Emotional Pain Mediates the Link Between Preoccupied Attachment and Non-suicidal Self-Injury in High Suicide Risk Psychiatric Inpatients

Suicide Crisis Syndrome: A systematic review

BACKGROUND

The objective of this systematic review is to describe the scientific evidence for the Suicide Crisis Syndrome (SCS), a presuicidal cognitive and affective state consisting of five symptomatic dimensions: entrapment, affective disturbance, loss of cognitive control, hyperarousal, and social withdrawal. The aim of this article is to summarize the emerging literature on the SCS and to assess the extent to which a uniform syndrome can be assumed.

METHODS

A systematic literature search was conducted in three different databases (PubMed, PsycInfo, and Google Scholar) using the search terms "Suicide Crisis Inventory," "Suicide Crisis Syndrome," "Narrative Crisis Model of Suicide," and "Suicide Trigger State."

RESULTS

In total, 37 articles from 2010 to 2022 were identified by search criteria. Twenty-one articles published between 2017 and 2022 were included in the systematic review. All but three studies were conducted in the United States and examined clinical samples of adult high-risk psychiatric in- and outpatients. Sample sizes ranged from N = 170 to 4846. The findings confirm the unidimensional structure of the proposed disorder and support the predictive validity for short-term suicidal behavior above and beyond suicidal ideation.

CONCLUSION

Despite the promising predictive validity of the SCS, a precise prediction of future suicidal behavior remains difficult.

Non-Suicidal Self-Injury in Russian Patients with Suicidal Ideation

BACKGROUND

Nonsuicidal self-injury (NSSI) is recognized as a public health concern for its association with unfavorable outcomes, including suicidal behavior. The aim of this study is to identify factors associated with NSSI among patients with nonpsychotic mental disorders (NPMD) and suicidal ideation in Russia.

METHODS

A retrospective cohort study was conducted in the Moscow Research and Clinical Center for Neuropsychiatry between November 2017 and May 2019. The sample was composed of consecutive patients with lifetime suicidal ideation (from the Self-Injurious Thoughts and Behavior Interview) seen in the center's psychiatric ward for NPMD. The patients were divided into two groups: those with and without lifetime NSSI. Sociodemographic variables, psychiatric diagnosis, family history of mental disorders, history of physical or sexual abuse, sexual behavior, ad-hoc psychiatric treatments, suicidal ideation, plans, and gestures or attempts were investigated.

RESULTS

Six thousand, two hundred and four consecutive patients were screened for suicidal ideation. Out of a total of 361 patients (87.3% females) with suicidal ideation, 217 (60.1%) reported NSSI. Variables independently associated with NSSI included age <25 years (OR 6.0, CI 2.5-14.7), dissatisfaction with the perceived parenting style (OR 3.3, CI 1.5-7.4), bullying (OR 2.6, CI 1.0-6.5), severe body modifications (OR 11.9, CI 1.1-134.3), experience with illicit drugs (OR 4.4, CI 1.9-10.3), and eating disorders (OR 4.9, CI 2.0-11.8).

LIMITATIONS

Retrospective design, referral population, single center study, and exclusion of psychotic patients.

CONCLUSIONS

NSSI is associated with age <25 years old, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug-use, and lifetime eating disorders.HIGHLIGHTSNonsuicidal self-injury is a significant public health concern for its association with suicidal behavior.60.1% of Russian patients with non-psychotic mental disorders (NPMD) and suicidal ideation reported lifetime NSSI.NSSI in Russian patients with NPMD and suicidal ideation is associated with age less than 25 years, dissatisfaction with perceived parenting style, bullying, severe body modifications, lifetime experience of illicit drug use, and lifetime eating disorders.

From motivation, decision-making to action: An fMRI study on suicidal behavior in patients with major depressive disorder

OBJECTIVE

We explored the neural mechanisms underlying disadvantageous risk decision making in un-medicated major depressive disorder patients who had recent suicide attempts.

METHODS

53 patients with major depressive disorder (MDD), including 23 with a history of suicide attempts (SA) and 30 without (NS), and 30 healthy controls (HCs) completed pertinent psychometric assessments, and the dynamic decision making balloon analogue risk task (BART) under fMRI. We also built a 4-parameter Bayesian computational modeling for decision making analyses.

RESULTS

Several distinct findings emerged. First, SA patients had no depression intensity difference but higher pain avoidance in psychometrics, and more risk aversion in the BART when compared to the NS patients, with computational modeling confirming such reduced risk-taking propensity. Second, SA patients showed smaller left insular cortex activation than NS patients during the high risk, decisional phase of BART, and the modulation correlated with pain avoidance in both SA and NS groups. Third, during feedback phase of loss trials of the BART, SA patients had greater activation in the left dorsolateral prefrontal cortex (dlPFC) than NS patients.

CONCLUSION

Taken together, we present novel findings and propose interpretations that the differential insula activation likely relates to high uncertainty-aversion in SA patients, contrary to the typical view that they are impulsive and risk prone. The differential left dlPFC activation likely suggests hypersensitivity to loss, contributing to conservative decision-making at large, and extreme choices such as suicide when value estimations are compromised and emotionally overwhelmed. The interactive interpretation places a renewed focus on psychological pain avoidance as a robust motivator for suicidal behavior.