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Cherry JC, Fitzpatrick EA, Sandila NK, Lovas D, Hurley KF. Non-suicidal self-injury at a Canadian paediatric emergency department. CAN J EMERG MED 2024; 26:259-265. [PMID: 38565769 DOI: 10.1007/s43678-024-00657-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Accepted: 01/24/2024] [Indexed: 04/04/2024]
Abstract
OBJECTIVE Our primary objective was to determine agreement between non-suicidal self-injury recorded at triage and during subsequent mental health assessment. The secondary objective was to describe patients who reported non-suicidal self-injury. METHODS This is a health records review of patients aged 12-18 years who had an Emergency Mental Health Triage form on their health record from an ED visit June 1, 2017-May 31, 2018. We excluded patients with diagnoses of autism spectrum disorder or schizophrenia. We abstracted data from the Mental Health Triage form, Emergency Mental Health and Addictions Service Assessment forms and Assessment of Suicide and Risk Inventory. We calculated Cohen's Kappa coefficient, sensitivity, and negative predictive value to describe the extent to which the forms agreed and the performance of triage for identifying non-suicidal self-injury. We compared the cohort who reported non-suicidal self-injury with those who did not, using t-tests, Wilcoxon rank-sum tests, and chi-square tests. RESULTS We screened 955 ED visits and included 914 ED visits where 558 (58.4%) reported a history of non-suicidal self-injury. There were significantly more females in the group reporting non-suicidal self-injury (82.1%, n = 458) compared to the group not reporting non-suicidal self-injury (45.8%, n = 163). Patients reporting non-suicidal self-injury did so in triage and detailed Mental Health Assessment 64.7% of the time (Cohen's Kappa Coefficient 0.6); triage had sensitivity of 71.5% (95% CI 67.3-75.4) and negative predictive value of 71.2% (95% CI 68.2-74.0). Cutting was the most common method of non-suicidal self-injury (80.3%). CONCLUSION Screening at triage was moderately effective in identifying non-suicidal self-injury compared to a detailed assessment by a specialised mental health team. More than half of children and adolescents with a mental health-related concern in our ED reported a history of non-suicidal self-injury, most of which were female. This symptom is important for delineating patients' coping strategies.
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Affiliation(s)
- Jonathan C Cherry
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada.
| | - Eleanor A Fitzpatrick
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
| | | | - David Lovas
- Department of Psychiatry, IWK Health, Dalhousie University, Halifax, NS, Canada
| | - Katrina F Hurley
- Division of Pediatric Emergency Medicine, IWK Health Emergency Department, Dalhousie University, Halifax, NS, Canada
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Hedna K, Jonson M, Sigström R, Åberg M, Wilhelmson K, Waern M. Healthcare visits for mental disorders and use of psychotropic medications before and after self-harm in a cohort aged 75. Aging Ment Health 2023; 27:2052-2060. [PMID: 36803189 DOI: 10.1080/13607863.2023.2179974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/05/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Non-fatal self-harm (SH) is a major risk factor for late-life suicide. A better knowledge of the clinical management of older adults who self-harm is needed to establish where improvements could be made for the implementation of effective suicide prevention interventions. We therefore assessed contacts with primary and specialised care for mental disorders and psychotropic drug use during the year before and after a late-life non-fatal SH episode. METHOD Longitudinal population-based study in adults aged ≥75 years with SH episode between 2007 and 2015 retrieved from the regional database VEGA. Healthcare contacts for mental disorders and psychotropic use were assessed during the year before and after the index SH episode. RESULTS There were 659 older adults who self-harmed. During the year before SH, 33.7% had primary care contacts with a mental disorder, 27.8% had such contacts in specialised care. Use of specialised care increased sharply after the SH, reaching a maximum of 68.9%, but this figure dropped to 19.5% by the end of the year. Use of antidepressants increased from 41% before to 60% after the SH episode. Use of hypnotics was extensive before and after SH (60%). Psychotherapy was rare in both primary and specialised care. CONCLUSION The use of specialised care for mental disorders and antidepressant prescribing increased after SH. The drop in long-term healthcare visits should be further explored to align primary and specialised healthcare to the needs of older adults who self-harmed. The psychosocial support of older adults with common mental disorders needs to be strengthened.
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Affiliation(s)
- Khedidja Hedna
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Statistikkonsulterna AB, Gothenburg, Sweden
| | - Mattias Jonson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Affective Clinic, Gothenburg, Sweden
| | - Robert Sigström
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Department of Cognition and Old Age Psychiatry, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Maria Åberg
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Regionhälsan, Gothenburg, Sweden
| | - Katarina Wilhelmson
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Acute Medicine and Geriatrics, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Margda Waern
- AgeCap Center, Department of Psychiatry and Neurochemistry, Gothenburg University, Gothenburg, Sweden
- Neuropsychiatric Epidemiology Unit, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Sahlgrenska University Hospital, Psychosis Clinic, Gothenburg, Sweden
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Jakobsen SG, Nielsen T, Larsen CP, Andersen PT, Lauritsen J, Stenager E, Christiansen E. Definitions and incidence rates of self-harm and suicide attempts in Europe: A scoping review. J Psychiatr Res 2023; 164:28-36. [PMID: 37311401 DOI: 10.1016/j.jpsychires.2023.05.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 05/02/2023] [Accepted: 05/18/2023] [Indexed: 06/15/2023]
Abstract
INTRODUCTION European countries use various terminologies for self-harm and attempted suicide, which are sometimes used interchangeably. This complicates cross-country comparisons of incidence rates. This scoping review aimed to examine the definitions used and the possibilities to identify and compare incidence rates of self-harm and attempted suicide in Europe. METHODS A literature search was conducted in Embase, Medline and PsycINFO for studies published from 1990 to 2021, followed by grey literature searches. Data were collected for total populations originating from health care institutions or registries. Results were presented in tabular form supplemented by a qualitative summary by area. RESULTS A total of 3160 articles were screened, resulting in 43 studies included from databases and further 29 studies from other sources. Most studies used the term 'suicide attempt' rather than 'self-harm' and reported person-based rates with annual incidence rates from age 15+. None of the rates were considered comparable due to different reporting traditions related to classification codes and statistical approaches. CONCLUSION The present extensive literature on self-harm and attempted suicide cannot be used to compare findings between countries because of the high degree of heterogeneity among studies. International agreement on definitions and registration practices is needed to improve knowledge and understanding of suicidal behaviour.
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Affiliation(s)
- Sarah Grube Jakobsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark.
| | - Torben Nielsen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Christina Petrea Larsen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
| | - Pernille Tanggaard Andersen
- Unit for Health Promotion Research, Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Jens Lauritsen
- Accident Analysis Group, Department of Orthopaedic Surgery and Traumatology, Odense University Hospital & Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Elsebeth Stenager
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Erik Christiansen
- Research Unit of Mental Health, Children and Adult, Aabenraa, Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Centre for Suicide Research, Odense, Denmark
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Newell V, Phillips L, Jones C, Townsend E, Richards C, Cassidy S. A systematic review and meta-analysis of suicidality in autistic and possibly autistic people without co-occurring intellectual disability. Mol Autism 2023; 14:12. [PMID: 36922899 PMCID: PMC10018918 DOI: 10.1186/s13229-023-00544-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/27/2023] [Indexed: 03/17/2023] Open
Abstract
BACKGROUND Suicidality is highly prevalent in autistic people without co-occurring intellectual disabilities, and high autistic traits are found in adults who have attempted suicide. However, prevalence rates for both autistic and possibly autistic people have not been synthesised meta-analytically. AIMS To (1) calculate pooled prevalence estimates of suicidality in autistic people and possibly autistic people without co-occurring intellectual disability; (2) evaluate the influence of participant and study level characteristics on heterogeneity; and (3) determine the quality of evidence. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed. PsycINFO, Embase, MEDLINE and Web of Science were systematically searched from 1992 to January 25, 2022. Empirical quantitative studies reporting prevalence of suicidal ideation, suicide plans, or suicide attempts and behaviours were considered for inclusion. Random effects models were used to estimate pooled prevalence of each suicidality outcome with 95% confidence intervals. Heterogeneity was explored using sensitivity and moderator analyses. RESULTS Data from 48,186 autistic and possibly autistic participants in 36 primary studies were meta-analysed. Pooled prevalence of suicidal ideation was 34.2% (95% CI 27.9-40.5), suicide plans 21.9% (13.4-30.4), and suicidal attempts and behaviours 24.3% (18.9-29.6). High levels of heterogeneity (I2 > 75) were observed in all three analyses. Estimates did not differ between autistic or possibly autistic samples. Geographical location (p = 0.005), transgender or gender non-conforming samples (p < 0.001) and type of report (p < 0.001) significantly moderated suicidal ideation, whereas age group (p = 0.001) and measure of suicidality (p = 0.001) significantly moderated suicide plans. There was a significant association between the proportion of male participants and prevalence of suicide plans, with a decrease in the proportion of males for every unit change of suicide plan prevalence (p = 0.013). No variables were found to moderate estimates of suicide attempts and behaviours. CONCLUSIONS The results confirm suicidality is highly prevalent in both autistic and possibly autistic people without co-occurring intellectual disability and highlights potential moderators. Possibly autistic individuals require more attention in clinical and research considerations going forward to further understand and prevent suicide in both groups.
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Affiliation(s)
- Victoria Newell
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK.
| | - Lucy Phillips
- School of Sport, Exercise and Health Sciences, Loughborough University, Epinal Way, Loughborough, LE11 3TU, UK
| | - Chris Jones
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Ellen Townsend
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road, Birmingham, B15 2TT, UK
| | - Sarah Cassidy
- School of Psychology, University of Nottingham, University Park, Nottingham, NG7 2RD, UK
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Thomas AT, Waite J, Williams CA, Kirk J, Oliver C, Richards C. Phenotypic characteristics and variability in CHARGE syndrome: a PRISMA compliant systematic review and meta-analysis. J Neurodev Disord 2022; 14:49. [PMID: 36045324 PMCID: PMC9429597 DOI: 10.1186/s11689-022-09459-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 08/15/2022] [Indexed: 12/01/2022] Open
Abstract
Background CHARGE syndrome (OMIM #214800) is a phenotypically complex genetic condition characterised by multi-system, multi-sensory impairments. Behavioural, psychological, cognitive and sleep difficulties are not well delineated and are likely associated with biopsychosocial factors. Methods This meta-analysis investigated the prevalence of clinical features, physical characteristics and conditions, behavioural, psychological, cognitive and sleep characteristics in CHARGE syndrome, and statistically evaluated directional associations between these characteristics. Pooled prevalence estimates were calculated using reliable, prespecified quality weighting criteria, and meta-regression was conducted to identify associations between characteristics. Results Of the 42 eligible studies, data could be extracted for 1675 participants. Prevalence estimates were highest for developmental delay (84%), intellectual disability (64%), aggressive behaviour (48%), self-injurious behaviour (44%) and sleep difficulties (45%). Meta-regression indicated significant associations between intellectual disability and choanal atresia, intellectual disability and inner ear anomalies, sleep difficulties and growth deficiency, and sleep difficulties and gross motor difficulties. Conclusions Our comprehensive review of clinical features, behavioural, psychological, cognitive and physical characteristics, conditions and comorbidities in CHARGE syndrome provides an empirically based foundation to further research and practice. Supplementary Information The online version contains supplementary material available at 10.1186/s11689-022-09459-5.
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Affiliation(s)
- Andrea T Thomas
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK. .,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.
| | - Jane Waite
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.,Aston University, Birmingham, UK
| | - Caitlin A Williams
- Centre for Educational Development, Appraisal and Research (CEDAR), University of Warwick, Coventry, UK
| | - Jeremy Kirk
- Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.,Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
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Ng-Cordell E, Kolesnik-Taylor A, O'Brien S, Astle D, Scerif G, Baker K. Social and emotional characteristics of girls and young women with DDX3X-associated intellectual disability: a descriptive and comparative study. J Autism Dev Disord 2022:10.1007/s10803-022-05527-w. [PMID: 35536379 PMCID: PMC9087164 DOI: 10.1007/s10803-022-05527-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2022] [Indexed: 11/30/2022]
Abstract
DDX3X variants are a common cause of intellectual disability (ID) in females, and have been associated with autism spectrum disorder and emotional-behavioural difficulties. In this study, we compared phenotypic data for 23 females with DDX3X variants, to 23 females with ID and other genetic diagnoses. We found a wide range of adaptive, social and emotional function within the DDX3X group. Autism characteristics did not differ between DDX3X and comparison groups, while levels of anxiety and self-injurious behaviour (SIB) were significantly higher in the DDX3X group. Within the DDX3X group, adaptive function, autism characteristics, anxiety and SIB scores were positively correlated, with evidence for group-specific associations with SIB. Future work is warranted to explore the multilevel mechanisms contributing to social and emotional development in individuals with DDX3X variants.
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Affiliation(s)
- Elise Ng-Cordell
- Department of Psychology, University of British Columbia, Vancouver, Canada.,MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Anna Kolesnik-Taylor
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sinéad O'Brien
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Duncan Astle
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom
| | - Gaia Scerif
- Department of Experimental Psychology, University of Oxford, Oxford, United Kingdom
| | - Kate Baker
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge, United Kingdom. .,Department of Medical Genetics, University of Cambridge, Cambridge, United Kingdom.
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Bourlond F, Velter C, Lipsker D. Penile edema following self-injection: A report on two cases. Ann Dermatol Venereol 2021; 148:55-56. [PMID: 33461794 DOI: 10.1016/j.annder.2020.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 03/26/2020] [Accepted: 07/16/2020] [Indexed: 11/29/2022]
Affiliation(s)
- F Bourlond
- Clinique dermatologique, HUS, 1, place de l'Hôpital, 67091 Strasbourg, France.
| | - C Velter
- Clinique dermatologique, HUS, 1, place de l'Hôpital, 67091 Strasbourg, France
| | - D Lipsker
- Clinique dermatologique, HUS, 1, place de l'Hôpital, 67091 Strasbourg, France
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Abstract
Self-injurious behaviour is purportedly common in autism, but prevalence rates have not yet been synthesised meta-analytically. In the present study, data from 14,379 participants in thirty-seven papers were analysed to generate a pooled prevalence estimate of self-injury in autism of 42% (confidence intervals 0.38-0.47). Hand-hitting topography was the most common form of self-injury (23%), self-cutting topography the least common (3%). Sub-group analyses revealed no association between study quality, participant intellectual disability or age and overall prevalence rate of self-injury. However, females obtained higher prevalence rates than males (p = .013) and hair pulling and self-scratching were associated with intellectual disability (p = .008 and p = .002, respectively). The results confirm very high rates of self-injury in autism and highlight within group risk-markers.
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Affiliation(s)
- Catherine Steenfeldt-Kristensen
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
- Children's Neurodevelopmental Service, Coventry and Warwickshire Partnership Trust, City of Coventry Health Centre, Paybody Building, 2 Stoney Stanton Road, Coventry, CV1 4FS, UK
| | - Chris A Jones
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
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Juel A, Berring LL, Hybholt L, Erlangsen A, Larsen ER, Buus N. Relatives' experiences of providing care for individuals with suicidal behaviour conceptualized as a moral career: A meta-ethnographic study. Int J Nurs Stud 2020; 113:103793. [PMID: 33161331 DOI: 10.1016/j.ijnurstu.2020.103793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/21/2020] [Accepted: 10/06/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND An increasing number of qualitative research articles have reported on relatives' experiences of providing care for individuals displaying suicidal behaviour. To contribute more fully to theory and practice, these reported experiences must be synthesized. OBJECTIVES To identify original qualitative studies of relatives' experiences of providing care for individuals with non-fatal suicidal behaviour and to systematically review and synthesize this research using a meta-ethnographic approach. DESIGN Systematic review and meta-ethnography. DATA SOURCES Literature searches were undertaken in six bibliographic databases (PubMed, CINAHL, Embase, PsycINFO, Web of Science and Scopus) and limited to peer-reviewed original studies. Eligible studies reported relatives' experiences of providing care for individuals with suicidal behaviour, published in English or a Scandinavian language. REVIEW METHODS One reviewer screened the titles, abstracts and full texts and then collaborated with another reviewer on excluding ineligible studies. A two-step strategy was used while reviewing publications: 1) appraising study quality, and 2) classifying study findings according to degree of data interpretation. This strategy was used for each study by two independent reviewers who subsequently reached a shared decision on inclusion. Noblit and Hare's methodology for translation and synthesis was followed in developing a novel theoretical interpretation of relatives' experiences. The concept of moral career was adopted in producing this synthesis. RESULTS Of 7,334 publications screened, 12 studies were eligible for inclusion. The synthesis conveyed relatives' moral career as comprising four stages, each depicting relatives' different perspectives on life and felt identities. First, relatives negotiated conventional ideas about normalcy and positioned themselves as living abnormal family lives in the stage from normal to abnormal. The first career movement could be mediated by social interactions with professionals in the stage feeling helpful or feeling unhelpful. For some relatives, this negotiated perspective of abnormality got stuck in an impasse. They did not interact with their surroundings in ways that would enable them to renegotiate these fixed views, and this stage was named stuck in abnormality. For other relatives, career movement took place as relatives re-positioned themselves as negotiating an alternative perspective of normalcy in the stage from abnormal to normal. CONCLUSIONS Interactions with other people facing similar difficulties enabled relatives to shift perspectives and alleviated experiences of distress.
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Affiliation(s)
- A Juel
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark; Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup, Copenhagen 2900, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark.
| | - L L Berring
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark; Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark.
| | - L Hybholt
- Center for Relationships and De-escalation, Psychiatry Region Zealand, Fælledvej 6, 1, Slagelse 4200, Denmark.
| | - A Erlangsen
- Danish Research Institute for Suicide Prevention, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup, Copenhagen 2900, Denmark; Department of mental health, Johns Hopkins Bloomberg School of Public Health, 624N. Broadway, S850, Baltimore, MD 21205, United States; Center of Mental Health Research, The Australian National University, Building 63, Canberra ACT 2601, Australia; Copenhagen Research Center for Mental Health, Mental Health Centre Copenhagen, Gentofte Hospitalsvej 15, 4, Hellerup 2900, Denmark.
| | - E R Larsen
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark; Mental Health Department Odense, University Clinic, Mental Health Service, J. B. Winsløws Vej 18, Odense 5000, Denmark.
| | - N Buus
- Department of Regional Health Research, University of Southern Denmark, J.B. Winsløws Vej 19, Odense 5000, Denmark; Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, 88 Mallett St, Camperdown, NSW 2050, Australia; The Centre for Family-Based Mental Health Care, St. Vincent's Private Hospital. 390 Victoria St, Darlinghurst, NSW 2010, Australia; St. Vincent's Hospital Sydney, 390 Victoria St., Darlinghurst, NSW 2010, Australia.
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Bull LE, Oliver C, Woodcock KA. Skin Picking in People with Prader-Willi Syndrome: Phenomenology and Management. J Autism Dev Disord 2021; 51:286-97. [PMID: 32495267 DOI: 10.1007/s10803-020-04504-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Skin picking is highly prevalent in people with Prader-Willi syndrome (PWS). This study addressed the temporal (frequency, duration) and wider characteristics (e.g. type of skin picked, apparent motivations, or management strategies) of skin picking to inform intervention strategies. Nineteen parents/carers who observe skin picking shown by the person they care for completed a semi-structured interview. Results were consistent with previous research but advanced the field by finding that most participants picked skin with an imperfection and that parents/carers most commonly use distraction as a management strategy. Interventions that are behavioural, support emotion regulation and/ or are used in the typically developing population are therefore likely to be beneficial for future research.
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Ulloa Flores RE, Mayer Villa PA, de la Peña Olvera F, Palacios Cruz L, Victoria Figueroa G. DSM-5 Non-Suicidal Self-Injury Criteria in a Clinical Sample of Self-Harming Mexican Adolescents. Rev Colomb Psiquiatr (Engl Ed) 2020; 49:39-43. [PMID: 32081207 DOI: 10.1016/j.rcp.2018.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 04/26/2018] [Accepted: 04/27/2018] [Indexed: 11/15/2022]
Abstract
INTRODUCTION The DSM-5 diagnostic criteria for non-suicidal self-injury (NSSI) needs to be validated in non-European populations. The aims of this study were to determine how common NSSI was in a sample of self-harming Mexican adolescents and examine the associated variables. METHODS We examined the medical records of 585 adolescents with a history of self-injurious behaviour who attended a public hospital in Mexico City from 2005 to 2012. A group of experts established the diagnosis according to the DSM-5. The clinical and demographic characteristics of patients with and without NSSI were compared. RESULTS NSSI was diagnosed in 351 patients (60%) with evidence of self-harm. The main reasons for not being diagnosed were a previous suicide attempt (criterion A, 158 subjects [26.87%]) and another diagnosis that better explained the self-injurious behaviour (criterion F, 60 subjects [10.25%]). The NSSI group had a higher proportion of males (26.5% vs 16.2%) and patients with behavioural disorders (28.5% vs 13.7%). These patients were also found to seek psychiatric support in relation to their self-harm more frequently (31.9% vs 14.1%). The associated clinical characteristics included behavioural disorder (OR=2.51; 95% CI, 1.62-3.90), personality disorders (OR=0.56; 95% CI, 0.33-0.97), hospital admission (OR=0.23; 95% CI, 0.16-0.33), depressive symptoms (OR=0.60; 95% CI, 0.42-0.85), anxiety symptoms (OR=2.08; 95% CI, 1.31-3.31) and self-harming to influence others (OR=2.19; 95% CI, 1.54-3.11). CONCLUSIONS More than half of the adolescents in the clinical sample with self-injury met DSM-5 criteria for NSSI. There are clinical and demographic characteristics which may be associated with this diagnosis.
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Affiliation(s)
- Rosa Elena Ulloa Flores
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México.
| | - Pablo Adolfo Mayer Villa
- División de Investigación, Hospital Psiquiátrico Infantil Dr. Juan N. Navarro, Ciudad de México, México
| | | | - Lino Palacios Cruz
- Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Ciudad de México, México
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Ohlis A, Bjureberg J, Lichtenstein P, D'Onofrio BM, Fruzzetti AE, Cederlöf M, Hellner C. Comparison of suicide risk and other outcomes among boys and girls who self-harm. Eur Child Adolesc Psychiatry 2020; 29:1741-1746. [PMID: 32056009 PMCID: PMC7641927 DOI: 10.1007/s00787-020-01490-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 02/02/2020] [Indexed: 11/25/2022]
Abstract
Little is known about sex differences in outcomes of self-harm, and there are inconclusive results concerning the association between sex, self-harm, and suicide attempts. The aim of this study was to explore sex differences in outcomes of self-harm in adolescence. In this cohort study, all individuals (0-17 years) enrolled at the child- and adolescent mental health services (CAMHS) in Stockholm between 2001 and 2015 (N = 110,072) were followed in national registers from their last contact with the CAMHS, until end of 2015. Exposure was self-harm as reason for contact, outcome measures were: alcohol-/substance use disorder, psychiatric hospitalization, non-violent or violent crime, and suicide. Differences in outcomes rates between exposed versus unexposed males, and exposed versus unexposed females, were examined using Cox regressions, expressed as hazard ratios (HR) with 95% confidence intervals (CI). Median follow-up time was 5.8 years (Q1: 2.3 years; Q3: 9.7 years). Self-harm was documented in 2.2% (N = 1241) males and 8.7% (4716) females. Exposed individuals had higher HR for all outcomes as compared with unexposed individuals of their own sex. Exposed females had more pronounced risk for drug use disorder (HR 11.2; 95% CI 9.9-12.7) compared with exposed males (HR 6.5, 95% 5.2-8.0). Both males and females who had engaged in self-harm had elevated risks for future suicide. Adjusting for socio-economic status and age at start of follow-up only marginally affected the associations. Females and males with self-harm had similarly elevated risk for suicide, and self-harm was also an important risk marker for other adverse outcomes within both sexes.
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Affiliation(s)
- Anna Ohlis
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
| | - Johan Bjureberg
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brian M D'Onofrio
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- Department of Psychological and Brain Sciences, Indiana University, Bloomington, IN, USA
| | - Alan E Fruzzetti
- Department of Psychiatry, Harvard Medical School, Boston, MA, USA
| | - Martin Cederlöf
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Clara Hellner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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13
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Hielscher E, Connell M, Lawrence D, Zubrick SR, Hafekost J, Scott JG. Association between psychotic experiences and non-accidental self-injury: results from a nationally representative survey of adolescents. Soc Psychiatry Psychiatr Epidemiol 2019; 54:321-330. [PMID: 30478528 DOI: 10.1007/s00127-018-1629-4] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
PURPOSE The association between psychotic experiences (PEs) and non-accidental self-injury (NASI; including self-harm and suicide attempts) is well established, although variables influencing this relationship have not been comprehensively examined. This study aimed to investigate (1) the cross-sectional PE-NASI association before and after adjustment for confounders, and (2) the individual contribution of each confounding and potentially mediating variable to the association. METHODS A random sample of Australian adolescents aged 14-17 years (n = 1998) completed self-report questions regarding any self-harm, suicidality or PEs experienced in the past 12 months in 2013-2014 as part of the Young Minds Matter Survey, a national household survey. We conducted logistic regression analyses to investigate the association between NASI and PEs, after controlling for confounders (sociodemographics, substance use, and parental mental illness) as well as the influence of potential mediators (major depression, bullying, psychological distress, sleep, self-esteem, disordered eating behaviour, social isolation, and intervention factors). RESULTS Except for special messages, all PE subtypes (auditory and visual hallucinatory experiences [HEs], and two of the three delusional experiences [DEs]) were associated with NASI after adjustment for confounders (OR range: 2.60-5.21). Depression and psychological distress significantly influenced all PE-NASI associations, where depression appeared to fully explain the DE-NASI association, and partially attenuate the HE-NASI association. Variables such as parental mental illness, disordered eating behaviour, and social isolation had negligible effects in nearly all self-harm and attempted suicide models. CONCLUSIONS Adolescents reporting any PE in the past 12 months reported increased likelihood of NASI in the same time period and, auditory HEs in particular, were strongly and independently associated with self-harm and suicide attempts. These results highlight the importance of PEs as indicators of risk of self-injurious behaviour among Australian youth.
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Affiliation(s)
- Emily Hielscher
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia. .,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia. .,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.
| | - Melissa Connell
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, West Perth, WA, Australia.,Centre for Child Health Research, The University of Western Australia, Perth, WA, Australia
| | - Jennifer Hafekost
- Graduate School of Education, The University of Western Australia, Perth, WA, Australia
| | - James G Scott
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Queensland Centre for Mental Health Research (QCMHR), The Park Centre for Mental Health, Brisbane, QLD, Australia.,Metro North Mental Health, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
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14
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Qin P, Sun S, Bøe AS, Stanley B, Mehlum L. Injuries prior and subsequent to index poisoning with medication among adolescents: a national study based on Norwegian patient registry. BMC Psychiatry 2018; 18:200. [PMID: 29914430 PMCID: PMC6006963 DOI: 10.1186/s12888-018-1778-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Accepted: 06/07/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Adolescents treated for self-poisoning with medication have a high prevalence of mental health problems and constitute a high-risk population for self-harm repetition. However, little is known about whether this population is also prone to injuries of other forms. METHODS Data were extracted from the Norwegian Patient Registry to include all incidents of treated injuries in adolescents aged 10-19 years who were treated for self-poisoning with medication during 2008-2011. This longitudinal approach allowed for the inclusion of injuries of various forms both before and after the index poisoning with medication. Gender differences and associations of injuries with recorded deliberate self-harm or psychiatric comorbidity at index poisoning were analysed. Forms of injury and psychiatric illnesses were coded according to the ICD-10 system. RESULTS 1497 adolescents treated for self-poisoning with medication were identified from the source database, including 1144 (76.4%) girls and 353 (23.6%) boys. For these 1497 adolescents a total of 2545 injury incidents were recorded in addition to the index poisoning incidents, consisting of 778 injury incidents taking place before the index poisoning and 1767 incidents taking place subsequently. Altogether 830 subjects (55.4%) had an injury treated either before or after the index poisoning. Injuries to the hand and wrist as well as injuries to the head, neck and throat were predominant in males. Females were more likely to repeat poisoning with medication, particularly those with psychiatric disorders. CONCLUSION Adolescents treated for poisoning with medication represent a high-risk population prone to both prior and subsequent injuries of other forms, and should be assessed for suicidal intent and psychiatric illness.
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Affiliation(s)
- Ping Qin
- National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372, Oslo, Norway.
| | - Shihua Sun
- 0000 0004 1761 1174grid.27255.37Department of Epidemiology, Shandong University School of Public Health and Shandong University Center for Suicide Prevention Research, Jinan, China
| | - Anne Seljenes Bøe
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
| | - Barbara Stanley
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway ,0000000419368729grid.21729.3fDepartment of Psychiatry, Columbia University College of Physicians and Surgeons, New York, NY USA
| | - Lars Mehlum
- 0000 0004 1936 8921grid.5510.1National Centre for Suicide Research and Prevention, Institute of Clinical medicine, University of Oslo, Sognsvannsveien 21, N-0372 Oslo, Norway
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15
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Perera J, Wand T, Bein KJ, Chalkley D, Ivers R, Steinbeck KS, Shields R, Dinh MM. Presentations to NSW emergency departments with self-harm, suicidal ideation, or intentional poisoning, 2010-2014. Med J Aust 2018; 208:348-353. [PMID: 29669496 DOI: 10.5694/mja17.00589] [Citation(s) in RCA: 94] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2017] [Accepted: 01/09/2018] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To evaluate population trends in presentations for mental health problems presenting to emergency departments (EDs) in New South Wales during 2010-2014, particularly patients presenting with suicidal ideation, self-harm, or intentional poisoning. DESIGN, SETTING AND PARTICIPANTS This was a retrospective, descriptive analysis of linked Emergency Department Data Collection registry data for presentations to NSW public hospital EDs over five calendar years, 2010-2014. Patients were included if they had presented to an ED and a mental health-related diagnosis was recorded as the principal diagnosis. MAIN OUTCOME MEASURES Rates of mental health-related presentations to EDs by age group and calendar year, both overall and for the subgroups of self-harm, suicidal ideation and behaviour, and intentional poisoning presentations. RESULTS 331 493 mental health-related presentations to 115 NSW EDs during 2010-2014 were analysed. The presentation rate was highest for 15-19-year-old patients (2014: 2167 per 100 000 population), but had grown most rapidly for 10-14-year-old children (13.8% per year). The combined number of presentations for suicidal ideation, self-harm, or intentional poisoning increased in all age groups, other than those aged 0-9 years; the greatest increase was for the 10-19-year-old age group (27% per year). CONCLUSIONS The rate of mental health presentations to EDs increased significantly in NSW between 2010 and 2014, particularly presentations by adolescents. Urgent action is needed to provide better access to adolescent mental health services in the community and to enhance ED models of mental health care. The underlying drivers of this trend should be investigated to improve mental health care.
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Affiliation(s)
| | | | | | | | | | | | | | - Michael M Dinh
- Sydney Medical School, University of Sydney, Sydney, NSW
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16
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Tanimoto S, Yayama S, Suto S, Matoba K, Kajiwara T, Inoue M, Endo Y, Yamakawa M, Makimoto K. Self-harm and Suicide Attempts in a Japanese Psychiatric Hospital. East Asian Arch Psychiatry 2018; 28:23-27. [PMID: 29576553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Self-harm and attempted suicide are risk factors for suicide in psychiatric hospital in-patients. This study aimed to analyse the circumstances of self-harm and suicide attempts in a Japanese psychiatric hospital so as to improve management and care. METHODS Incident reports of self-harm and suicide attempts during a 12.4-year period from November 2000 to March 2013 were reviewed. A descriptive analysis was conducted in terms of age, sex, and diagnosis of patients, as well as level, ward, situations, and causes of incidents. RESULTS During the study period, 90 cases of self-harm and attempted suicide involving 58 patients were reported. The rate of self-harm and suicide attempts was 0.05 per 1000 patient-days. The types of selfharm and suicide attempts included hanging (n = 25), wrist cutting (n = 19), ingestion of foreign objects (n = 17), and others (n = 29). The single case of completed suicide involved hanging, in a patient with schizophrenia. Among 55 patients with relevant data, the most common clinical diagnosis was mood disorder (41.8%), followed by schizophrenia (36.4%). Mood disorder was 3.5 times as prevalent in females as in males (14 vs. 4). Fourteen patients with mood disorder (n = 8) or schizophrenia (n = 6) were repeatedly involved in 46 of 89 cases of self-harm or attempted suicide; 11 were female. One woman with mood disorder attempted suicide 9 times within the same year. The top 3 management and care factors related to self-harm and suicide attempts were failure to adhere to preventive procedures (28%), insufficient therapeutic communication (28%), and difficulty in predicting suicide (20%). CONCLUSION Self-harm and suicide attempts at this psychiatric hospital occurred at a rate of 0.05 per 1000 patient-days between late 2000 and early 2013. Efforts are needed to increase compliance with suicide prevention procedures and therapeutic communication, so as to improve management and care of psychiatric in-patients and prevent them from committing suicide.
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Affiliation(s)
- S Tanimoto
- Department of Nursing, Ishikawa Prefectural Nursing University, Ishikawa, Japan
| | - S Yayama
- Department of Nursing, Kyoto Gakuen University, Kyoto, Japan
| | - S Suto
- Department of Community Medicine, Nara Medical University, Nara, Japan
| | - K Matoba
- Department of Nursing, Osaka Aoyama University, Osaka, Japan
| | - T Kajiwara
- Department of Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - M Inoue
- School of Human Services and Social Work, Griffith University, Queensland, Australia
| | - Y Endo
- Department of Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - M Yamakawa
- Department of Nursing, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - K Makimoto
- School of Nursing of Rehabilitation, Konan Women's University, Hyogo, Japan
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17
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Smithuis L, Kool-Goudzwaard N, de Man-van Ginkel JM, van Os-Medendorp H, Berends T, Dingemans A, Claes L, van Elburg AA, van Meijel B. Self-injurious behaviour in patients with anorexia nervosa: a quantitative study. J Eat Disord 2018; 6:26. [PMID: 30305903 PMCID: PMC6169009 DOI: 10.1186/s40337-018-0214-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 08/29/2018] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Many patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136). METHODS A cross-sectional design using a self-report questionnaire. Mann-Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests. RESULTS Our results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in "feeling relieved" and a significant decrease in "feeling angry at myself", "feeling anxious" and "feeling angry at others". This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts. CONCLUSIONS Professionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.
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Affiliation(s)
- Linda Smithuis
- Parnassia Psychiatric Institute, Rotterdam, The Netherlands.,2Inholland University of Applied Sciences, Amsterdam, The Netherlands
| | - Nienke Kool-Goudzwaard
- 2Inholland University of Applied Sciences, Amsterdam, The Netherlands.,Intensive Treatment Centre, Fivoor, The Hague, The Netherlands
| | - Janneke M de Man-van Ginkel
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands
| | - Harmieke van Os-Medendorp
- Julius Center for Health Sciences and Primary Care, Department of Nursing Science, University Medical Center Utrecht, University Utrecht, Utrecht, The Netherlands.,5Department of Dermatology, University Medical Center Utrecht, Utrecht, the Netherlands.,6Department of Allergology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Tamara Berends
- Altrecht Eating Disorders Rintveld, Zeist, The Netherlands
| | - Alexandra Dingemans
- Rivierduinen Eating disorders Ursula, Rivierduinen, Leiden, The Netherlands.,9Institute of Psychology, Leiden University, Leiden, the Netherlands
| | - Laurence Claes
- 10Faculty of Psychology and Educational Sciences, KU Leuven, Leuven, Belgium.,11Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Annemarie A van Elburg
- Clinical Psychology, Altrecht Eating Disorders Rintveld, Zeist, The Netherlands.,13Faculty of Social Sciences, Utrecht University, Utrecht, The Netherlands
| | - Berno van Meijel
- 14Mental Health Nursing, Inholland University of Applied Sciences, Amsterdam, The Netherlands.,15Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Parnassia Psychiatric Institute, The Hague, The Netherlands.,GGZ-VS, Academy for Masters in Advanced Nursing Practice, Utrecht, The Netherlands
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18
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Sinnaeve R, van den Bosch LMC, Hakkaart-van Roijen L, Vansteelandt K. Effectiveness of step-down versus outpatient dialectical behaviour therapy for patients with severe levels of borderline personality disorder: a pragmatic randomized controlled trial. Borderline Personal Disord Emot Dysregul 2018; 5:12. [PMID: 30002832 PMCID: PMC6040072 DOI: 10.1186/s40479-018-0089-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 06/26/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Step-down dialectical behaviour therapy (DBT) is a treatment consisting of 3 months of residential DBT plus 6 months of outpatient DBT. The program was specifically developed for people suffering from severe borderline personality disorder (BPD). The present study examines the effectiveness and cost-effectiveness of step-down DBT compared to 12 months of regular, outpatient DBT. METHODS Eighty-four participants reporting high levels of BPD-symptoms (mean age 26 years, 95% female) were randomly assigned to step-down versus standard DBT. Measurements were conducted at baseline and after 3, 6, 9 and 12 months. The Lifetime Parasuicide Count and BPD Severity Index (BPDSI) were used to assess suicidal behaviour, non-suicidal self-injury (NSSI) and borderline severity. Costs per Quality Adjusted Life Year (QALY) were calculated using data from the EQ-5D-3L and the Treatment Inventory Cost in Psychiatric Patients (TIC-P). RESULTS In step-down DBT, 95% of patients started the program, compared to 45% of patients in outpatient DBT. The probability of suicidal behaviour did not change significantly over 12 months. The probability of NSSI decreased significantly in step-down DBT, but not in outpatient DBT. BPDSI decreased significantly in both groups, with the improvement leveling off at the end of treatment. While step-down DBT was more effective in increasing quality of life, it also cost significantly more. The extra costs per gained QALY exceeded the €80,000 threshold that is considered acceptable for severely ill patients in the Netherlands. CONCLUSIONS A pragmatic randomized controlled trial in the Netherlands showed that 9 months of step-down DBT is an effective treatment for people suffering from severe levels of BPD. However, step-down DBT is not more effective than 12 months of outpatient DBT, nor is it more cost-effective. These findings should be considered tentative because of high noncompliance with the treatment assignment in outpatient DBT. Furthermore, the long-term effectiveness of step-down DBT, and moderators of treatment response, remain to be evaluated. TRIAL REGISTRATION www.clinicaltrials.govNCT01904227. Registered 22 July 2013 (retrospectively registered).
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Affiliation(s)
- Roland Sinnaeve
- 1GGZ Rivierduinen - Centre for Personality Disorders Jelgersma, Rhijngeesterstraatweg 13-C, 2342 AN Oegstgeest, The Netherlands.,3Z.org KU Leuven, University of Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium
| | - Louisa M C van den Bosch
- 1GGZ Rivierduinen - Centre for Personality Disorders Jelgersma, Rhijngeesterstraatweg 13-C, 2342 AN Oegstgeest, The Netherlands.,Present address: Scelta, Deventerstraat 459, 7323 PT Apeldoorn, The Netherlands
| | - Leona Hakkaart-van Roijen
- 2Erasmus School of Health Policy and Management (ESPHM) and institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Postbus 1738, 3000 DR Rotterdam, The Netherlands
| | - Kristof Vansteelandt
- 3Z.org KU Leuven, University of Leuven, Leuvensesteenweg 517, 3070 Kortenberg, Belgium
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19
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Goodyear-Smith F, Martel R, Darragh M, Warren J, Thabrew H, Clark TC. Screening for risky behaviour and mental health in young people: the YouthCHAT programme. Public Health Rev 2017; 38:20. [PMID: 29450092 PMCID: PMC5810064 DOI: 10.1186/s40985-017-0068-1] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 08/23/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND The prevalence of mental health concerns and risky health behaviours among young people is of global concern. A large proportion of young people in New Zealand (NZ) are affected by depression, suicidal ideation and other mental health concerns, but the majority do not access help. For NZ indigenous Māori, the burden of morbidity and mortality associated with mental health is considerably higher. Targeted screening for risky behaviours and mental health concerns among youth in primary care settings can lead to early detection and intervention for emerging or current mental health and psychosocial issues. Opportunistic screening for youth in primary care settings is not routinely undertaken due to competing time demands, lack of context-specific screening tools and insufficient knowledge about suitable interventions. Strategies are required to improve screening that are acceptable and appropriate for the primary care environment. This article outlines the development, utilisation and ongoing evaluation and implementation strategies for YouthCHAT. YOUTHCHAT YouthCHAT is a rapid, electronic, self-report screening tool that assesses risky health-related behaviours and mental health concerns, with a 'help question' that enables youth to prioritise areas they want help with. The young person can complete YouthCHAT in the waiting room prior to consultation, and after completion, the clinician can immediately access a summary report which includes algorithms for stepped-care interventions using a strength-based approach. A project to scale up the implementation is about to commence, using a co-design participatory research approach to assess acceptability and feasibility with successive roll-out to clinics. In addition, a counter-balanced randomised trial of YouthCHAT versus clinician-administered assessment is underway at a NZ high school. CONCLUSION Opportunistic screening for mental health concerns and other risky health behaviours during adolescence can yield significant health gains and prevent unnecessary morbidity and mortality. The systematic approaches to screening and provision of algorithms for stepped-care intervention will assist in delivering time efficient, early, more comprehensive interventions for youth with mental health concerns and other health compromising behaviours. The early detection of concerns and facilitation to evidence-based interventions has the potential to lead to improved health outcomes, particularly for under-served indigenous populations.
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Affiliation(s)
- Felicity Goodyear-Smith
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, University of Auckland, PB 92019, Auckland, New Zealand
| | - Rhiannon Martel
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, University of Auckland, PB 92019, Auckland, New Zealand
| | - Margot Darragh
- Department of General Practice and Primary Health Care, Faculty of Medical and Health Science, University of Auckland, PB 92019, Auckland, New Zealand
| | - Jim Warren
- Department of Computer Science, Faculty of Science, University of Auckland, PB 92019, Auckland, New Zealand
| | - Hiran Thabrew
- Department of Psychological Medicine, Faculty of Medical and Health Science, University of Auckland, PB 92019, Auckland, New Zealand
| | - Terryann C. Clark
- School of Nursing, Faculty of Medical and Health Science, University of Auckland, PB 92019, Auckland, New Zealand
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20
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Borschmann R, Young JT, Moran P, Spittal MJ, Heffernan E, Mok K, Kinner SA. Ambulance attendances resulting from self-harm after release from prison: a prospective data linkage study. Soc Psychiatry Psychiatr Epidemiol 2017; 52:1295-305. [PMID: 28389689 DOI: 10.1007/s00127-017-1383-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Incarcerated adults are at high risk of self-harm and suicide and remain so after release into the community. The aims of this study were to estimate the number of ambulance attendances due to self-harm in adults following release from prison, and to identify factors predictive of such attendances. METHODS Baseline surveys with 1309 adults within 6 weeks of expected release from prison between 2008 and 2010 were linked prospectively with state-wide correctional, ambulance, emergency department, hospital and death records in Queensland, Australia. Associations between baseline demographic, criminal justice and mental health-related factors, and subsequent ambulance attendances resulting from self-harm, were investigated using negative binomial regression. RESULTS During 4691 person-years of follow-up (median 3.86 years per participant), there were 2892 ambulance attendances in the community, of which 120 (3.9%) were due to self-harm. In multivariable analyses, being Indigenous [incidence rate ratio (IRR): 2.10 (95% CI 1.14-3.86)], having previously been hospitalised for psychiatric treatment [IRR: 2.65 (95% CI 1.44-4.87)], being identified by prison staff as being at risk of self-harm whilst incarcerated [IRR: 2.12 (95% CI 1.11-4.06)] and having a prior ambulance attendance due to self-harm [IRR: 3.16 (95% CI 1.31-7.61)] were associated with self-harm attendances. CONCLUSIONS Ambulance attendances resulting from self-harm following release from prison are common and represent an opportunity for tertiary intervention for self-harm. The high prevalence of such attendances, in conjunction with the strong association with prior psychiatric problems, reinforces the importance of providing appropriate ambulance staff training in the assessment and management of self-harm, and mental health problems more broadly, in this vulnerable population.
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21
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Abstract
Punch injuries are a form of self-harm characterised by the intentional act of striking an object with a closed fist. We aimed to describe the characteristics and trends in young people presenting with injuries sustained via the punch mechanism. A comprehensive retrospective review of medical records was completed of all young people aged 10-18 years presenting to our Central London Emergency Department over a 12-month period. A subset of the total group was identified as the punch injury subgroup. A total of 78 punch injury presentations were identified. In this subgroup, the male:female ratio is 4.57:1; 37.18% of presentations were associated with a fracture ( n = 29) and 35.90% ( n = 28) of patients re-presented following another punch injury, as a victim of violence, or by other psychiatric presentation. In conclusion, a male preponderance was observed, with frequent re-presentations, often in high-risk circumstances. An opportunity for screening, including mental health, social and substance misuse, was identified. Further research is needed to enable targeted effective interventions in this group.
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Affiliation(s)
- Cristal Oxley
- Paediatric Mental Health Team, Department of Paediatrics, Whittington Hospital, UK
| | - Jane E Roberts
- Paediatric Mental Health Team, Department of Paediatrics, Whittington Hospital, UK
| | - Sebastian Kraemer
- Paediatric Mental Health Team, Department of Paediatrics, Whittington Hospital, UK
| | - Giles Armstrong
- Paediatric Mental Health Team, Department of Paediatrics, Whittington Hospital, UK
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22
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Bitsika V, Sharpley CF, Andronicos NM, Agnew LL. What worries parents of a child with Autism? Evidence from a biomarker for chronic stress. Res Dev Disabil 2017; 62:209-217. [PMID: 28202252 DOI: 10.1016/j.ridd.2017.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 01/27/2017] [Accepted: 02/07/2017] [Indexed: 06/06/2023]
Abstract
BACKGROUND Previous studies have reported correlations between various aspects of the behaviour and symptomatology of children with Autism Spectrum Disorder (ASD) and their parents' self-reports of stress via standardised scales. AIMS To extend that literature, a physiological index of parental chronic stress was used instead of their self-reports-dysregulation of the Diurnal Rhythm (DR) of the Hypothalamic-Pituitary-Adrenal (HPA) axis. METHODS A sample of 149 parents of a child with ASD provided salivary cortisol at the predicted time of daily maximum cortisol concentration and at a time of daily lower concentration. Adherence to the predicted DR was assessed via a dichotomous (present/not-present) as well as a continuous measure, and MANOVA and linear regression were used to detect significant associations between ASD-related variables in their children and parents' DR. RESULTS Identified only a single significant correlate of DR dysregulation in both statistical procedures-Self-Injurious Behaviour (SIB) exhibited by their child and observed by the parents. CONCLUSIONS AND IMPLICATIONS These findings extend previous data using self-report indices of parental stress and should be included in parent-support settings to alert parents to the long-term health effects of the stress they experience in regard to their child's SIB.
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Affiliation(s)
- Vicki Bitsika
- Centre for Autism Spectrum Disorders, Bond University, Robina, Queensland 4229, Australia.
| | - Christopher F Sharpley
- Brain-Behaviour Research Group, University of New England, Armidale, 2351, New South Wales, Australia.
| | | | - Linda L Agnew
- Brain-Behaviour Research Group, University of New England, 2351, Australia.
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23
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Borschmann R, Thomas E, Moran P, Carroll M, Heffernan E, Spittal MJ, Sutherland G, Alati R, Kinner SA. Self-harm following release from prison: A prospective data linkage study. Aust N Z J Psychiatry 2017; 51:250-259. [PMID: 27012967 DOI: 10.1177/0004867416640090] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Prisoners are at increased risk of both self-harm and suicide compared with the general population, and the risk of suicide after release from prison is three times greater than for those still incarcerated. However, surprisingly little is known about the incidence of self-harm following release from prison. We aimed to determine the incidence of, identify risk factors for and characterise emergency department presentations resulting from self-harm in adults after release from prison. METHOD Cohort study of 1325 adults interviewed prior to release from prison, linked prospectively with State correctional and emergency department records. Data from all emergency department presentations resulting from self-harm were secondarily coded to characterise these presentations. We used negative binomial regression to identify independent predictors of such presentations. RESULTS During 3192 person-years of follow-up (median 2.6 years per participant), there were 3755 emergency department presentations. In all, 83 (6.4%) participants presented due to self-harm, accounting for 165 (4.4%) presentations. The crude incidence rates of self-harm for males and females were 49.2 (95% confidence interval: [41.2, 58.7]) and 60.5 (95% confidence interval: [44.9, 81.6]) per 1000 person-years, respectively. Presenting due to self-harm was associated with being Indigenous (incidence rate ratio: 2.01; 95% confidence interval: [1.11, 3.62]), having a lifetime history of a mental disorder (incidence rate ratio: 2.13; 95% confidence interval: [1.19, 3.82]), having previously been hospitalised for psychiatric treatment (incidence rate ratio: 2.68; 95% confidence interval: [1.40, 5.14]) and having previously presented due to self-harm (incidence rate ratio: 3.91; 95% confidence interval: [1.85, 8.30]). CONCLUSION Following release from prison, one in 15 ex-prisoners presented to an emergency department due to self-harm, within an average of 2.6 years of release. Demographic and mental health variables help to identify at-risk groups, and such presentations could provide opportunities for suicide prevention in this population. Transition from prison to the community is challenging, particularly for those with a history of mental disorder; mental health support during and after release may reduce the risk of adverse outcomes, including self-harm.
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Affiliation(s)
- Rohan Borschmann
- 1 Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Emma Thomas
- 2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,3 Department of Biostatistics, Harvard T.H. Chan School of Public Health, Harvard University, Cambridge, MA, USA
| | - Paul Moran
- 4 Centre for Academic Mental Health, School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - Megan Carroll
- 2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Ed Heffernan
- 5 Queensland Forensic Mental Health Service, QLD, Australia
| | - Matthew J Spittal
- 2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Georgina Sutherland
- 2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Rosa Alati
- 6 Faculty of Medicine and Biomedical Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Stuart A Kinner
- 1 Centre for Adolescent Health, Murdoch Childrens Research Institute, The Royal Children's Hospital Melbourne, Parkville, VIC, Australia.,2 Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia.,7 Griffith Criminology Institute and Menzies Health Institute Queensland, Griffith University, Mt Gravatt, QLD, Australia.,8 Mater Research Institute, The University of Queensland, Brisbane, QLD, Australia
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24
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Abstract
Adult ingestion of caustic substances is an unusual but serious surgical problem, with injuries likely to be more extensive than those in the corresponding paediatric population. After initial stabilisation and airway management, clinicians are presented with a complex multisystemic problem, frequently requiring a multidisciplinary approach involving several surgical disciplines and associated therapies. A new multidisciplinary team was convened to discuss complex ingestion injury in adults and established techniques were used to bring forward a proposed treatment algorithm. An algorithm may potentially improve clinical efficacy and risk in the management of these complex patients.
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Affiliation(s)
- M Rollin
- University College London Hospitals NHS Foundation Trust , UK
| | - A Jaulim
- University College London Hospitals NHS Foundation Trust , UK
| | - F Vaz
- University College London Hospitals NHS Foundation Trust , UK
| | - G Sandhu
- Imperial College Healthcare NHS Trust , UK
| | - S Wood
- Imperial College Healthcare NHS Trust , UK
| | - M Birchall
- University College London Hospitals NHS Foundation Trust , UK
| | - K Dawas
- University College London Hospitals NHS Foundation Trust , UK
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25
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Gormez A, Rana F, Varghese S. Pharmacological interventions for self-injurious behaviour in adults with intellectual disabilities: Abridged republication of a Cochrane systematic review. J Psychopharmacol 2014; 28:624-32. [PMID: 24785762 DOI: 10.1177/0269881114531665] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
We aimed to determine clinical effectiveness of pharmacological interventions for self-injurious behaviour in adults with intellectual disability. We searched the following databases: CENTRAL; MEDLINE; EMBASE; PsycINFO; CINAHL; SCI; SSCI; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Science and Humanities; ZETOC; World Cat .We also searched ClinicalTrials.gov,ICTRP and the reference lists of included trials. We included randomised controlled trials that examined drug interventions versus placebo for self-injurious behaviour. We found five double-blind, placebo-controlled trials, which included a total of 50 people. Four trials compared the effects of naltrexone versus placebo and one trial clomipramine versus placebo. We did not identify any relevant placebo-controlled trials for other drugs. We presented a narrative summary, as meta-analysis was not appropriate due to differences in study designs, differences between interventions and heterogeneous outcome measures. There was weak evidence in included trials that any active drug was more effective than placebo for people with intellectual disability demonstrating self-injurious behaviour. Due to sparse data, an absence of power and statistical significance, and high risk of bias for four of the included trials, we are unable to reach any definite conclusions about the relative benefits of naltrexone or clomipramine compared to placebo.
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Affiliation(s)
- A Gormez
- Southern Health NHS Foundation Trust, Psychiatry of Intellectual Disability, Oxford, UK
| | - F Rana
- Southern Health NHS Foundation Trust, Psychiatry of Intellectual Disability, Oxford, UK
| | - S Varghese
- Black Country Partnership NHS Foundation Trust, Psychiatry of Intellectual Disability, Wolverhampton, UK
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26
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Abstract
Surgeons frequently treat the consequences of self-harm. Self-harm is a common problem and presentations to Irish hospitals are increasing. It increases the risk of suicide and is associated with long term morbidity. Appropriate management can improve the prognosis. Surgeons require a number of skills to appropriately manage patients who self-harm. In this review we outline those skills including diagnosis, communication, capacity and risk assessment.
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Affiliation(s)
- James C Kinahan
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland.
| | - Siobhan MacHale
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin 9, Ireland; Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin 9, Ireland
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27
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Deb S, Farmah BK, Arshad E, Deb T, Roy M, Unwin GL. The effectiveness of aripiprazole in the management of problem behaviour in people with intellectual disabilities, developmental disabilities and/or autistic spectrum disorder--a systematic review. Res Dev Disabil 2014; 35:711-725. [PMID: 24405794 DOI: 10.1016/j.ridd.2013.12.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 12/10/2013] [Indexed: 06/03/2023]
Abstract
The management of problem behaviours (PB) in individuals with intellectual disabilities (ID), developmental disabilities (DD) and/or autistic spectrum disorders (ASD) can be challenging. Antipsychotic medications are commonly prescribed where other strategies have failed. A systematic review (SR) was conducted to establish the research evidence for the efficacy of aripiprazole in the management of PB in adults and children with ID, DD and/or ASD. Although included studies supported the efficacy of aripiprazole for this indication, the overall quality of studies was poor. Of the 20 studies included in this systematic review there were only two randomised controlled trials (RCTs) on children with ASD and/or ID/DD, both of which were conducted by the pharmaceutical company that manufactures aripiprazole, and it is not clear whether a number of same participants were included in both RCTs. One of the RCTs was extended into an open label long term follow up, which showed that aripiprazole's efficacy lasted over 52 weeks and the adverse effects were tolerable. Four studies were open label prospective studies, 11 were retrospective case reports which included four single case reports, and two were prospective case series. Most studies reported adverse effects from aripiprazole in the form of weight gain, increased appetite, sedation, tiredness, drooling and tremor. However, aripiprazole improved serum prolactin level in some participants and overall did not show any adverse effect on QTc interval. There is a need for more carefully designed RCTs into the use of aripiprazole in the management of PB in people with ID/DD and/or ASD, which should be carried out independent of pharmaceutical companies.
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Affiliation(s)
| | | | | | | | - Meera Roy
- Birmingham Community Healthcare NHS Trust, UK.
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28
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Ward F, Tharian P, Roy M, Deb S, Unwin GL. Efficacy of beta blockers in the management of problem behaviours in people with intellectual disabilities: a systematic review. Res Dev Disabil 2013; 34:4293-4303. [PMID: 24171827 DOI: 10.1016/j.ridd.2013.08.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2013] [Accepted: 08/15/2013] [Indexed: 06/02/2023]
Abstract
Both medication and non-medication based strategies are used in the management of problem behaviours in individuals with intellectual disabilities. Beta-adrenoceptor blocking medications are one group of drugs used for this purpose. However, despite its regular use, the evidence for the efficacy of these drugs for in this context is lacking. A systematic review was conducted to establish the research evidence for the efficacy of beta blockers in problem behaviours in adults and children with intellectual disabilities. Although the research identified supported the efficacy of beta blockers for this indication the overall quality of studies identified was poor and no randomised controlled trials were identified. There is a need for more robust research into the use of beta blockers for people with intellectual disabilities who show problem behaviours.
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Affiliation(s)
- Frances Ward
- Southern Health NHS Foundation Trust, United Kingdom.
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29
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Abel WD, Bourne PA, Hamil HK, Thompson EM, Martin JS, Gibson RC, Hickling FW. A public health and suicide risk in Jamaica from 2002 to 2006. N Am J Med Sci 2009; 1:142-7. [PMID: 22666687 PMCID: PMC3364645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Globally, suicide is the third leading cause of mortality among persons aged 15-44 years. However in Jamaica it is not among the leading cause of mortality; but its importance cannot be ignored because of this fact. AIMS This study seeks to 1) update the prevalence of suicide in Jamaica, 2) make comparisons with international data, 3) provide an understanding of age-sex composition of those who are committing suicides, and 4) provide public health practitioners with valuable information which will be used to inform policy decisions. MATERIALS AND METHODS Secondary data published by the Jamaica Constabulary Force was used for this study. Data were summarized using percentages and associations were examined by Kruskal-Wallis or Analysis of Variance. RESULTS The suicide rate averaged 2.26 per 100,000 over the last six years. In 2006, the suicide rate for males was 9 times higher than that of females. The group of 65-74 age, among the male population, recorded the highest suicide rate (11.3 per 100,000) and the 5-14 age group recorded the lowest (0.3 per 100,000). The highest rate for the female population (3.4 per 100,000) was recorded in the 65-74 age group. The 30-39 age group showed an overall higher rate of suicide over the study period, this was followed by the 40-49 age group. CONCLUSIONS Jamaica's suicide rate is among the lowest in the world and in spite of this, there is a need to formulate a suicide policy for the nation in particular males and young adults.
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Affiliation(s)
- Wendel D. Abel
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - Paul A Bourne
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies.,Correspondence to: Dr. Paul A Bourne, Research Fellow, Department of Community Health & Psychiatry, University of the West Indies (UWI), Mona, Kingston 7, Jamaica.
| | - Hayden K. Hamil
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - Eulalee M. Thompson
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - Jacqueline S. Martin
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - Roger C. Gibson
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
| | - Frederick W. Hickling
- Department of Community Health & Psychiatry, University of the West Indies, Mona, Kingston, Jamaica, West Indies
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