46 (23.8%) patients. The majority of patients (94.8%) did not find talking about the wish to hasten death to be upsetting, regardless of whether they presented it or not. The majority of patients (79.3%) considered that it was either quite or extremely important for the clinician to proactively assess the wish to hasten death and discuss this topic, regardless of whether they experienced it. CONCLUSIONS In this study, most of the advanced cancer patients did not find the assessment of wish to hasten death to be upsetting, and a substantial proportion of patients in this study believe that it is important to routinely evaluate it in this setting. These findings suggest that healthcare professionals can explore the wish to hasten death proactively in routine clinical practice without fear of upsetting patients.
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Affiliation(s)
- Josep Porta-Sales
- 1 Palliative Care Service, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain
- 2 Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Spain
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Iris Crespo
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Cristina Monforte-Royo
- 4 Nursing Department, Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Mar Marín
- 5 Medical Oncology Hospitalization Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain
| | - Sonia Abenia-Chavarria
- 5 Medical Oncology Hospitalization Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Spain
| | - Albert Balaguer
- 3 Faculty of Medicine and Health Sciences, Universitat Internacional de Catalunya, Barcelona, Spain
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9
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Adrian M, Lyon AR, Nicodimos S, Pullmann MD, McCauley E. Enhanced "Train and Hope" for Scalable, Cost-Effective Professional Development in Youth Suicide Prevention. CRISIS 2018; 39:235-246. [DOI: 10.1027/0227-5910/a000489] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: The knowledge base surrounding how to most effectively prepare and sustain practitioner knowledge and skills for suicide risk assessment and management is limited. Aims: This study examined the impact of a 6-hr continuing education training, and the effect of a posttraining reminder system, on mental health practitioners' knowledge, attitudes, and behavior surrounding suicide assessment and intervention. Method: Data were obtained prior to the training, immediately after the training, and at the 3-month follow-up. Medical record data were abstracted for a subsample of practitioners. Participants were randomly assigned to an e-mail reminder condition or no reminder condition that provided information related to the training. Results: All practitioners demonstrated increase s in suicide assessment knowledge and attitudes for engaging in suicide risk assessments from pre- to posttest, and gains were maintained at the 3-month follow-up. There was no effect of the e-mail reminder on practitioner knowledge, attitudes, or behaviors compared with the condition without the e-mail reminder. The use of e-mail reminders was not associated with any additional changes. Limitations: Limitations include predominantly self-report and small sample. Conclusion: Strategies to effectively change practitioner knowledge, attitudes, and behaviors toward suicidal clients may include continuing education. Efficient and effective designs of reminder systems for augmenting and supporting suicide assessment management training are needed.
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Affiliation(s)
- Molly Adrian
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, WA, USA
| | - Aaron R. Lyon
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Semret Nicodimos
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Michael D. Pullmann
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
| | - Elizabeth McCauley
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, WA, USA
- Seattle Children's Research Institute, Center for Child Health, Behavior, and Development, Seattle, WA, USA
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10
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Hou L, Guo Y, Lian B, Wang Y, Li C, Wang G, Li Q, Pang J, Sun H, Sun L. Synaptic Ultrastructure Might Be Involved in HCN 1-Related BDNF mRNA in Withdrawal-Anxiety After Ethanol Dependence. Front Psychiatry 2018; 9:215. [PMID: 29896126 PMCID: PMC5986948 DOI: 10.3389/fpsyt.2018.00215] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 05/07/2018] [Indexed: 12/27/2022] Open
Abstract
Withdrawal from ethanol dependence has been associated with heightened anxiety and reduced expression of Brain-derived neurotropic factor which promotes the synaptic transmission and plasticity of synapses. Hyperpolarization-activated cyclic nucleotide-gated channel 1 regulates expression; however, whether Hyperpolarization-activated cyclic nucleotide-gated channel 1-related Brain-derived neurotropic factor is involved in the synaptic ultrastructure that generates withdrawal-anxiety has been poorly perceived. Sprague-Dawley rats were treated with ethanol 3-9% (v/v) for a period of 21 days. Conditioned place preference and body weight were investigated during ethanol administration. Rats were subjected to behavioral testing and biochemical assessments after ethanol withdrawal, which was induced by abrupt discontinuation of the treatment. The results showed that the ethanol administration induced severe ethanol dependence behaviors, with higher body weight and more time in the ethanol-paired compartment. After withdrawal, rats had a higher total ethanol withdrawal score and explored less. Additionally, increased Hyperpolarization-activated cyclic nucleotide-gated channel 1 protein and gene expression and decreased Brain-derived neurotropic factor protein and gene expression were detected in the Ethanol group. Eventually, there was a negative correlation between the level of Brain-derived neurotropic factor mRNA and Hyperpolarization-activated cyclic nucleotide-gated channel 1 protein. Importantly, the synaptic ultrastructure changed in the Ethanol group, including increased synaptic cleft width and reduction in postsynaptic density thickness or synaptic curvature. The synthesis of the Brain-derived neurotropic factor mRNA could be down-regulated by higher Hyperpolarization-activated cyclic nucleotide-gated channel 1 protein expression. Changes in synaptic ultrastructure may be induced by lower Brain-derived neurotropic factor protein, which could be associated with the withdrawal-anxiety that is experiences after ethanol dependence.
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Affiliation(s)
- Lanwei Hou
- Department of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Yujuan Guo
- Department of Clinical Medicine, Weifang Medical University, Weifang, China
| | - Bo Lian
- Department of Bioscience and Technology, Weifang Medical University, Weifang, China
| | - Yanyu Wang
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Changjiang Li
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Gang Wang
- Laboratory for Cognitive Neuroscience, Weifang Medical University, Weifang, China
| | - Qi Li
- Department of Psychiatry and Centre for Reproduction Growth and Development, University of Hong Kong, Hong Kong, Hong Kong
| | - Jinjing Pang
- Department of Rehabilitation Medicine, Han Ting People's Hospital of Weifang, Weifang, China
| | - Hongwei Sun
- Department of Psychology, Weifang Medical University, Weifang, China
| | - Lin Sun
- Department of Clinical Medicine, Weifang Medical University, Weifang, China.,Department of Psychology, Weifang Medical University, Weifang, China
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Kim DW, Jeong KY, Kim KS. Psychological scales as predictors of emergency department hospitalizations in suicide attempters. Am J Emerg Med 2017; 36:93-99. [PMID: 28743477 DOI: 10.1016/j.ajem.2017.07.038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the psychological scales reflecting lethality and intent as predictors of suicide attempter's hospitalization. METHODS Data of suicide attempters aged over 15years, who visited the ED from January 2013 to June 2016, were retrospectively collected and they were divided into the hospitalization and discharge groups. We evaluated the Risk-Rescue Rating Scale (RRRS) and Self-Inflicted Injury Severity Form (SIISF) for lethality and Suicide Intent Scale (SIS) for intent, respectively. The predictive abilities of these scales for hospitalization were compared in terms of performance (AUCs) and goodness-of-fit (the Bayesian information criterion [BIC]). RESULTS A total of 382 suicide attempters were enrolled, of which 233 (61%) were hospitalized. The scores of all psychological scales were significantly higher in the hospitalization group and all scales were identified as independent predictors of hospitalization. The AUC of the RRRS tended to be higher than those of the SIS and SIISF; similarly, the RRRS demonstrated the best overall fit (the lowest BIC). The AUC of combined the RRRS and SIS was superior to that of any of the individual scales alone. While the AUC of combined the SIISF and SIS was superior to that of either individual scale, it was comparable to that of the RRRS. CONCLUSIONS The psychological scales can be helpful for predicting suicide attempter's hospitalization in emergency settings. Especially, the RRRS seemed to have a superior predictive ability. Moreover, combining the scales had significantly better predictive performance than use of the individual scale alone did.
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Affiliation(s)
- Dae Woong Kim
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Ki Young Jeong
- Department of Emergency Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea; Department of Emergency Medicine, Kyung Hee University School of Medicine, Seoul, Republic of Korea.
| | - Kyung Su Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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12
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Serra G, Koukopoulos A, De Chiara L, Napoletano F, Koukopoulos A, Sani G, Faedda GL, Girardi P, Reginaldi D, Baldessarini RJ. Child and Adolescent Clinical Features Preceding Adult Suicide Attempts. Arch Suicide Res 2017; 21:502-518. [PMID: 27673411 DOI: 10.1080/13811118.2016.1227004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The objective of this study was to identify the predictive value of juvenile factors for adult suicidal behavior. We reviewed clinical records to compare factors identified in childhood and adolescence between adult suicidal versus nonsuicidal major affective disorder subjects. Suicide attempts occurred in 23.1% of subjects. Age-at-first-symptom was 14.2 vs. 20.2 years among suicidal versus nonsuicidal subjects (p < 0.0001). More prevalent in suicidal versus non-suicidal subjects by multivariate analysis were: depressive symptoms, hyper-emotionality, younger-at-first-affective-episode, family suicide history, childhood mood-swings, and adolescence low self-esteem. Presence of one factor yielded a Bayesian sensitivity of 64%, specificity of 50%, and negative predictive power of 86%. Several juvenile factors were associated with adult suicidal behavior; their absence was strongly associated with a lack of adult suicidal behavior.
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13
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Spittal MJ, Shand F, Christensen H, Brophy L, Pirkis J. Community mental health care after self-harm: A retrospective cohort study. Aust N Z J Psychiatry 2017; 51:727-735. [PMID: 27821412 DOI: 10.1177/0004867416676366] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Presentation to hospital after self-harm is an opportunity to treat underlying mental health problems. We aimed to describe the pattern of mental health contacts following hospital admission focusing on those with and without recent contact with community mental health services (connected and unconnected patients). METHODS We undertook a data linkage study of all individuals admitted as a general or psychiatric inpatient to hospital after self-harm in New South Wales, Australia, between 2005 and 2011. We identified the proportion of admissions where the patient received subsequent in-person community mental health care within 30 days of discharge and the factors associated with receipt of that care. RESULTS A total of 42,353 individuals were admitted to hospital for self-harm. In 41% of admissions, the patient had contact with a community mental health service after discharge. Patients connected with community mental health services had 5.33 (95% confidence interval = [5.09, 5.59]) times higher odds of follow-up care than unconnected patients. Other factors, such as increasing age and treatment as a psychiatric inpatient, were associated with lower odds of follow-up community care. CONCLUSION Our study suggests that full advantage is not being taken of the opportunity to provide comprehensive mental health care for people who self-harm once they have been discharged from the inpatient setting. This is particularly the case for those who have not previously received community mental health care. There appears to be scope for system-level improvement in the way in which those who are treated for self-harm are followed up in the community.
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Affiliation(s)
- Matthew J Spittal
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Fiona Shand
- 2 Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Helen Christensen
- 2 Black Dog Institute, University of New South Wales, Sydney, NSW, Australia
| | - Lisa Brophy
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
| | - Jane Pirkis
- 1 Melbourne School of Population and Global Health, The University of Melbourne, Parkville, VIC, Australia
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Golshiri P, Akbari M, Zarei A. Case-control study of risk factors for suicide attempts in Isfahan, Iran. Int J Soc Psychiatry 2017; 63:109-114. [PMID: 28084153 DOI: 10.1177/0020764016685347] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Suicide is an important, preventable, public health problem worldwide, caused by the interaction of numerous environmental, biological and psychosocial factors. AIMS This study aimed to identify the factors associated with suicidal attempts in Isfahan, Iran, in 2015. METHODS In this case-control study, 175 cases who committed suicide and were admitted to emergency services were compared with 175 controls selected among outpatients from the same hospital without any history of suicide attempt. Demographic, psychosocial, personality traits, religiosity, coping skills, stressful life events, socioeconomic status and psychiatric distress were compared between groups. Multivariable logistic regression was used to identify independent risk factors for suicide. RESULTS Marital status, education, socioeconomic status, psychological distress, perceived social support, stress coping strategies, personality, religious beliefs, stress life events and general health condition were significantly different between groups. The regression analysis revealed that perceived social support (odds ratio (OR) = 0.962, 95% confidence interval (CI): 0.94-0.984), religious beliefs (OR = 0.923, 95% CI: 0.867-0.984) and stressful life event (OR = 1.524, 95% CI: 1.251-1.856) were significantly associated with suicide attempts. CONCLUSION Our finding showed that religious beliefs, perceived social support and stressful life events are the main factors associated with suicide attempts. So, positive strategies such as improvements in life skills to control stressful life events, religiosity and perceived social support can be used to control suicide attempts.
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Affiliation(s)
- Parastoo Golshiri
- 1 Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mojtaba Akbari
- 2 Department of Epidemiology, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Abbas Zarei
- 1 Department of Community Medicine, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Abstract
Suicidal behavior is strongly associated with depression, especially if accompanied by behavioral activation, dysphoria, or agitation. It may respond to some treatments, but the design of scientifically sound, ethical trials to test for therapeutic effects on suicidal behavior is highly challenging. In bipolar disorder, and possibly also unipolar major depression, an underprescribed medical intervention with substantial evidence of preventive effects on suicidal behavior is long-term treatment with lithium. It is unclear whether this effect is specifically antisuicidal or reflects beneficial effects of lithium on depression, mood instability, and perhaps aggression and impulsivity. Antisuicidal effects of anticonvulsant mood stabilizers (carbamazepine, lamotrigine, valproate) appear to be less than with lithium. Further evaluation is needed for potential antisuicidal effects of atypical antipsychotics with growing evidence of efficacy in depression, particularly acute bipolar depression, while generally lacking risk of inducing agitation, mania, or mood instability. Short-term and long-term value and safety of antidepressants are relatively secure for unipolar depression but uncertain and poorly tested for bipolar depression; their effects on suicidal risk in unipolar depression may be age-dependent. Sedative anxiolytics are virtually unstudied as regards suicidal risks. Adequate management of suicidal risks in mood disorder patients requires comprehensive, clinically skillful monitoring and timely interventions.
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Abstract
OBJECTIVES Homicide is overwhelmingly committed by men compared to women. Conservative estimates suggest that more than a third of these individuals have a treatable psychiatric disorder. These data present an opportunity to mental health clinicians to assist in the prevention of homicide by improving men's mental health. METHODS We review the current literature on men's mental health with a focus on assessing and reducing homicide risk in men with psychiatric conditions. RESULTS Bipolar disorder and schizophrenia appear to share a neural endophenotype that is a risk factor for homicide. Dual disorders, or the presence of a substance use disorder with other major mental illness, are a major risk factor for homicide in males. Dual diagnosis disorders, personality disorders and pathological traits and male depression share emotion dysregulation, irritability, and reactive aggression. Promoting physician education, addressing firearm safety, reducing the reluctance of men relative to women to engage in help-seeking behaviour, and using targeted risk interviews which integrate these data are all currently recommended. CONCLUSIONS The main focus in prevention of homicidal behaviour in males with psychiatric disorders should be to identify high risk groups, to provide adequate treatment, and to facilitate compliance with long-term treatment while considering male specific problems and needs.
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Affiliation(s)
- Leo Sher
- Icahn School of Medicine at Mount Sinai , New York , USA
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Mergui J, Raveh D, Gropp C, Golmard JL, Jaworowski S. Prevalence and characteristics of cluster B personality disorder in a consultation-liaison psychiatry practice. Int J Psychiatry Clin Pract 2015; 19:65-70. [PMID: 25363196 DOI: 10.3109/13651501.2014.981543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Quantitative studies on cluster B-personality disorder (PD) in the general hospital are scarce. The aim of this study is to examine the prevalence and characteristics of cluster B-PD patients in a consultation-liaison practice. METHODS Files of 258 consecutive patients referred for psychiatric consultation were examined. Cluster B patients were compared with the remaining patients. RESULTS Eleven point six percent of these patients were diagnosed with a cluster B-PD. On univariate analysis, cluster B patients were more likely to be younger (P < 0.001), unmarried (P = 0.005), and without organic medical illness (P < 0.001).These patients had a shorter admission (P < 0.0001), and were more frequently treated in the emergency room (66.6% versus 37.5%, P = 0.02).There was a trend toward comorbid substance use disorder (P = 0.09). On multivariate analysis, cluster B patients presented significantly with self-harming behavior/ideation (80% versus 18%, OR = 12.07; 95% CI = 4.37-33.31; P < 0.0001). CONCLUSIONS In view of the high prevalence of cluster B-PD in our preliminary study, general hospital staff requires practical skills for managing these high-maintenance patients. We believe that this study and further research will promote evidence-based recommendations for consultation-liaison psychiatrists.
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Affiliation(s)
- Joseph Mergui
- Department of Consultation Liaison Psychiatry, Shaare Zedek Medical Center affiliated with the Hebrew University Medical School , Jerusalem , Israel
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Schuller B, Steidl S, Batliner A, Schiel F, Krajewski J, Weninger F, Eyben F. Medium-term speaker states—A review on intoxication, sleepiness and the first challenge. COMPUT SPEECH LANG 2014. [DOI: 10.1016/j.csl.2012.12.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Linares OA, Daly D, Stefanovski D, Boston RC. The CYP2D6 gene determines oxycodone's phenotype-specific addictive potential: implications for addiction prevention and treatment. Med Hypotheses 2014; 82:390-4. [PMID: 24495562 DOI: 10.1016/j.mehy.2014.01.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Revised: 01/06/2014] [Accepted: 01/13/2014] [Indexed: 10/25/2022]
Abstract
We propose a hypothesis for predicting addictive potential of oral drugs, in general, and oxycodone's addictive potential, in particular. We hypothesize that a patient's CYP2D6 phenotype determines oxycodone's addictive potential, in part, via genotype-specific regulation of its clearance; although, other possible modulators of oxycodone's addiction potential exist. For example, brain CYPs related to phenotype could be involved. To pilot test our hypothesis, we used a mathematical model which postulates that oxycodone's addictive potential is given by: LAP=E/(ka/ke), where LAP represents addictive potential, E represents euphoric potency, ka is the absorption rate constant of drug from the gastrointestinal tract, and ke is the systemic elimination rate constant of drug by all processes responsible for its removal from plasma. Using CYP2D6 phenotype-specific oxycodone pharmacokinetic parameter values derived from published data, our hypothesis predicted that the canonical order of oxycodone's addictive potential was UM>EM>IM>PM, with corresponding LAP values of 0.24, 0.21, 0.17, and 0.15 respectively. Our hypothesis about oxycodone's addictive potential may provide a unifying approach useful for both personalized medicine dosing and predicting addictive potential of oral drugs in humans, since it is based on both oxycodone's pharmacogenetics and pharmacokinetics.
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Affiliation(s)
- Oscar A Linares
- Plymouth Pharmacokinetic Modeling Study Group, 46425 Southview Lane, Plymouth, MI 48170, USA.
| | - David Daly
- Plymouth Pharmacokinetic Modeling Study Group, 46425 Southview Lane, Plymouth, MI 48170, USA
| | - Darko Stefanovski
- Cedars-Sinai Medical Center, Biomedical Sciences Division, 8700 Beverly Boulevard, West Hollywood, CA 90048, USA
| | - Raymond C Boston
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, 3600 Market Street, Philadelphia, PA 19104-2646, USA
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Melle I, Ann Barrett E. Insight and suicidal behavior in first-episode schizophrenia. Expert Rev Neurother 2014; 12:353-9. [DOI: 10.1586/ern.11.191] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Irwin SA, Mausbach BT, Koo D, Fairman N, Roepke-Buehler SK, Chattillion EA, Dimsdale JE, Patterson TL, Ancoli-Israel S, Mills PJ, von Känel R, Ziegler MG, Grant I. Association between hospice care and psychological outcomes in Alzheimer's spousal caregivers. J Palliat Med 2013; 16:1450-4. [PMID: 24093721 PMCID: PMC3822398 DOI: 10.1089/jpm.2013.0130] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2013] [Indexed: 11/13/2022] Open
Abstract
CONTEXT Dementia care giving can lead to increased stress, physical and psychosocial morbidity, and mortality. Anecdotal evidence suggests that hospice care provided to people with dementia and their caregivers may buffer caregivers from some of the adverse outcomes associated with family caregiving in Alzheimer's Disease (AD). OBJECTIVES This pilot study examined psychological and physical outcomes among 32 spousal caregivers of patients with AD. It was hypothesized that caregivers who utilized hospice services would demonstrate better outcomes after the death of their spouse than caregivers who did not utilize hospice. METHODS The charts of all spousal caregivers enrolled in a larger longitudinal study from 2001 to 2006 (N=120) were reviewed, and participants whose spouse had died were identified. Of these, those who received hospice care (n=10) were compared to those who did not (n=22) for various physiological and psychological measures of stress, both before and after the death of the care recipient. An Analysis of Covariance (ANCOVA), with postdeath scores as the dependent variable and pre-death scores as covariates, was used for all variables. RESULTS Significant group differences were found in postdeath depressive symptoms (HAM-D; F(1,29)=6.10, p<0.05) and anxiety symptoms (HAM-A; F(1,29)=5.71, p<0.05). Most psychological outcome variables demonstrated moderate effect sizes with a Cohen's d of>0.5 between groups. CONCLUSIONS These data suggest that hospice enrollment may ameliorate the detrimental psychological effects in caregivers who have lost a spouse with Alzheimer's Disease. Based on these pilot data, further prospective investigation is warranted.
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Affiliation(s)
- Scott A. Irwin
- Department of Psychiatry and Psychosocial Services, San Diego Hospice and The Institute for Palliative Medicine, San Diego, California
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Brent T. Mausbach
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Derek Koo
- Department of Psychiatry and Psychosocial Services, San Diego Hospice and The Institute for Palliative Medicine, San Diego, California
| | - Nathan Fairman
- Department of Psychiatry and Behavioral Sciences, UC Davis School of Medicine, Sacramento, California
| | | | - Elizabeth A. Chattillion
- San Diego Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, California
| | - Joel E. Dimsdale
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Thomas L. Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Sonia Ancoli-Israel
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Paul J. Mills
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Roland von Känel
- Department of Psychiatry, University of California, San Diego, La Jolla, California
- Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland
| | - Michael G. Ziegler
- Department of Psychiatry, University of California, San Diego, La Jolla, California
| | - Igor Grant
- Department of Psychiatry, University of California, San Diego, La Jolla, California
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Irwin SA, Iglewicz A, Nelesen RA, Lo JY, Carr CH, Romero SD, Lloyd LS. Daily oral ketamine for the treatment of depression and anxiety in patients receiving hospice care: a 28-day open-label proof-of-concept trial. J Palliat Med 2013; 16:958-65. [PMID: 23805864 PMCID: PMC3717203 DOI: 10.1089/jpm.2012.0617] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2013] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Depression and anxiety are prevalent and undertreated in patients receiving hospice care. Standard antidepressants do not work rapidly or often enough to benefit most of these patients. Ketamine has many properties that make it an interesting candidate for rapidly treating depression and anxiety in patients receiving hospice care. To test this hypothesis, a 28-day, open-label, proof-of-concept trial of daily oral ketamine administration was conducted in order to evaluate the tolerability, potential efficacy, and time to potential efficacy in treating depression and anxiety in patients receiving hospice care. METHODS In this open-label study, 14 subjects with symptoms of depression or depression mixed with anxiety warranting psychopharmacological intervention received daily oral doses of ketamine hydrochloride (0.5 mg/kg) over a 28-day period. The primary outcome measure was the Hospital Anxiety and Depression Scale (HADS), which was used to rate overall depression and anxiety symptoms at baseline, and on days 3, 7, 14, 21, and 28. RESULTS Over the 28-day trial there was significant improvement in both depressive symptoms (F5,35=8.03, p=0.002, η(2)=0.534) and symptoms of anxiety (F5,35=14.275, p<0.001, η(2)=0.67) for the eight subjects that completed the trial. One hundred percent of subjects completing the trial responded to ketamine for both anxiety and depression. A significant response in depressive symptoms occurred by day 14 for depression (mean Δ=3.5, d=1.14, 95% CI=1.09-5.9, p=0.01) and day 3 for anxiety (mean Δ=2.4, d=0.67, 95% CI=1.0-3.7, p=0.004). These improvements remained significant through day 28 for both depression (mean Δ=4.0, d=1.34, 95% CI=2.3-5.9, p=0.001) and anxiety (mean Δ=6.09, d=1.34, 95% CI=3.6-8.6, p<0.001). Side effects were rare, the most common being diarrhea, trouble sleeping, and trouble sitting still. CONCLUSIONS Patients who received daily oral ketamine experienced a robust antidepressant and anxiolytic response with few adverse events. The response rate for depression is similar to those found with IV ketamine; however, the time to response is more protracted. The findings of the potential efficacy of oral ketamine for depression and the response of anxiety symptoms are novel. Further investigation with randomized, controlled clinical trials is necessary to firmly establish the efficacy and safety of oral ketamine for the treatment of depression and anxiety in patients receiving hospice care or other subject populations.
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Affiliation(s)
- Scott A Irwin
- The Institute for Palliative Medicine at San Diego Hospice, San Diego, California 92103, USA.
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Suicide attempt and suicidal ideation and their associations with demographic and clinical correlates and quality of life in Chinese schizophrenia patients. Soc Psychiatry Psychiatr Epidemiol 2013; 48:447-54. [PMID: 22847130 DOI: 10.1007/s00127-012-0555-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 07/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES This study aimed to examine the prevalence and correlates of lifetime suicide attempts and current suicidal ideation in community-dwelling schizophrenia patients in China. METHOD A sample of 540 schizophrenia patients was randomly selected in Beijing, China. All subjects were interviewed using standardized assessment instruments and their basic socio-demographic and clinical data including history of suicide attempts were collected. RESULTS The prevalence of lifetime suicide attempts and the point prevalence of suicidal ideation were 12.0%, and 21.1%, respectively. In multiple logistic regression analyses, the presence of lifetime suicide attempt was independently associated with rural residence, having major medical conditions and better social functioning, while higher likelihood of current suicidal ideation was associated with past suicide attempt, the severity of overall psychopathology and depressive symptoms and lower psychological quality of life (QOL). CONCLUSION Among Chinese outpatients with schizophrenia, increased current symptoms and poorer QOL were correlated with current suicidal ideation, while demographic factors and indicators of greater social support were mostly correlated with lifetime suicide attempts. This study may help to identify important subgroups of patients with schizophrenia at particularly high risk of suicidal behavior.
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Fishbain DA, Bruns D, Meyer LJ, Lewis JE, Gao J, Disorbio JM. Exploration of the relationship between disability perception, preference for death over disability, and suicidality in patients with acute and chronic pain. PAIN MEDICINE 2012; 13:552-61. [PMID: 22487542 DOI: 10.1111/j.1526-4637.2012.01358.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HYPOTHESIS Passive, active, and historical suicidality are associated with preference for death over disability. DESIGN Community nonpatients without pain, community patients with pain, and patients with acute and chronic pain were compared for endorsement of disability perception and preference for death over disability. Phi correlations and chi-square analyses were calculated between preference for death over disability and six suicidality items representing passive, active, and historical suicidality. Logistic regression was used to predict preference for death over disability in patients with acute and chronic pain. RESULTS For patients with acute and chronic pain, endorsement of preference for death over disability correlated significantly with all six suicidality items. The logistic regression models identified the following variables as predictors for preference for death over disability in patients with acute pain: the Behavior Health Inventory (BHI 2) family dysfunction scale, history of wanting to die, and disability perception. For patients with chronic pain, predictors were the BHI 2 Borderline scale, history of wanting to die, treated fairly by family item, frequent suicide ideation, people I trust turn on me item, and disability perception. Preference for death over disability was a statistically significant predictor in patients with chronic pain for disability perception, recent suicide ideation, having a suicidal plan, and a history of wanting to die but was not a significant predictor for any suicide items in patients with acute pain. CONCLUSION Preference for death over disability is associated with passive and active suicide ideation and historical suicidality in patients with chronic pain.
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Affiliation(s)
- David A Fishbain
- Department of Psychiatry, Miller School of Medicine at University of Miami, Miami, Florida 33136, USA.
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Ethanol withdrawal activates nitric oxide-producing neurons in anxiety-related brain areas. Alcohol 2011; 45:641-52. [PMID: 21194876 DOI: 10.1016/j.alcohol.2010.11.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 11/29/2010] [Accepted: 11/29/2010] [Indexed: 11/23/2022]
Abstract
The present study investigated whether nitric oxide (NO)-producing neurons localized in brain areas related to anxiety are also activated after ethanol withdrawal. Male Wistar rats were subjected to an oral ethanol self-administration procedure, in which they were offered 6-8% (vol/vol) ethanol solution for a period of 21 days followed by abrupt discontinuation of the treatment. Control animals received control dietary fluid for similar periods of time. Twenty-four or 48 h after ethanol discontinuation, the animals were exposed to the open field for 10 min. Two hours later, their brains were removed and processed for Fos immunohistochemistry and nicotinamide adenine dinucleotide phosphate-diaphorase histochemistry (which is used to detect NO-producing neurons). Decreased exploratory activity was observed in animals subjected to 24-h withdrawal, characterized by a shorter distance traveled in the open field. Additionally, increased Fos expression was detected in brain areas, such as the cingulate and piriform cortices, several hypothalamic nuclei, amygdaloid nuclei, most subdivisions of the periaqueductal gray matter, and dorsal raphe nucleus (DRN). Ethanol withdrawal activated NO-producing neurons in the paraventricular nucleus (PVN) of the hypothalamus, dorsolateral periaqueductal gray matter (DLPAG), and DRN. The results show that ethanol withdrawal activates NO-producing neurons in the PVN, DLPAG, and DRN, which are brain areas implicated in the modulation of emotional, autonomic, and motor expression of anxiety-like behaviors.
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Daigle MS, Pouliot L, Chagnon F, Greenfield B, Mishara B. Suicide attempts: prevention of repetition. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2011; 56:621-9. [PMID: 22014695 DOI: 10.1177/070674371105601008] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To present an overview of promising strategies to prevent repetition of suicidal behaviours. METHOD This literature review on tertiary preventive interventions of suicide attempts was produced using the computerized databases PubMed and PsycINFO from January 1966 to September 2010, using French- and English-language limits and the key words: suicid* or deliberate self-harm and treatment* or therapy or intervention* or management. RESULTS Thirteen of the 35 included studies showed statistically significant effects of fewer repeated attempts or suicides in the experimental condition. Overall, 22 studies focused on more traditional approaches, that is, pharmacological or psychological approaches. Only 2 of the 6 pharmacological treatments proved significantly superior to a placebo- a study of lithium with depression and flupenthixol with personality disorders. Eight out of 16 psychological treatments proved superior to treatment as usual or another approach: cognitive-behavioural therapy (CBT) (n = 4), (including dialectical behaviour therapy [n = 2]); psychodynamic therapy (n = 2); mixed (CBT plus psychodynamic therapy [n = 1]); and motivational approach and change in therapist (n = 1). Among the 8 studies using visit, postal, or telephone contact or green-token emergency card provision, 2 were significant: one involving telephone follow-up and the other telephone follow-up or visits. Hospitalization was not related to fewer attempts, and 1 of the 4 outreach approaches had significant results: a program involving individualized biweekly treatment. The rationale behind these single or multiple approaches still needs to be clarified. There were methodological flaws in many studies and some had very specific limited samples. CONCLUSIONS There is a need for more research addressing the problem in definitions of outcomes and measurement of the dependent variables, gender-specific effects, and inclusion of high-risk groups. There is a need for the development and evaluation of new approaches that support collaboration with community resources and more careful assessment and comparisons of existing treatments with different populations.
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Verwey B, van Waarde JA, Bozdağ MA, van Rooij I, de Beurs E, Zitman FG. Reassessment of suicide attempters at home, shortly after discharge from hospital. CRISIS 2011; 31:303-10. [PMID: 21190928 DOI: 10.1027/0227-5910/a000041] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Assessment of suicide attempters in a general hospital may be influenced by the condition of the patient and the unfavorable circumstances of the hospital environment. AIMS To determine whether the results of a reassessment at home shortly after discharge from hospital differ from the initial assessment in the hospital. METHODS In this prospective study, systematic assessment of 52 suicide attempters in a general hospital was compared with reassessment at home, shortly after discharge. RESULTS Reassessments at home concerning suicide intent, motives for suicide attempt, and dimensions of psychopathology did not differ significantly from the initial hospital assessment. However, patients' motives for the suicide attempt had changed to being less impulsive and more suicidal, worrying was significantly higher, and self-esteem was significantly lower. A third of the patients had forgotten their aftercare arrangements and most patients who initially felt no need for additional help had changed their mind at reassessment. CONCLUSIONS Results from this group of suicide attempters suggest that a brief reassessment at home shortly after discharge from hospital should be considered.
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Affiliation(s)
- Bas Verwey
- Rijnstate Hospital, Arnhem, The Netherlands.
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DeFalco RJ, Erlichman M, Tickoo S, Passik SD. Substance abuse issues in oral and maxillofacial practice. Oral Maxillofac Surg Clin North Am 2011; 22:527-35. [PMID: 20970719 DOI: 10.1016/j.coms.2010.07.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Substance abuse has far-reaching consequences for individuals, their families, and the community. Medications with abuse potential play an important role in the management of pain and are widely prescribed by the oral and maxillofacial surgeon. Reducing the likelihood of abuse and providing appropriate pain management for the known abuser are critical aspects of perioperative patient management. Health care providers are not immune to substance abuse and may, in fact, be at an elevated risk. Identification of impaired providers is essential to help them find the appropriate treatment and counseling and to prevent harm to their patients, family, friends, or associates.
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Affiliation(s)
- Robert J DeFalco
- St Joseph's Regional Medical Center, Department of Oral and Maxillofacial Surgery, 703 Main Street, Paterson, NJ 07503, USA.
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Miret M, Nuevo R, Morant C, Sainz-Cortón E, Jiménez-Arriero MÁ, López-Ibor JJ, Reneses B, Saiz-Ruiz J, Baca-García E, Ayuso-Mateos JL. The Role of Suicide Risk in the Decision for Psychiatric Hospitalization After a Suicide Attempt. CRISIS 2011; 32:65-73. [DOI: 10.1027/0227-5910/a000050] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. Aims: To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. Methods: Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). Results: 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. Conclusions: Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.
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Affiliation(s)
- Marta Miret
- Psychiatry Department, Autónoma University of Madrid, La Princesa University Hospital, Madrid, Spain
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Spain
| | - Roberto Nuevo
- Psychiatry Department, Autónoma University of Madrid, La Princesa University Hospital, Madrid, Spain
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Spain
| | - Consuelo Morant
- Department of Mental Health, Madrid Regional Health Council, Spain
| | | | - Miguel Ángel Jiménez-Arriero
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Spain
- Psychiatry Department, 12 de Octubre University Hospital, University Complutense, Madrid, Spain
| | - Juan J. López-Ibor
- Institute of Psychiatry and Mental Health, San Carlos University Hospital, University Complutense, Madrid, Spain
| | - Blanca Reneses
- Institute of Psychiatry and Mental Health, San Carlos University Hospital, University Complutense, Madrid, Spain
| | - Jerónimo Saiz-Ruiz
- Psychiatry Department, Ramón y Cajal University Hospital, University of Alcalá, Alcalá de Henares, Spain
| | - Enrique Baca-García
- Department of Psychiatry, Fundación Jiménez Díaz, Autónoma University of Madrid, Spain
- Psychiatry Department, Columbia University, New York, USA
| | - José Luis Ayuso-Mateos
- Psychiatry Department, Autónoma University of Madrid, La Princesa University Hospital, Madrid, Spain
- Instituto de Salud Carlos III, Centro de Investigación en Red de Salud Mental, CIBERSAM, Spain
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Penagaluri P, Walker KL, El-Mallakh RS. Hallucinations, Pseudohallucinations, and Severity of Suicidal Ideation Among Emergency Psychiatry Patients. CRISIS 2010; 31:53-6. [DOI: 10.1027/0227-5910/a000002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims: This study investigated relative relationships between auditory hallucinations and nonpsychotic hallucinations (pseudohallucinations), and suicidal risk. Methods: A sample of 206 consecutive patients seen in an emergency psychiatric service was evaluated for the presence and intensity of hallucinatory experiences (the hallucination item of the Positive and Negative Symptoms Scale), suicidal intensity (the suicide item of the Montgomery Asberg Depression Rating Scale), and cumulative suicide risk (the total number of risk factors). Results: Individuals with nonpsychotic hallucinations experienced greater intensity of suicidal ideation versus subjects with no hallucinations or subjects with psychotic hallucinations (p = .0001). Conclusions: Pseudohallucinosis is associated with higher intensity of suicidal ideation compared with psychotic hallucinations or no hallucinations.
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Affiliation(s)
- Praveen Penagaluri
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Kristin L. Walker
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
| | - Rif S. El-Mallakh
- Department of Psychiatry and Behavioral Sciences, University of Louisville School of Medicine, Louisville, KY, USA
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Halderman BL, Eyman JR, Kerner L, Schlacks B. A paradigm for the telephonic assessment of suicidal ideation. Suicide Life Threat Behav 2009; 39:639-47. [PMID: 20121327 DOI: 10.1521/suli.2009.39.6.639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
A three-stage paradigm for telephonically assessing suicidal risk and triaging suicidal callers as practiced in an Employee Assistance Program Call Center was investigated. The first hypothesis was that the use of the procedure would increase the probability that callers would accept the clinician's recommendations, evidenced by fewer police interventions. The second hypothesis was that there would be an increase in confirmed appointments with providers. Samples involved three separate 6-month periods. Results indicate the effectiveness of the paradigm with both hypotheses supported. Follow-up data for the year after completion of this study yielded similar results.
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Affiliation(s)
- Brent L Halderman
- New Directions Behavioral Health, P.O. Box 6729, Leawood, KS 66206-0729, USA.
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Pompili M, Rihmer Z, Innamorati M, Lester D, Girardi P, Tatarelli R. Assessment and treatment of suicide risk in bipolar disorders. Expert Rev Neurother 2009; 9:109-36. [PMID: 19102673 DOI: 10.1586/14737175.9.1.109] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Completed suicide and suicide attempts are major issues in the management of bipolar disorders. There is evidence that suicide rates among these patients are more than 20-fold higher than the general population and, furthermore, suicidal behavior is much more lethal in bipolar disorder than in the general population. Patients with mood disorders may sometimes exhibit highly perturbed mixed states, which usually increase the risk of suicide. Such states are particularly frequent in bipolar II patients, especially if patients are treated with antidepressant monotherapy (unprotected by mood stabilizers), when depression switches into mania (or vice versa), or when depression lifts and functioning approaches normality. Researchers worldwide agree that treatment involving lithium is the best way to protect patients from suicide risk. Psychosocial activities, including psychoeducation, can protect bipolar patients either directly or, more probably, indirectly by increasing adherence to treatment and helping in daily difficulties that otherwise may lead to demoralization or hopelessness. An extensive understanding of the psychosocial circumstances and the psychopathology of bipolar patients (including temperament) may help clinicians describe the clinical picture accurately and prevent suicidal behavior in these patients.
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Revisions to the Canadian Emergency Department Triage and Acuity Scale (CTAS) adult guidelines. CAN J EMERG MED 2009; 10:136-51. [PMID: 18371252 DOI: 10.1017/s1481803500009854] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Irwin SA, Ferris FD. The opportunity for psychiatry in palliative care. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:713-24. [PMID: 19087465 DOI: 10.1177/070674370805301103] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The need for psychiatrists to work with patients and families living with chronic life-threatening illnesses has never been greater. Further, psychiatrists may find exciting work within the relatively new field of palliative care, which is devoted to the prevention and relief of all suffering. Increasingly, individuals are living longer with multiple issues that cause suffering, interfere with their lives, and often lead to psychosocial sequelae. To ensure state-of-the-art care for patients and families throughout an illness and any ensuing bereavement period, many experienced psychiatrists are needed as consultants to, and as members of, interdisciplinary palliative care teams. This need presents limitless opportunities for psychiatrists to care for patients, provide education, and engage in research. The potential to make a difference is great.
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Affiliation(s)
- Scott A Irwin
- Psychiatry Programs, The Institute for Palliative Medicine at San Diego Hospice, San Diego, California 92103, USA.
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39
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Friedman SH, Holden CE, Hrouda DR, Resnick PJ. Maternal Filicide and Its Intersection With Suicide. ACTA ACUST UNITED AC 2008. [DOI: 10.1093/brief-treatment/mhn011] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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40
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Irwin SA, Rao S, Bower K, Palica J, Rao SS, Maglione JE, Soskins M, Betterton AE, Ferris FD. Psychiatric issues in palliative care: recognition of depression in patients enrolled in hospice care. J Palliat Med 2008; 11:158-63. [PMID: 18333728 DOI: 10.1089/jpm.2007.0140] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Major depression is prevalent, difficult to assess, underrecognized, and undertreated in hospice settings. Furthermore, it is associated with significant morbidity and mortality. A retrospective chart review of 2716 patients receiving hospice care was conducted in order to determine the baseline rate of recognition of depression in patients with advanced, life-threatening illnesses by frontline hospice clinicians. Documentation of "depression" as either a diagnosis or problem was used as an estimate of how often these disorders were considered significant issues by the treating interdisciplinary team. Of the patients receiving home/long-term care, 10.8% (234/2168) had depression documented as a diagnosis or significant problem. The presence of recognized depression in this setting was associated with significant differences in gender, marital status, and terminal diagnoses. Total length of hospice care was also significantly longer. Of patients receiving inpatient care, 13.7% (75/548) had depression documented as a diagnosis or significant problem. Recognized depression in this setting was associated with significant differences in marital status, length of inpatient stay, and total time in hospice care. If documentation is representative of the care that the interdisciplinary teams provide, depression of any kind appears to be underrecognized in this population. In fact, it is on the low end of prevalence estimates in the literature. Improved depression assessment is needed in order to minimize the impact of depression on patients living with advanced, life-threatening illnesses.
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Affiliation(s)
- Scott A Irwin
- Center for Palliative Studies, San Diego Hospice & Palliative Care, San Diego, California, USA.
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41
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Bantjes J, van Ommen C. The Development and Utilisation of a Suicide Risk Assessment Interview Schedule. SOUTH AFRICAN JOURNAL OF PSYCHOLOGY 2008. [DOI: 10.1177/008124630803800210] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide is increasingly widespread in South Africa and is considered to constitute a serious public health problem. It is not only the most common emergency encountered by mental health care professionals but also has the distinction of being one of the few potentially fatal psychological conditions. The accurate determination of suicide risk in clinical practice is difficult. Despite vast amounts of research, no one assessment tool or method, when applied to individual clients, has been demonstrated to be ultimately superior in helping clinicians to accurately estimate risk. A clinician's failure to adequately assess suicide risk may result in morbidity or mortality, and has the added complication of leaving the clinician to face negative emotional, personal, professional, and legal consequences. This article illustrates how research findings and empirical studies have been utilised to formulate a Suicide Risk Assessment Interview Schedule (SRAIS) designed to assist the clinician to make a thorough assessment of suicide risk by avoiding errors of omission. Two case vignettes are included to illustrate how the SRAIS has been used to guide the process of risk assessment and management.
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Affiliation(s)
- Jason Bantjes
- Student Counselling Centre, Rhodes University, PO Box 94, Grahamstown, 6140, South Africa
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Karlsson L, Pelkonen M, Heilä H, Holi M, Kiviruusu O, Tuisku V, Ruuttu T, Marttunen M. Differences in the clinical characteristics of adolescent depressive disorders. Depress Anxiety 2008; 24:421-32. [PMID: 17051545 DOI: 10.1002/da.20233] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Our objective was to analyze differences in clinical characteristics and comorbidity between different types of adolescent depressive disorders. A sample of 218 consecutive adolescent (ages 13-19 years) psychiatric outpatients with depressive disorders was interviewed for DSM-IV Axis I and Axis II diagnoses. We obtained data by interviewing the adolescents themselves and collecting additional background information from the clinical records. Lifetime age of onset for depression, current episode duration, frequency of suicidal behavior, psychosocial impairment, and the number of current comorbid psychiatric disorders varied between adolescent depressive disorder categories. The type of co-occurring disorder was mainly consistent across depressive disorders. Minor depression and dysthymia (DY) presented as milder depressions, whereas bipolar depression (BPD) and double depression [DD; i.e., DY with superimposed major depressive disorder (MDD)] appeared as especially severe conditions. Only earlier lifetime onset distinguished recurrent MDD from first-episode MDD, and newly emergent MDD appeared to be as impairing as recurrent MDD. Adolescent depressive disorder categories differ in many clinically relevant aspects, with most differences reflecting a continuum of depression severity. Identification of bipolarity and the subgroup with DD seems especially warranted. First episode MDD should be considered as severe a disorder as recurring MDD.
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Affiliation(s)
- Linnea Karlsson
- The National Public Health Institute, Department of Mental Health and Alcohol Research, Helsinki, Finland.
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43
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Révision des lignes directrices de l’Échelle canadienne de triage et de gravité (ÉTG) pour les adultes. CAN J EMERG MED 2008. [DOI: 10.1017/s1481803500009866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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44
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Fedorowicz VJ, Falissard B, Foulon C, Dardennes R, Divac SM, Guelfi JD, Rouillon F. Factors associated with suicidal behaviors in a large French sample of inpatients with eating disorders. Int J Eat Disord 2007; 40:589-95. [PMID: 17607699 DOI: 10.1002/eat.20415] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE The objective of the present study was to identify factors associated with suicidal behaviors among patients with eating disorders. METHOD A large database including sociodemographic and clinical characteristics of 1,009 consecutive patients hospitalized for an eating disorder in Paris, France, was examined. Data gathered upon admission to hospital were analyzed to identify factors associated with a history of suicide attempt or current suicidal ideation, among the whole sample as well as among each subtype of eating disorder. RESULTS Among the whole sample, the factor most strongly associated with suicide attempt or suicidal ideation was the diagnostic category, with the highest odds ratio for bulimia nervosa followed by anorexia nervosa of the binging/purging subtype. Among diagnostic subgroups, the strongest factors were drug use, alcohol use, and tobacco use. CONCLUSION Suicide risk should be monitored carefully among patients with eating disorders, paying particular attention to combinations of risk factors.
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Affiliation(s)
- Valérie J Fedorowicz
- Clinique de Maladies Mentales et de l'Encéphale, Hôpital Sainte-Anne, Paris, France.
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Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, Valenstein M. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health 2007; 97:2193-8. [PMID: 17971541 DOI: 10.2105/ajph.2007.115477] [Citation(s) in RCA: 151] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES We sought to report clinical and demographic factors associated with suicide among depressed veterans in an attempt to determine what characteristics identified depressed veterans at high risk for suicide. METHODS We used longitudinal, nationally representative data (1999-2004) to determine suicide rates among depressed veterans, estimating time until suicide using Cox proportional hazards regression models. RESULTS Of 807694 veterans meeting study criteria, 1683 (0.21%) committed suicide during follow-up. Increased suicide risks were observed among male, younger, and non-Hispanic White patients. Veterans without service-connected disabilities, with inpatient psychiatric hospitalizations in the year prior to their qualifying depression diagnosis, with comorbid substance use, and living in the southern or western United States were also at higher risk. Posttraumatic stress disorder (PTSD) with comorbid depression was associated with lower suicide rates, and younger depressed veterans with PTSD had a higher suicide rate than did older depressed veterans with PTSD. CONCLUSIONS Unlike the general population, older and younger veterans are more prone to suicide than are middle-aged veterans. Future research should examine the relationship between depression, PTSD, health service use, and suicide risks among veterans.
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Affiliation(s)
- Kara Zivin
- Serious Mental Illness Treatment Research and Evaluation Center (SMITREC), Health Services Research and Development (HSR&D) Center of Excellence, Department of Veterans Affairs, Ann Arbor, Mich, USA.
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46
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Hsiung RC. A suicide in an online mental health support group: reactions of the group members, administrative responses, and recommendations. ACTA ACUST UNITED AC 2007; 10:495-500. [PMID: 17711356 DOI: 10.1089/cpb.2007.9999] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Suicides in online mental health support groups are inevitable. This case report of such a suicide describes the responses of the group members and the moderator and makes recommendations. Members of a large, public, mental health message board supported each other, and the moderator, a mental health professional, managed the milieu. A member joined in February 2001 and killed herself in April 2002. The initial response of the members was grief. The moderator attempted to minimize suicide contagion by not making any special announcements and to facilitate mourning by starting a memorial thread. There were no reports of self-injury in response to the suicide, and the online ventilation of grief may in fact have had some preventative effect. One member went to the funeral, and gradually, the group moved on. The moderator later implemented a memorial page. The responses of online groups to suicide may, like those of real-life groups, have resuscitation, rehabilitation, and renewal phases. Diffusion of dependency, a searchable archive, and threaded, asynchronous discussion may facilitate mourning, but anonymity may increase vulnerability to false reports. A thread started in memory of a deceased member may function like a virtual memorial service. A memorial page may function like a virtual cemetery. Preliminary recommendations can be made regarding suicide prevention and responding to suicide in moderated online mental health support groups.
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Affiliation(s)
- Robert C Hsiung
- Department of Psychiatry, University of Chicago, Chicago, Illinois 60637-1507, USA.
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Abstract
This article reviews and integrates empirically grounded advances in the assessment of suicidality. The practices discussed are consistent with existing standards of care, practice guidelines, and applicable research. The authors differentiate between risk assessment and prediction and then emphasize the important role of time in risk assessment. We present and illustrate a continuum of suicidality for risk assessment and offer practical recommendations for clinical decision making and treatment.
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Affiliation(s)
- Craig J Bryan
- Department of Psychology & Neuroscience, Baylor University, TX 97334, USA
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48
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Pompili M, Girardi P, Tatarelli G, Angeletti G, Tatarelli R. Suicide after surgical treatment in patients with epilepsy: a meta-analytic investigation. Psychol Rep 2006; 98:323-38. [PMID: 16796084 DOI: 10.2466/pr0.98.2.323-338] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Suicide is a major issue in surgically treated epileptic patients. A meta-analysis was performed comparing suicides in a sample of such patients and in the general population. The Index Medicus and the World Health Statistics Annual were searched to ascertain the suicide rates in the age groups indicated in the studies of epileptic patients for specific years and country. 11 studies were selected, comprising 2,425 patients, 24 of whom committed suicide. Data obtained for each study were processed together to calculate the mean number of suicides per 100,000 individuals with surgically treated epilepsy for each year. This meta-analysis shows that suicide in patients with epilepsy after surgical treatment is more frequent than in the general population. Results are discussed with particular attention to possible causative factors.
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Affiliation(s)
- Maurizio Pompili
- McLean Hospital, Harvard Medical School, Belmont, Massachusetts, USA.
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49
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Wilens TE, Biederman J. Alcohol, drugs, and attention-deficit/ hyperactivity disorder: a model for the study of addictions in youth. J Psychopharmacol 2006; 20:580-8. [PMID: 16174669 DOI: 10.1177/0269881105058776] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
There has been increasing interest in the developmental origins of substance use disorders (SUDs) in children and adolescents. Because of its early onset, high prevalence and known risk for SUD, attention deficit hyperactivity disorder (ADHD) is a model developmental disorder to evaluate in context to SUDs. A selected review of the literature was undertaken examining ADHD as an antecedent disorder to subsequent SUD. ADHD and its co-occurring comorbid psychopathology increase the risk for cigarette smoking and SUD and is associated with greater SUD severity and chronicity. The treatment of ADHD appears to decrease the risk for cigarette smoking and SUD. ADHD is an important antecedent disorder in children and adolescents worthy of further targeted preventive efforts to diminish the risk for cigarette smoking and SUD.
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Affiliation(s)
- Timothy E Wilens
- Clinical Research Program in Pediatric Psychopharmacology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA.
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Auquier P, Lançon C, Rouillon F, Lader M, Holmes C. Mortality in schizophrenia. Pharmacoepidemiol Drug Saf 2006; 15:873-9. [PMID: 17058327 DOI: 10.1002/pds.1325] [Citation(s) in RCA: 94] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this article is to describe the current status of knowledge on excess mortality in schizophrenia and its causative factors, and to expand upon previous work evaluating approaches that may reduce mortality rates. METHODS Literature available since 1995 was identified in a computerized search of the bibliographical databases Medline and Embase, using the topics 'mortality' and 'schizophrenia', and in a cross-reference search for articles that were particularly relevant. RESULTS Schizophrenia is associated with mortality rates that are two to three times higher than those expected or observed in the general population. This excess of mortality is accounted for by a combination of an increased risk of suicide, in particular in young male patients soon after diagnosis, and more importantly, a higher number of natural deaths. In order to diminish the level of suicide among people with schizophrenia, the majority of research has focused on the identification of risk factors that predispose patients to attempt or commit suicide, while unhealthy styles, polypharmacy and inadequate healthcare have been shown to contribute to the high natural mortality. The link between the use of antipychotics and mortality has not been yet clarified. CONCLUSION Dramatically increased mortality of schizophrenia patients is well established. It is time to move beyond this topic, and work towards interventions that aim at reducing the mortality risk in such patients.
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Affiliation(s)
- Pascal Auquier
- Département de Santé Publique, Faculté de Médecine, La Timone, Marseille, France.
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