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Teck Sng Tay A, Teck Cheng SE. Maladaptive Personality Traits of Inpatients with Self-Harm Behavior and Its Association with Suicide Intent Severity. Psychodyn Psychiatry 2023; 51:350-373. [PMID: 37712666 DOI: 10.1521/pdps.2023.51.3.350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/16/2023]
Abstract
Introduction: Inpatients with self-harm behavior utilize a high proportion of health care resources, and determining their suicide risk may be challenging. This study examines how maladaptive personality traits in people who self-harm are associated with suicide intent severity. Methods: This was a 5-month cross-sectional study. The International Personality Disorders Examination (IPDE) ICD-10 questionnaire, Beck's Suicide Intent Scale (SIS), and the Depression Anxiety Stress Scale (DASS) 21 were administered. Sociodemographic and clinical data were recorded with STATA version 10.1 for statistical analyses. Results: Thirty-seven out of 40 (92.50%) inpatients participated in this study. About two-thirds (n = 24, 64.86%) were first-time self-harmers, with self-poisoning (n = 33, 89.19%) being the most common method. About two-thirds (n = 24, 64.86%) had low to moderate suicide intent. The most common diagnosis was adjustment disorder (n = 21, 56.76%). Around one-third had at least severe ratings for depressive, anxiety, and stress symptoms. All screened positive for at least one class of maladaptive personality traits, with the majority (n = 33, 89.19%) having more than one class of maladaptive personality traits. The three most prevalent classes of maladaptive personality traits were anankastic (n = 28, 75.68%), schizoid (n = 25, 67.57%), and paranoid (n = 23, 62.16%). Only dissocial traits were positively correlated with suicide intent severity (regression coefficient = 1.37, p = .017) following adjustment for the most important confounder, DASS 21. Discussion: Maladaptive personality traits were common in inpatients with self-harm behavior, with dissocial traits being positively correlated with suicide intent severity. This finding may inform suicide prevention strategies for patients who self-harm.
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Affiliation(s)
- Andre Teck Sng Tay
- Senior Consultant Psychiatrist at the Department of Psychological Medicine, Changi General Hospital and Clinical Assistant Professor, Duke-NUS Medical School and Clinical Senior Lecturer at the Yong Loo Lin School of Medicine, National University of Singapore
| | - Samuel Eng Teck Cheng
- Senior Consultant Psychiatrist, Department of Psychological Medicine, Changi General Hospital, Clinical Assistant Professor at Duke-NUS Medical School, and Clinical Senior Lecturer at Yong Loo Lin School of Medicine, National University of Singapore
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Barrimi M, Serraj K, Rammouz I, Alouane R, Messaoudi N, Bellaoui M. Prevalence of and Risk Factors for Suicide Attempts Among Patients With Severe Psychiatric Disorders in Eastern Morocco. CRISIS 2023; 44:21-28. [PMID: 34674543 DOI: 10.1027/0227-5910/a000825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: Suicide attempts are common in patients with severe psychiatric disorders; however, they are rarely studied in this population. Aims: To investigate the prevalence and risk factors associated with suicide attempts among patients with severe psychiatric disorders. Method: This is a cross-sectional study of patients admitted to the Mohammed VI University Hospital of Psychiatry in Oujda, Morocco. Results: A total of 250 patients with a psychiatric disorder were recruited in this study. Among these, 78 cases (31.2%) had a personal history of suicide attempts. A personal history of suicide attempt was significantly higher among women compared to men (45.5% vs. 27.2%, p = .0099). The most common method of suicide attempts was jumping from heights (31%). Patients with a personal history of suicide attempts had a significantly higher prevalence of alcohol consumption (p = .0063), family history of psychiatric disorders (p = .002), family history of suicide attempt (p = .00004), and family history of suicide (p = .018) compared to those who had never made suicide attempts. Limitations: As suicidal behavior is highly stigmatized in Morocco, the number of patients who have made a suicide attempt may be underestimated. Conclusion: Our findings justify the need to provide specialized support to psychiatric patients with risk factors for suicide attempts.
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Affiliation(s)
- Mohammed Barrimi
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Khalid Serraj
- Department of Internal Medicine, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Ismail Rammouz
- Department of Psychiatry, Faculty of Medicine and Pharmacy, Ibn Zohr University, Agadir, Morocco
| | - Rachid Alouane
- Department of Psychiatry, Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Najoua Messaoudi
- Department of Psychiatry, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
| | - Mohammed Bellaoui
- Genetics Unit, Medical Sciences Research Laboratory, Faculty of Medicine and Pharmacy, University Mohammed Premier, Oujda, Morocco
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Chaudhury S, Gajbhiya A, Menon P, Saldanha D. Assessment of suicidal ideation in psychiatry outpatient department patients: A crosssectional study. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_328_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Giordano V, Santos FSE, Prata C, do Amaral NP. Patterns and management of musculoskeletal injuries in attempted suicide by jumping from a height: a single, regional level I trauma center experience. Eur J Trauma Emerg Surg 2020; 48:915-920. [PMID: 32936309 DOI: 10.1007/s00068-020-01499-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Accepted: 09/08/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND Suicide is a common cause of death in Brazil, with an overall increase of 62.5% during the last 30-year period. The study aims to determine overall patient characteristics and symptomatic indicators of complications among survivors. METHODS In this retrospective cross-sectional study, we collected and analyzed clinical information of all patients aged > 10 years who presented to our hospital with a history of attempted suicide by jumping from a height in a 7-year period. Records were searched for primary demographic data, radiographs and CT scans were reviewed to determine injury characteristics, and records and operative notes were searched to look for symptomatic indicators of complications among survivors. Baseline demographics and the distribution on skeletal injuries were compared between the survivor and non-survivor patients using the Chi-squared for categorical variables and the Student's t-test for continuous variables. Among survivors, univariate and multivariate analysis were performed to investigate independent risk factors of attempted suicide and complications. RESULTS A total of 222 patients attempted suicide by jumping from a height. At multivariate analysis, the middle-aged patient was the unique identified risk factor for suicide by jumping from a height. Overall mortality was 67.6%. The main independent cause for death was traumatic brain injury. Among survivors, there was a higher incidence of foot and ankle fractures, and pelvic ring injuries. The overall complication rate for survivor patients was 51.4%, with acute infection being the most prevalent complication. At multivariate analysis, middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures were identified as risk factors for acute complications. CONCLUSION Middle-aged people are at significant risk for attempting suicide by jumping from a height in Brazil, independently of gender, with 67.6% deaths. Traumatic brain injury, higher ISS, and more than 3 skeletal injuries are independent variables related to this fatal outcome. Acute complications occur in approximately 50% of survivors. Middle-aged men, foot and ankle injuries, open pelvic injuries, and open fractures are risk factors for complications.
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Affiliation(s)
- Vincenzo Giordano
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil.
- Clínica São Vicente, Rede D'or São Luiz, Rio de Janeiro, RJ, Brazil.
| | - Fabrício Santos E Santos
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Celso Prata
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
| | - Ney Pecegueiro do Amaral
- Serviço de Ortopedia e Traumatologia Prof. Nova Monteiro, Hospital Municipal Miguel Couto, Rua Mário Ribeiro 117/2º andar, Leblon, Rio de Janeiro, RJ, 22430-160, Brazil
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Qi L, Zhang Y, Wang L, Wang R, Wu J, Zhou X, Chen J, Zhang S, Zhou Y, Zhang XY. Sex differences in psychotic and non-psychotic major depressive disorder in a Chinese Han population. J Affect Disord 2020; 268:55-60. [PMID: 32158007 DOI: 10.1016/j.jad.2020.03.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 01/15/2020] [Accepted: 03/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sex differences between psychotic depression (PD) and non-psychotic depression (NPD) have received little systematic study. This study was conducted to investigate sex difference in patients with psychotic and non-psychotic major depressive disorder in a Chinese Han population. METHODS In this cross-sectional study, a total of 1718 first-episode and drug-naïve outpatients with major depressive disorder were recruited. Demographic and clinical characteristics were collected. All subjects were rated on the Hamilton Depression Rating Scale (HAMD), Hamilton Anxiety Rating Scale (HAMA) and the Positive and Negative Syndrome Scale (PANSS). RESULTS The prevalence of PD in female patients (10.97%) was higher than that in male patients (7.99%). Analysis of variance (ANOVA) showed that female patients were older compared with male patients in NPD group, but there were no significant differences in demographic and clinical variables between female and male PD patients. Further, there were no sex differences in the scores of HAMD, HAMA and positive symptom subscale of PANSS in both PD and NPD groups. Two-way ANOVA showed that PD patients had significantly higher scores on the HAMD, HAMA and positive symptom subscale of PANSS than non-PD patients. However, there were no significant effects of sex and sex* subtypes. LIMITATIONS The main limitations are cross-sectional design and inability to control selection bias. CONCLUSIONS Our findings show significant differences in clinical profiles between PD and NPD patients; however, no sex difference has been observed in the either PD or NPD patients.
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Affiliation(s)
- Ling Qi
- School of Health Science and Nursing, Wuhan Polytechnic University, Wuhan, China
| | - Yaping Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Liewei Wang
- Wuhan Xinzhou District Mental Health Center, Wuhan, China
| | - Ruoxi Wang
- School of Medicine and Health Management,Tongji Medical College of Huazhong University of Science & Technology,Wuhan, China
| | - Jiang Wu
- Medical Department, Wuhan Youfu Hospital,Wuhan, China
| | - Xin Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China
| | - Jing Chen
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Shufang Zhang
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Yongjie Zhou
- Research Center for Psychological and Health Sciences, China University of Geosciences, Wuhan, China; Affiliated Wuhan Mental Health Center,Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China.
| | - Xiang Yang Zhang
- CAS Key Laboratory of Mental Health, Institute of Psychology, Chinese Academy of Sciences, Beijing, China; Department of Psychology, University of Chinese Academy of Sciences, Beijing, China.
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Ohbe H, Goto T, Yamazaki R, Jo T, Matsui H, Fushimi K, Yasunaga H. Clinical Trajectories of Suicide Attempts and Self-harm in Patients Admitted to Acute-care Hospitals in Japan: A Nationwide Inpatient Database Study. J Epidemiol 2020; 31:231-236. [PMID: 32249268 PMCID: PMC7878706 DOI: 10.2188/jea.je20200018] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background For patients with suicide attempts or self-harm, acute-care hospitals often function as the primary or sole point of contact with the healthcare system. However, little is known about patient characteristics or clinical trajectories of suicide attempts and self-harm episodes among those admitted to acute-care hospitals. This study aimed to describe the characteristics of suicide attempts and self-harm among patients admitted to acute-care hospitals, and the clinical practices provided in these hospitals, using a nationwide inpatient database in Japan. Methods Using data from the Japanese Diagnosis Procedure Combination inpatient database from June 2015 to March 2017, we identified patients with emergency admission for suicide attempts or self-harm. We did not include patients with elective admission to psychiatric hospitals or outpatients. We described patient characteristics, treatments for physical injuries, psychiatric interventions, and discharge status. Results We identified 17,881 eligible patients during the 22-month study period. Overall, 38% of the patients did not have any psychiatric or behavioral comorbidities at admission. The most common suicide method was drug overdose (50%), followed by hanging (18%), jumping from a height (13%), cutting or piercing without wrist cutting (7.1%), poisoning (6.6%), and wrist cutting (5.4%). Suicide was completed by 2,639 (15%) patients. Among patients discharged to home, 51% did not receive any psychiatric intervention. In 468 acute-care hospitals (54%), no psychiatric intervention was provided during the study period. Conclusion We found that half of acute-care hospitals did not provide any hospital-based psychiatric care for patients with suicide attempts or self-harm.
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Affiliation(s)
- Hiroyuki Ohbe
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Tadahiro Goto
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo.,Graduate School of Medical Science, University of Fukui
| | - Ryuichi Yamazaki
- Department of Psychiatry, The Jikei University School of Medicine
| | - Taisuke Jo
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo
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Van Veen M, Wierdsma AI, van Boeijen C, Dekker J, Zoeteman J, Koekkoek B, Mulder CL. Suicide risk, personality disorder and hospital admission after assessment by psychiatric emergency services. BMC Psychiatry 2019; 19:157. [PMID: 31122268 PMCID: PMC6533743 DOI: 10.1186/s12888-019-2145-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 05/06/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The main objectives of the mobile Psychiatric Emergency Services (PES) in the Netherlands are to assess the presence of a mental disorder, to estimate risk to self or others, and to initiate continuity of care, including psychiatric hospital admission. The aim of this study was to assess the associations between the level of suicidality and risk of voluntary or involuntary admission in patients with and without a personality disorder who were presented to mobile PES. METHODS Observational data were obtained in three areas of the Netherlands from 2007 to 2016. In total, we included 71,707 contacts of patients aged 18 to 65 years. The outcome variable was voluntary or involuntary psychiatric admission. Suicide risk and personality disorder were assessed by PES-clinicians. Multivariable regression analysis was used to explore associations between suicide risk, personality disorder, and voluntary or involuntary admission. RESULTS Independently of the level of suicide risk, suicidal patients diagnosed with personality disorder were less likely to be admitted voluntarily than those without such a diagnosis (admission rate .37 versus .46 respectively). However, when the level of suicide risk was moderate or high, those with a personality disorder who were admitted involuntarily had the same probability of involuntary admission as those without such a disorder. CONCLUSIONS While the probability of voluntary admission was lower in those diagnosed with a personality disorder, independent of the level of suicidality, the probability of involuntary admission was only lower in those whose risk of suicide was low. Future longitudinal studies should investigate the associations between (involuntary) admission and course of suicidality in personality disorder.
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Affiliation(s)
- Mark Van Veen
- Research Group for Social Psychiatry and Mental Health Nursing, University of Applied Science, Nijmegen, The Netherlands.
- Altrecht Mental Health Services, Utrecht, The Netherlands.
| | - André I Wierdsma
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
| | | | - Jack Dekker
- Faculty of Behavioural and Movement Sciences, VU Faculties, Amsterdam, The Netherlands
| | - Jeroen Zoeteman
- Faculty of Behavioural and Movement Sciences, VU Faculties, Amsterdam, The Netherlands
- Arkin Mental Health Care, Department of Emergency Psychiatry, Amsterdam, The Netherlands
| | - Bauke Koekkoek
- Research Group for Social Psychiatry and Mental Health Nursing, University of Applied Science, Nijmegen, The Netherlands
- Pro Persona Mental Health Services, Wolfheze, The Netherlands
| | - Cornelis L Mulder
- Epidemiological and Social Psychiatric Research Institute, Department of Psychiatry, Erasmus MC, Rotterdam, The Netherlands
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands
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Dickens GL, Lamont E, Mullen J, MacArthur N, Stirling FJ. Mixed‐methods evaluation of an educational intervention to change mental health nurses' attitudes to people diagnosed with borderline personality disorder. J Clin Nurs 2019; 28:2613-2623. [DOI: 10.1111/jocn.14847] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Revised: 11/26/2018] [Accepted: 12/17/2018] [Indexed: 11/28/2022]
Affiliation(s)
| | - Emma Lamont
- School of Health and Social Sciences Abertay University Dundee UK
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Dickens GL, Lamont E, Stirling FJ. Student health professionals' attitudes and experience after watching "Ida's Diary", a first-person account of living with borderline personality disorder: Mixed methods study. NURSE EDUCATION TODAY 2018; 65:128-135. [PMID: 29567593 DOI: 10.1016/j.nedt.2018.03.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Accepted: 03/06/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND There is increasing interest in the use of commercial movies in nursing education, or "cinenurducation". There is a need for educational interventions which target mental health nurses' attitudes towards people with borderline personality disorder. OBJECTIVES To investigate and evaluate the experience and effects of attendance at a screening of the movie Ida's Diary, a first-person account of living with borderline personality disorder. DESIGN Mixed methods design comprising a within-subjects AB longitudinal survey, and a qualitative analysis of participant-generated data and researcher field notes from a World Café discussion group. SETTINGS One university in Scotland. PARTICIPANTS N = 66 undergraduate and postgraduate mental health nursing and counselling students. METHODS Participants completed measures of cognitive and emotional attitudes towards, and knowledge about, people with borderline personality disorder before and after one of two film screenings. We conducted a World Café discussion group after the second screening. Resulting data were subject to a qualitative thematic analysis. RESULTS Quantitative analysis revealed a five-factor cognitive and a single-factor emotional attitude structure. Cognitive-attitudinal items related to treatment deservingness and value of mixed treatment approaches improved across iterations. Total knowledge score did not change, but one item about borderline personality disorder as a precursor to schizophrenia received considerably more incorrect endorsement post-screening. Qualitative analysis revealed five themes: Facilitation and inhibition of learning; promotion but not satiation of appetite for knowledge; challenging existing understanding; prompting creativity and anxiety; and initiating thinking about the bigger picture. CONCLUSIONS Participants found the film thought provoking; it increased their appetite for knowledge. Findings suggest that screening should be delivered in conjunction with more didactic information about borderline personality disorder.
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Affiliation(s)
- Geoffrey L Dickens
- Division of Mental Health Nursing and Counselling, Abertay University, Bell Street, Dundee DD1 1HG, United Kingdom.
| | - Emma Lamont
- Faculty of Health Sciences and Sport, Room J06 Pathfoot, University of Stirling, Stirling FK9 4LA, United Kingdom.
| | - Fiona J Stirling
- Division of Mental Health Nursing and Counselling, Abertay University, Bell Street, Dundee DD1 1HG, United Kingdom.
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Mental disorders and suicide attempt in rural China. Psychiatry Res 2018; 261:190-196. [PMID: 29309959 DOI: 10.1016/j.psychres.2017.12.087] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2017] [Revised: 12/06/2017] [Accepted: 12/31/2017] [Indexed: 11/22/2022]
Abstract
The prevalence of various mental disorders and their age and gender specific characteristics among suicide attempters remains unclear in rural China. This study using 1:1 paired case-control design included 409 suicide attempters and 409 paired controls matched on age, gender and place of residence. Mental disorders were assessed using the Structured Clinical Interview for DSM-IV-TR Axis I Disorders. The prevalence of mental disorders was 32.3% for suicide attempters and 4.9% for paired controls. Mental disorder constituted a significant risk factor for suicide attempt with an adjusted odds ratio of 7.16 (95%CI: 3.65-14.04). The prevalence of mental disorders was higher among male than female suicide attempters. Major depressive disorder was most common in female suicide attempters while alcohol use disorder was most common in the males. The prevalence of mental disorders seemed to increase with age. Suicide attempters of higher ages were more prone to have mood disorders, especially a major depression. Suicide attempters with mental disorders differed from those without mental disorders on a number of socio-economic characteristics and suicidal behavior features. These insights should be taken into account in strategies and efforts to improve mental health care and ultimately to reduce suicidal behavior among residents in rural China.
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[Suicide risk in somatoform disorders]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT ÖSTERREICHISCHER NERVENÄRZTE UND PSYCHIATER 2017; 32:9-17. [PMID: 28940150 DOI: 10.1007/s40211-017-0248-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 08/14/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND The somatoform disorders include a group of complex disorders consist of somatic symptoms for which there are no identifiable organic cause or pathogenetic mechanisms. Given the importance of these disorders and the need to clarify the diagnosis of somatoform disorder affecting the suicide risk, we took into consideration the scientific literature to investigate the correlation between the two conditions. METHODS We performed a bibliographic search through Medline, Embase, PsycINFO, Scopus, SciELO, ORCID, Google Scholar, DOAJ using the following terms: somatoform, somatization disorder, pain disorder AND psychological factor, suicide, parasuicide, suicidality. RESULTS In all studies reported in our review, the suicidal behavior risk is high. But in the majority, the data are relatively unreliable because it takes into account the category nosographic "Neurotic, stress-related and somatoform disorders", too wide to be able to identify the clinical characteristics of patients at risk of only somatoform disorder. CONCLUSIONS Several studies conclude that psychiatric comorbidity increases the suicide risk: patients with two or more psychiatric disorders are more likely to commit a suicide attempt; in particular if there is a axis I diagnosis, the risk reduplicate. The somatization disorder seems to have a significant psychiatric comorbidity in particular with anxious and affective disorders spectrum.
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12
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Motivation factors for suicidal behavior and their clinical relevance in admitted psychiatric patients. PLoS One 2017; 12:e0176565. [PMID: 28445517 PMCID: PMC5405953 DOI: 10.1371/journal.pone.0176565] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 04/12/2017] [Indexed: 11/19/2022] Open
Abstract
Background Suicidal behavior (SB) is a major, worldwide health concern. To date there is limited understanding of the associated motivational aspects which accompany this self-initiated conduct. Aims To develop a method for identifying motivational features associated with SB by studying admitted psychiatric patients, and to examine their clinical relevance. Methods By performing a factor analytic study using data obtained from a patient sample exhibiting high suicidality and a variety of SB methods, Motivations for SB Scale (MSBS) was constructed to measure the features. Data included assessments of DSM-IV psychiatric and personality disorders, suicide intent, depressive symptomatology, overt aggression, recent life events (RLEs) and methods of SB, collated from structured interviews. Association of identified features with clinical variables was examined by correlation analyses and MANCOVA. Results Factor analyses elicited a 4-factor solution composed of Interpersonal-testing (IT), Interpersonal-change (IC), Self-renunciation (SR) and Self-sustenance (SS). These factors were classified according to two distinctions, namely interpersonal vs. intra-personal directedness, and the level of assumed influence by SB or the relationship to prevailing emotions. Analyses revealed meaningful links between patient features and clinical variables. Interpersonal-motivations (IT and IC) were associated with overt aggression, low suicidality and RLE discord or conflict, while SR was associated with depression, high suicidality and RLE separation or death. Borderline personality disorder showed association with IC and SS. When self-strangulation was set as a reference SB method, self-cutting and overdose-taking were linked to IT and SS, respectively. Conclusions The factors extracted in this study largely corresponded to factors from previous studies, implying that they may be useful in a wider clinical context. The association of these features with SB-related factors suggests that they constitute an integral part of the process leading to SB. These results provide a base for further research into clinical strategies for patient management and therapy.
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Dickens GL, Lamont E, Gray S. Mental health nurses’ attitudes, behaviour, experience and knowledge regarding adults with a diagnosis of borderline personality disorder: systematic, integrative literature review. J Clin Nurs 2016; 25:1848-75. [DOI: 10.1111/jocn.13202] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/18/2015] [Indexed: 12/15/2022]
Affiliation(s)
- Geoffrey L Dickens
- Division of Mental Health Nursing and Counselling; Abertay University; Dundee UK
- NHS Fife Research and Development Department; Queen Margaret Hospital; Dunfermline UK
| | - Emma Lamont
- Division of Mental Health Nursing and Counselling; Abertay University; Dundee UK
| | - Sarah Gray
- NHS Fife Research and Development Department; Queen Margaret Hospital; Dunfermline UK
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Dickens GL, Hallett N, Lamont E. Interventions to improve mental health nurses’ skills, attitudes, and knowledge related to people with a diagnosis of borderline personality disorder: Systematic review. Int J Nurs Stud 2016; 56:114-27. [DOI: 10.1016/j.ijnurstu.2015.10.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/28/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
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Dickens GL, Frogley C, Mason F, Anagnostakis K, Picchioni MM. Experiences of women in secure care who have been prescribed clozapine for borderline personality disorder. Borderline Personal Disord Emot Dysregul 2016; 3:12. [PMID: 27761261 PMCID: PMC5055694 DOI: 10.1186/s40479-016-0049-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 10/01/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Clozapine is an atypical antipsychotic medicine which can cause significant side-effects. It is often prescribed off-license in severe cases of borderline personality disorder contrary to national treatment guidelines. Little is known about the experiences of those who take clozapine for borderline personality disorder. We explored the lived-experience of women in secure inpatient care who were prescribed clozapine for borderline personality disorder. FINDINGS Adult females (N = 20) participated in audio-taped semi-structured interviews. Transcripts were subject to thematic analysis. The central themes related to evaluation, wellbeing, understanding and self-management; for many, their subjective wellbeing on clozapine was preferred to prior levels of functioning and symptomatology, sometimes profoundly so. The negative and potentially adverse effects of clozapine were explained as regrettable but relatively unimportant. CONCLUSIONS When psychological interventions are, at least initially, ineffective then clozapine treatment is likely to be evaluated positively by a group of women with borderline personality disorder in secure care despite the potential disadvantages.
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Affiliation(s)
- Geoffrey L Dickens
- Division of Mental Health Nursing and Counselling, School of Social and Health Sciences, Abertay University, Bell Street, Dundee, DD1 1HG UK
| | - Catherine Frogley
- St Andrew's Academic Centre, Northampton, NN1 5DG UK ; School of Psychology, Faculty of Arts and Human Sciences, AD Building, University of Surrey, Guildford, Surrey GU2 7XH UK
| | - Fiona Mason
- St Andrew's Academic Centre, Northampton, NN1 5DG UK ; Medical School, University of Buckingham, Yeomanry House, Hunter Street, Buckingham, MK18 1EG UK
| | | | - Marco M Picchioni
- St Andrew's Academic Centre, Northampton, NN1 5DG UK ; Department of Forensic and Neurodevelopmental Science, King's College London Institute of Psychiatry Psychology and Neuroscience, De Crespigny Park, Denmark Hill London, SE5 8AF UK
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Tomita T, Yasui-Furukori N, Sugawara N, Ogasawara K, Katagai K, Saito H, Sawada K, Takahashi I, Nakamura K. Prevalence of major depressive disorder among hemodialysis patients compared with healthy people in Japan using the Structured Clinical Interview for DSM-IV. Neuropsychiatr Dis Treat 2016; 12:2503-2508. [PMID: 27757034 PMCID: PMC5053379 DOI: 10.2147/ndt.s106817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We investigated the prevalence of depression in hemodialysis (HD) patients using the Center for Epidemiologic Studies for Depression (CES-D) scale and the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (SCID) and compared the rates with those of community dwelling people in Japan. PATIENTS AND METHODS A total of 99 patients undergoing HD were recruited. Blood sampling was performed no later than 2 weeks prior to assessment. As a reference group for SCID and CES-D evaluation, 404 age- and sex-matched healthy controls who had participated in the Iwaki Health Promotion Project were included in this study. The SCID and the CES-D scale were administered to all participants to diagnose their depression. Participants who met the criteria of a major depressive episode according to the SCID were classified as SCID depression and the participants whose CES-D score was 16 or higher were classified as CES-D depression. RESULTS Ninety-nine HD patients completed the evaluation and data collection. There were no significant differences in age, sex, or CES-D scores between HD patients and controls. There were 12 cases of SCID depression in HD patients and four cases in controls. There was a significant difference between HD patients and controls in the prevalence of SCID depression. There were no significant differences between the two groups with regard to demographic or clinical data. There were 19 HD patients and 24 controls who showed CES-D depression. There was no significant difference between HD patients and controls in the prevalence of CES-D depression. There was a significant difference in potassium level between the two groups, but there were no significant differences in any of the other items. CONCLUSION There were significantly more HD patients showing SCID depression than controls in the present study. In clinical settings, the SCID might be useful in surveying cases of depression detected by screening tools among HD patients.
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Affiliation(s)
- Tetsu Tomita
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Yasui-Furukori
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Norio Sugawara
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan; Aomori Prefectural Center for Mental Health and Welfare, Aomori, Japan
| | | | - Koki Katagai
- School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Hisao Saito
- Department of Urology, Oyokyo Kidney Research Institute, Hirosaki, Japan
| | - Kaori Sawada
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Ippei Takahashi
- Department of Social Medicine, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
| | - Kazuhiko Nakamura
- Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan
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Hayashi N, Igarashi M, Imai A, Yoshizawa Y, Asamura K, Ishikawa Y, Tokunaga T, Ishimoto K, Tatebayashi Y, Kumagai N, Ishii H, Okazaki Y. Pathways from life-historical events and borderline personality disorder to symptomatic disorders among suicidal psychiatric patients: A study of structural equation modeling. Psychiatry Clin Neurosci 2015; 69:563-71. [PMID: 25645160 DOI: 10.1111/pcn.12280] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 01/07/2015] [Accepted: 01/21/2015] [Indexed: 11/30/2022]
Abstract
AIMS Suicidal behavior (SB) is a major mental health problem. The research has identified many factors related to SB, such as problems in the developmental period and psychiatric and personality disorders. However, the interrelation of these factors has not been clearly delineated. METHODS The subjects were 155 patients consecutively admitted with SB to a psychiatric center in Tokyo. Structured interviews, including the Structured Clinical Interview for DSM-IV (SCID)-I and SCID-II, were conducted to determine characteristics of the SB-related factors. To illustrate their interrelation, this study applied the technique of structural equation modeling. The latent constructs of life-historical events, borderline personality disorder (BPD) features and three symptomatic disorders (depression, anxiety disorders and substance dependence) were aligned in the chronological order of their manifestation, and connected one another within the model. Indicator variables of life-historical events were maltreatment in the developmental period and early onset of problematic behaviors. Indicators of BPD features and symptomatic disorders included the scales composed of the items in the SCID-I and II. RESULTS The constructed model with favorable goodness-of-fit indices confirmed that BPD features had a mediating role in which they were influenced by life-historical events, and exerted an influence on the symptomatic disorders. Outside the BPD-mediating paths, the model suggested three clinically interpretable links between life-historical events and symptomatic disorders. CONCLUSIONS The model of this study demonstrated the pathways from life-historical events and BPD to symptomatic disorders, and indicated a generating process of psychiatric comorbidity among suicidal patients. The wide-range view this study portrayed has important clinical implications, and deserves further substantiation by future studies.
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Affiliation(s)
- Naoki Hayashi
- Department of Psychiatry, Teikyo University School of Medicine, Tokyo, Japan
| | - Miyabi Igarashi
- Tokyo Metropolitan Chubu Comprehensive Center for Mental Health and Welfare, Tokyo, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yuka Yoshizawa
- Osaka Prefectural Tondabayashi Health Center, Osaka, Japan
| | | | | | - Taro Tokunaga
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kayo Ishimoto
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Naoki Kumagai
- Tokyo Government Bureau of Social Welfare and Public Health, Tokyo, Japan
| | - Hidetoki Ishii
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuji Okazaki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.,Michinoo Hospital, Nagasaki, Japan
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Pires MCDC, Raposo MCF, Sougey EB, Bastos Filho OC, Silva TS, Passos MPD. Indicadores de risco para tentativa de suicídio por envenenamento: um estudo caso-controle. JORNAL BRASILEIRO DE PSIQUIATRIA 2015. [DOI: 10.1590/0047-2085000000078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
RESUMO Objetivo Considerando o envenenamento como o método mais utilizado para a tentativa de suicídio e a escassez de evidências nacionais sobre o tema, investigamos alguns possíveis indicadores de risco nesse tipo de tentativa. Métodos Estudo do tipo caso-controle em uma emergência geral de um hospital público, na cidade do Recife com 220 indivíduos, distribuídos em dois grupos de 110 pacientes cada, que estavam em tratamento, sendo o grupo casos os sobreviventes de tentativa de suicídio por envenenamento e os controles, sem história de intoxicação/envenenamento nem tentativa de suicídio, pareados por gênero e idade. Resultados O gênero feminino predominou na amostra (70,9%), com idade média de 29 anos; 73% declararam etnia branca ou morena; menos da metade vivia em convívio marital; a maioria tinha religião; ambos tinham poucos anos de estudo. Houve diferença significativa (p = 0,003) para dependência financeira entre os grupos, com chance 2,25 vezes maior para tentar suicídio entre os casos. Ter sofrido fatos traumáticos e abuso sexual na infância revelou diferença significativa. Conclusões Foram considerados indicadores de risco no grupo caso: estar em dependência financeira de terceiros, ter sofrido abuso sexual na infância, ideação suicida, histórico de transtorno mental na família, possuir algum transtorno mental e, principalmente, comorbidade(s) psiquiátrica(s). No modelo de regressão, foi possível estimar uma chance de tentativa de suicídio por envenenamento de até 94,0% na presença conjunta de quatro fatores. A pesquisa representa uma das primeiras iniciativas para ampliação das discussões sobre os fatores de risco para tentativa de suicídio em âmbito nacional.
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de Bernier GL, Kim YR, Sen P. A systematic review of the global prevalence of personality disorders in adult Asian populations. Personal Ment Health 2014; 8:264-75. [PMID: 25182011 DOI: 10.1002/pmh.1270] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2013] [Revised: 07/14/2014] [Accepted: 07/19/2014] [Indexed: 11/06/2022]
Abstract
BACKGROUND No systematic reviews have been conducted into the prevalence of personality disorders (PD) in Asian populations. This review aims to investigate the prevalence of all PD subtypes within community and clinical Asian (Chinese, Indian, Japanese and South Korean) populations worldwide. METHOD Seven databases were searched in addition to manual examination and reference tracking. Exclusion criteria were applied with the remaining studies subjected to quality appraisal. RESULTS Nineteen studies were included for review. Results were grouped by community studies in Asian countries, clinical studies in Asian countries and comparative studies. Prevalence of PD assessed by clinical judgement was lower than that by diagnostic tools. The highest rates of PD were found in suicidal cohorts within the various countries. Four of the five comparative studies found lower prevalence rates of PD in Asians compared with the overall sample. CONCLUSION Insufficient consistent research has been published to ascertain the prevalence of PD in Asians and whether it is higher or lower than in Western cohorts. Asians presenting with suicidal ideation may benefit from PD assessment.
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Hayashi N, Igarashi M, Imai A, Yoshizawa Y, Utsumi K, Ishikawa Y, Tokunaga T, Ishimoto K, Harima H, Tatebayashi Y, Kumagai N, Nozu M, Ishii H, Okazaki Y. Post-hospitalization course and predictive signs of suicidal behavior of suicidal patients admitted to a psychiatric hospital: a 2-year prospective follow-up study. BMC Psychiatry 2012; 12:186. [PMID: 23114285 PMCID: PMC3549906 DOI: 10.1186/1471-244x-12-186] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2012] [Accepted: 10/25/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Suicidal patients admitted to a psychiatric hospital are considered to be at risk of suicidal behavior (SB) and suicide. The present study aimed to seek predictors of SB recurrence of the high-risk patients by examining their post-hospitalization course. METHOD The design was 2-year prospective follow-up study of patients consecutively admitted with SB to a psychiatric center in Tokyo. The DSM-IV diagnoses and SB-related features of subjects were determined in structured interviews. Subsequently, the subjects underwent a series of follow-up assessments at 6-month intervals. The assessment included inquiries into SB recurrence, its accompanying suicidal intent (SI) and SF-8 health survey. Analyses of serial change over time in the follow-up data and Cox proportional hazards regression analyses of SB recurrence were performed. RESULTS 106 patients participated in this study. The dropout rate during the follow-up was 9%. Within 2 years, incidences of SB as a whole, SB with certain SI (suicide attempt) and suicide were 67% (95% CI 58 - 75%), 38% (95% CI 29 - 47%) and 6% (95% CI 3 - 12%), respectively. Younger age, number of lifetime SBs and maltreatment in the developmental period were predictive of SB as a whole, and younger age and hopelessness prior to index admission were predictive of suicide attempt. Regarding diagnostic variables, anxiety disorders and personality disorders appeared to have predictive value for SB. Additionally, poor physical health assessed during the follow-up was indicated as a possible short-term predictor of SB recurrence. CONCLUSIONS This study demonstrated a high incidence of SB and suicide and possible predictors of SB recurrence in the post-hospitalization period of psychiatric suicidal patients. Specialized interventions should be developed to reduce the suicide risk of this patient population.
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Affiliation(s)
- Naoki Hayashi
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan.
| | - Miyabi Igarashi
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Atsushi Imai
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yuka Yoshizawa
- Osaka Prefectural Tondabayashi Health Center, Osaka, Japan
| | - Kaori Utsumi
- Osaka Prefectural Tondabayashi Health Center, Osaka, Japan
| | | | - Taro Tokunaga
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Kayo Ishimoto
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Hirohiko Harima
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan
| | - Yoshitaka Tatebayashi
- Affective Disorders Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan
| | - Naoki Kumagai
- Disabled Persons Programs Division, Bureau of Social Welfare and Public Health, Tokyo Metropolitan Government, Tokyo, Japan
| | - Makoto Nozu
- Tokyo Metropolitan Tama Comprehensive Center for Mental Health and Welfare, Tokyo, Japan
| | - Hidetoki Ishii
- Graduate School of Education and Human Development, Nagoya University, Nagoya, Japan
| | - Yuji Okazaki
- Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital, Tokyo, Japan,Schizophrenia Research Team, Tokyo Metropolitan Institute of Medical Science, Tokyo, Japan,Michinoo Hospital, Nagasaki, Japan
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Abstract
To review the literature related to recent temperamental and biological findings on borderline personality disorder (BPD) and major depression, the close link between the two disorders, and the latest therapeutical findings on BPD, focusing on the conditions of co-morbidity between depression and BPD. The National Institutes of Health's PubMed database was used to identify indexed studies on BPD, depression and the co-morbidity between the two. Only studies published between 2000 and 2011 were assessed. Similar temperamental features have been demonstrated in BPD and depression. The strong link between the two disorders seems to be widely recognized by scientific community. Psychotherapy and new antipsychotics are the topics of current major interest of research. The therapeutic targets in the case of co-morbidity are BPD features associated with depressive symptoms, thus influencing prognosis. A global assessment is, in fact, fundamental for a successful therapy for the treatment of the several aspects of a complex psychopathological phenomenon.
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Affiliation(s)
- Maria Luca
- Department of Medical and Surgery Specialties, Psychiatry Unit of the University Hospital "Policlinico-Vittorio Emanuele" of Catania (Sicily), Via S. Sofia 78, 95100, Catania (Sicily), Italy.
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Höfer P, Rockett IRH, Värnik P, Etzersdorfer E, Kapusta ND. Forty years of increasing suicide mortality in Poland: undercounting amidst a hanging epidemic? BMC Public Health 2012; 12:644. [PMID: 22883342 PMCID: PMC3543353 DOI: 10.1186/1471-2458-12-644] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 08/01/2012] [Indexed: 01/09/2023] Open
Abstract
Background Suicide rate trends for Poland, one of the most populous countries in Europe, are not well documented. Moreover, the quality of the official Polish suicide statistics is unknown and requires in-depth investigation. Methods Population and mortality data disaggregated by sex, age, manner, and cause were obtained from the Polish Central Statistics Office for the period 1970-2009. Suicides and deaths categorized as ‘undetermined injury intent,’ ‘unknown causes,’ and ‘unintentional poisonings’ were analyzed to estimate the reliability and sensitivity of suicide certification in Poland over three periods covered by ICD-8, ICD-9 and ICD-10, respectively. Time trends were assessed by the Spearman test for trend. Results The official suicide rate increased by 51.3% in Poland between 1970 and 2009. There was an increasing excess suicide rate for males, culminating in a male-to-female ratio of 7:1. The dominant method, hanging, comprised 90% of all suicides by 2009. Factoring in deaths of undetermined intent only, estimated sensitivity of suicide certification was 77% overall, but lower for females than males. Not increasing linearly with age, the suicide rate peaked at ages 40-54 years. Conclusion The suicide rate is increasing in Poland, which calls for a national prevention initiative. Hangings are the predominant suicide method based on official registration. However, suicide among females appears grossly underestimated given their lower estimated sensitivity of suicide certification, greater use of “soft” suicide methods, and the very high 7:1 male-to-female rate ratio. Changes in the ICD classification system resulted in a temporary suicide data blackout in 1980-1982, and significant modifications of the death categories of senility and unknown causes, after 1997, suggest the need for data quality surveillance.
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Affiliation(s)
- Peter Höfer
- Department of Psychiatry and Psychotherapy, Medical University of Vienna,Vienna, Austria
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