Severe transient suicidality due to hemispheric hyperperfusion after successful acute stroke thrombolysis

Meta-analysis of 5-hydroxytryptamine transporter gene promoter region polymorphism and post-stroke depression

Objective

To investigate the relationship between 5-hydroxytryptamine transporter gene promoter region (5-HTTLPR) gene polymorphism and post-stroke depression (PSD).

Methods

We searched the CNKI, China Science and Technology Journal, China WanFang, PubMed, Embase, and Web of Science databases for studies of the relationship between 5-HTTLPR polymorphism and PSD. Data were evaluated using Stata software.

Results

The L allele was significantly related to the S allele (OR = 0.57, 95% confidence interval (CI) 0.49–0.65). The dominant genotype LL + LS was related to SS (OR = 0.48, 95%CI 0.39–0.59), the recessive genotype LL was related to LS + SS (OR = 0.39, 95%CI: 0.30–0.51), the homozygous genotype LL was related to SS (OR = 0.24, 95%CI 0.18–0.33), and the heterozygous genotype LS was related to SS (OR = 0.55, 95 CI 0.44–0.68). All the differences were significant. Ethnicity subgroup analysis showed significant differences among the five genotypes in both Asians and Caucasians. Hardy–Weinberg equilibrium (HWE) subgroup analysis showed that, after removal of a non-HWE-conforming control group, all five genotypes were significant and genotypes LL, LS + LL, and LS and L allele had beneficial effects on recovery from PSD.

Conclusion

5-HTTLPR gene polymorphism is strongly associated with PSD, and the LL, LS + LL, and LS genotypes and L allele may protect against this condition.

Psychometric properties of the psychological strain scales (PSS) in suicide attempters and community controls of rural China

BACKGROUND

Psychological Strain Scales (PSS) were developed to measure four types of strain comprising value strain, deprivation strain, aspiration strain, and coping strain. This study aimed to evaluate the psychometric properties of the Chinese version of 40-item PSS in suicide attempters and community controls of rural China.

METHODS

Data of this study came from the investigation of 132 suicide attempters and their paired community controls matched with the same sex, age (±3 years) and residence in five counties in rural Shandong, China. The Chinese version of PSS, the Center for Epidemiologic Studies Depression Scale (CES-D), the Trait Anxiety Inventory (TAI) and the Self-esteem Scale (SES) were administered and reliability test and validity test of the PSS were conducted.

RESULTS

Cronbach's α and Guttman Spilt-Half coefficient of PSS was 0.942 and 0.842 for suicide attempters, and 0.950 and 0.874 for community controls. For both suicide attempters and community controls, the Exploratory Factor Analysis indicated a one-factor structure of each strain scale, which accorded with the original factor structure proposed by the authors. The scores of the total PSS and four subscales were positively correlated with the scores of CES-D and TAI; and negatively correlated with the score of SES, which indicated a good performance in convergent validity.

LIMITATIONS

This study was limited to its generalizability to the Chinese urban population.

CONCLUSIONS

The Chinese version of the 40-item PSS has satisfactory psychometric properties in terms of reliability and validity in Chinese rural suicide attempters and community controls.

Resilience of patients with chronic diseases: A systematic review

The purpose of this research was to contribute to the development of a resilience-promoting programme for patients with chronic diseases. A systematic review of literature concerning resilience interventions for patients with chronic diseases was conducted by searching PubMed (including Medline), Science Direct, Web of Science, PsycARTICLES, CINAHL Plus, Embase, and the Cochrane Database for articles featuring the terms "resilience," "resiliency," "resilient," "cancer," "stroke," "heart disease," "diabetes" and "COPD" and published between 8 January 2017 and 15 January 2017. We included all English studies relevant to the topic; however, we excluded: (1) nonrandomised controlled trials and (2) those that mentioned the term "resilience" but did not apply it in their analysis. Seventeen studies-10 on cancer, four on cardiovascular diseases and three on diabetes-were deemed suitable for analysis. We found that, in these studies, (1) diverse definitions of resilience were applied, (2) various intervention durations were used and (3) complex programmes were applied within the resilience-improving programmes. Our research encourages efforts to operationalise the construct of resilience, so it can be applied in clinical settings, and for the development of more systematic intervention programmes.

A Meta-Analysis of the Rates of Suicide Ideation, Attempts and Deaths in People with Epilepsy

This meta-analysis aimed to evaluate the association between epilepsy and suicide. We systematically searched PubMed, PsycINFO, Embase and Web of Science for studies that reported the prevalence of suicidality in the form of suicide ideation, attempts and deaths among people with epilepsy (PWE). Studies were included if they reported the numbers of patients who died by suicide and concurrently suffered from epilepsy, assessed suicide ideation, or studied suicide attempts in PWE by validated instruments or diagnostic interviews. We used the random effects model to calculate the pooled odds ratios (OR) and standard mean differences (SMDs). We performed subgroup analyses. Seven case-control studies were included in the comparison of rates of suicide attempts between PWE and controls, with a total of 821,594 participants. Our analyses demonstrated a positive association between epilepsy and suicide attempts (pooled OR = 3.25, 95% confidence interval (CI): 2.69–3.92, p < 0.001), indicating that PWE have an elevated risk of suicide. The pooled prevalence for suicide ideation (24 studies) and suicide attempts (18 studies) were 23.2% (95% CI: 0.176–0.301) and 7.4% (95% CI: 0.031–0.169) respectively. The pooled rate of death due to suicide (10 studies) was 0.5% (95% CI: 0.002–0.016). Meta-regression showed that mean age and proportion of male gender were significant moderators for prevalence of suicide attempts and death due to suicide in PWE. Young PWE could be triggered by relationship problems and male PWE might use more lethal methods to attempt suicide. This meta-analysis provides the most up-to-date information on the prevalence of suicide among people with epilepsy and guidance on strategies to improve current psychiatric services provided for this population.

Concomitant Psychiatric Symptoms in Neurological Outpatients

To estimate the prevalence of concomitant psychiatric disorders in neurological outpatients and to assess the value of simple screening questionnaires in the identification of psychiatric symptoms, we analyzed a total of 803 patients who visited neurology clinics with neurological symptoms over a six-month period. Using self-reported questionnaires, we assessed psychiatric symptoms, such as stress (Perceived Stress Scale, PSS), depression (Patient Health Question 9, PHQ9), and anxiety (Generalized Anxiety Disorder 7, GAD7). According to the disease subtypes, we analyzed the psychiatric scales based on gender and age group. The prevalence of psychiatric comorbidities was lowest in patients with cerebrovascular disease (CVD) and highest among patients with cognitive decline and epilepsy. The overall prevalence of psychiatric symptoms markedly decreased with age. This decline was statistically significant for all questionnaires (PSS ≥ 14, p for trend = 0.027; PQH9 ≥ 10, p for trend = 0.005; GAD7 ≥ 10, p for trend = 0.002) and was more pronounced in males. Considering the high incidence of undetected psychiatric comorbidities and their associated burden, proactive psychiatric management should be included in neurological care. Psychiatric questionnaires could also be an effective screening tool for identifying psychiatric symptoms accompanying neurological symptoms.

Suicide, Stigma, and Utilizing Social Media Platforms to Gauge Public Perceptions

Introduction: Suicide, a multifaceted complex outcome that arises from numerous biopsychosocial factors, is a public health concern which is growing in numbers despite valiant prevention efforts. There is still a lot of stigma surrounding suicide that needs to be addressed. Social media is growing exponentially and there are many forums where suicidality is being discussed. As a result, we conducted a brief survey on the perception of suicide on social media platforms of Facebook and Reddit in order to gather more information. Results: Of the 152 respondents, 86% believed that suicide is preventable, and 72.85% believed that it is a person's right to die by suicide. About a third (31.79%) had lost someone close to them to suicide. Respondents who did not think suicide was preventable also viewed suicide as either a sign of strength (42.86%) or a revenge act (33.3%). Those who responded that someone close to them died by suicide believed that the media glorified suicide (56.25%) while those who did not lose someone, did not believe that (66.99%). Women (61%) found social media to be a good platform for people to ask for help while men did not (60.61%). Conclusions: We utilized the social media platforms to gauge the perception of suicide and found among the sample of mostly young white respondents, suicide is not stigmatized, most believed it is preventable and it is a person's right to die by suicide. While women found social media to be a good platform to ask for support, men did not, which is in keeping with the trend that women tend to be more willing to seek help. A third of the group had lost someone close to them to suicide which was the national average, who tended to believe that media glorified suicide. Limitations of this study include the fact that those who respond voluntarily to a survey likely have an interest in the topic, and this might not accurately reflect the public opinion and attitude.

Which Patients Are Prescribed Escitalopram?: Predictors for Escitalopram Prescriptions and Functional Outcomes among Patients with Acute Ischemic Stroke

Recent studies have demonstrated that antidepressants could enhance functional recovery via neuroplasticity beyond solely treating depression. However, since Koreans typically show a greater aversion to seeking psychiatric care than citizens of Western countries, the number of antidepressant prescriptions is low. Through this study, we aim to identify the factors that lead to the prescription of antidepressants in subjects with acute ischemic stroke (AIS) in clinical practice. A total of 775 patients with ischemic stroke (IS) participated in this study from March 2010 to May 2013. We used binary logistic regression to find predictors for escitalopram prescriptions. To reveal predictors for short-term functional outcomes, we used an adjusted regression model using a propensity score. Among the 775 participants, 39 (5.03%) were prescribed escitalopram. The duration of hospital stay (odds ratio (OR) = 1.07; 95% confidence interval (CI) = 1.04–1.10) and the use of mechanical ventilation were significantly more closely related to escitalopram prescriptions as compared to non-escitalopram prescriptions (OR = 5.15; 95% CI = 1.53–17.40). The use of escitalopram, on the other hand, was not significantly associated with short-term functional outcomes (OR = 1.27; 95% CI = 0.50–3.25). Duration of hospital stay and use of mechanical ventilation were significantly related to escitalopram prescriptions.