Distribution by Scientific Domains

Selected Abstracts

Parsing the general and specific components of depression and anxiety with bifactor modeling,

Leonard J. Simms Ph.D.
Abstract Recent hierarchical models suggest that both general and specific components are needed to fully represent the variation observed among mood and anxiety disorders. However, little is known about the relative size, severity, and psychological meaning of these components. We studied these features through bifactor modeling of the symptoms from the Inventory of Depression and Anxiety Symptoms [IDAS; Watson et al., 2007] in 362 community adults, 353 psychiatric patients, and 673 undergraduates. Results revealed that although all IDAS symptom types loaded prominently both on a general factor as well as specific factors, some symptom groups,such as dysphoria, generalized anxiety, and irritability,were influenced more strongly by the general factor, whereas others,e.g., appetite gain, appetite loss, and low well-being,contained a larger specific component. Second, certain symptom groups,e.g., Suicidality, Panic, Appetite Loss, and Ill Temper,reflected higher severity than other symptom groups. Finally, general factor scores correlated strongly with markers of general distress and negative emotionality. These findings support a hierarchical structure among mood and anxiety symptoms and have important implications for how such disorders are described, assessed, and studied. Depression and Anxiety 0:1,13, 2007. Published 2007 Wiley-Liss, Inc. [source]

Suicidality among Finnish anaesthesiologists

Background: Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians. Methods: A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%. Results: One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8,33.0), low social support (10.5, 4.0,27.9), and family problems (6.5, 3.4,12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3,7.1) and superiors (2.1, 1.2,3.6), on-call-related stress symptoms (3.9, 1.9,8.3) and low organizational justice (1.9, 1.1,3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor. Conclusions: The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians. [source]

Central nervous system effects of natural and synthetic glucocorticoids

Pierluigi Fietta MD
Natural glucocorticoids (NGC) physiologically modulate body homeostasis and coordinate adaptive responses to stress, involving almost all organs and tissues, including brain. Since their therapeutic availability, synthetic GC (SGC) have been successfully prescribed for a variety of diseases. Mounting evidence, however, demonstrated pleiotropic adverse effects (AE), including central nervous system (CNS) disturbances, which are often misdiagnosed or underestimated. The aim of the present study was therefore to review and discuss the CNS effects of both NGC and SGC. A detailed search was carried out of the available literature using the PubMed (US National Library of Medicine) database. Cortisolemia plays a crucial role in control of behavior, cognition, mood, and early life programming of stress reactivity. Hypercortisolemia or SGC treatments may induce behavioral, psychic and cognitive disturbances, due to functional and, over time, structural alterations in specific brain target areas. These AE are generally dose and time dependent (infrequent at prednisone-equivalent doses <20 mg/day) and usually reversible. Pediatric patients are particularly susceptible. Behavioral changes, including feeding and sleeping modifications, are common. Psychic AE are unpredictable and heterogeneous, usually mild/moderate, severe in 5,10% of cases. Manic symptoms have been mostly associated with short SGC courses, and depressive disorder with long-term treatments. Suicidality has been reported. Cognitive AE peculiarly affect declarative memory performance. Physiologic levels of NGC are essential for efficient brain functions. Otherwise, hypercortisolemia and SGC treatments may cause dose-/time-dependent neuropsychic AE and, over time, structural alterations in brain target areas. Clinicians should carefully monitor patients, especially children and/or when administering high doses SGC. [source]

Suicidality , the challenge for public mental health services

Thomas Callaly
No abstract is available for this article. [source]

Prevalence and correlates of traumatic brain injury among delinquent youths

Brian E. Perron
Background,Delinquent youth frequently exhibit high-risk behaviours that can result in serious injury. However, little is known about traumatic brain injuries (TBIs) and their correlates in this population. Aims,To examine the period prevalence and correlates of TBIs in delinquent youths. Method,Interviews were conducted with 720 (97.3%) residents of 27 Missouri Division of Youth Services rehabilitation facilities between March 1 and May 31, 2003. Participants [mean age (Mage) = 15.5, standard deviation (SD) = 1.2, 87% male] completed measures assessing TBI, substance use, psychiatric symptoms, and antisocial traits/behaviours. TBI was defined as ever having sustained a head injury causing unconsciousness for more than 20 minutes. Results,Nearly one-in-five youths (18.3%) reported a lifetime TBI. Youths with TBIs were significantly more likely than youths without to be male, have received a psychiatric diagnosis, report an earlier onset of criminal behaviour/substance use and more lifetime substance use problems and past-year criminal acts, evidence psychiatric symptoms, report lifetime suicidality, be impulsive, fearless, and external in locus of control and criminally victimized in the year preceding incarceration. Male gender and frequency of own criminal victimization were important predictors of TBI in multivariate analyses. Regression analyses adjusted for demographic factors, indicated that youths with TBIs were at significantly elevated risk for current depressive/anxious symptoms, antisocial behaviour, and substance abuse problems. Conclusions,TBI is common among delinquent youth and associated with wide ranging psychiatric dysfunction; however, the causal role of TBIs in the pathogenesis of co-morbid conditions remains unclear. Copyright © 2008 John Wiley & Sons, Ltd. [source]

The evolution of depression and suicidality in first episode psychosis

R. Upthegrove
Upthegrove R, Birchwood M, Ross K, Brunett K, McCollum R, Jones L. The evolution of depression and suicidality in first episode psychosis. Objective:, To have a clearer understanding of the ebb and flow of depression and suicidal thinking in the early phase of psychosis, whether these events are predictable and how they relate to the early course of psychotic symptoms. Method:, Ninety-two patients with first episode psychosis (FEP) completed measures of depression, including prodromal depression, self-harm and duration of untreated psychosis. Follow-up took place over 12 months. Results:, Depression occurred in 80% of patients at one or more phases of FEP; a combination of depression and suicidal thinking was present in 63%. Depression in the prodromal phase was the most significant predictor of future depression and acts of self-harm. Conclusion:, Depression early in the emergence of a psychosis is fundamental to the development of future depression and suicidal thinking. Efforts to predict and reduce depression and deliberate self-harm in psychosis may need to target this early phase to reduce later risk. [source]

The impact of panic-agoraphobic comorbidity on suicidality in hospitalized patients with major depression

Lily A. Brown B.S.
Abstract Background: Previous research in outpatient samples suggests that panic and agoraphobic comorbidity is related to suicidality in outpatients with major depression. The purpose of the study was to further investigate this relationship specifically in a hospitalized sample. Method: This study examined the severity of current suicidal ideation and behaviors in a psychiatric hospital sample diagnosed with major depressive disorder alone (MDD; n=28) versus MDD plus panic-agoraphobic spectrum disorders (MDD+PAS; n=69). Results: Members of the MDD+PAS group were significantly more likely to have had a suicide attempt history, higher current depression severity, and higher current suicidal severity compared with individuals in the MDD alone group. The relationship between the current suicidality and comorbid PAS remained significant after controlling for the overall depression severity and other clinical factors. Conclusions: These findings suggest that panic-agoraphobic comorbidity is associated with a greater risk for suicidality in hospitalized patients, which cannot be adequately explained by the level of current depression alone. The clinical and research implications for these findings are discussed. Depression and Anxiety, 2010. © 2010 Wiley-Liss, Inc. [source]

Early adversity in chronic depression: clinical correlates and response to pharmacotherapy,,

Daniel N. Klein Ph.D.
Abstract Background: There is growing evidence suggesting that early adversity may be a marker for a distinct pathway to major depressive disorder (MDD). We examined associations between childhood adversity and a broad variety of clinical characteristics and response to pharmacotherapy in a large sample of patients with chronic forms of MDD. Methods: Subjects included 808 patients with chronic forms of MDD (chronic MDD, double depression, or recurrent MDD with incomplete recovery between episodes and a total continuous duration of >2 years) who were enrolled in a 12-week open-label trial of algorithm-guided pharmacotherapy. Baseline assessments included a semi-structured diagnostic interview, and clinician- and self-rated measures of depressive symptoms, social functioning, depressotypic cognitions, and personality traits, and childhood adversity. Patients were re-evaluated every 2 weeks. Results: A longer duration of illness; earlier onset; greater number of episodes, symptom severity, self-rated functional impairment, suicidality, and comorbid anxiety disorder; and higher levels of dysfunctional attitudes and self-criticism were each associated with multiple forms of childhood adversity. A history of maternal overcontrol, paternal abuse, paternal indifference, sexual abuse, and an index of clinically significant abuse each predicted a lower probability of remission. Among patients completing the 12-week trial, 32% with a history of clinically significant abuse, compared to 44% without such a history, achieved remission. Conclusions: These findings indicate that a history of childhood adversity is associated with an especially chronic form of MDD that is less responsive to antidepressant pharmacotherapy. Depression and Anxiety, 2009. Published 2009 Wiley-Liss, Inc. [source]

Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication

E. Messias
Messias E, Clarke DE, Goodwin RD. Seasonal allergies and suicidality: results from the National Comorbidity Survey Replication. Objective:, Studies have shown an association between allergies and suicidality, and a seasonality of suicide has also been described. We hypothesize an association between history of seasonal allergies and suicide ideation and attempt. Method:, Data came from the National Comorbidity Survey Replication, a nationally representative sample (n = 5692) of adults living in the US. Logistic regression models were used to calculate adjusted odds ratios (OR) controlling for the following: age, sex, race, smoking, asthma and depression. Results:, After weighting and adjustment, a positive and statistically significant association was found between history of seasonal allergies and history of suicidal ideation [adjusted OR = 1.27 (1.01,1.58)]. We found no association between history of seasonal allergies and history of suicide attempts [adjusted OR = 1.17 (0.89,1.52)]. Conclusion:, Findings from a population-based sample support the hypothesized relationship between allergies and suicidal ideation. [source]

Outcome of suicidal patients with schizophrenia: results from a naturalistic study

R. Schennach-Wolff
Schennach-Wolff R, Jäger M, Seemüller F, Obermeier M, Schmauss M, Laux G, Pfeiffer H, Naber D, Schmidt LG, Gaebel W, Klosterkötter J, Heuser I, Maier W, Lemke MR, Rüther E, Klingberg S, Gastpar M, Möller H-J, Riedel M. Outcome of suicidal patients with schizophrenia: results from a naturalistic study. Objective:, Purpose was to assess suicidality before and at the time of admission in patients with schizophrenia and compare outcome differences. Method:, Biweekly PANSS (Positive and Negative Syndrome Scale), HAMD (Hamilton Depression Rating Scale) and UKU (Udvalg for Klinske Undersogelser Side Effect Rating Scale) ratings were evaluated in 339 in-patients with schizophrenic spectrum disorders. Response was defined as an initial 20% PANSS total score reduction at discharge, remission was defined according to the proposed consensus criteria by the Remission in Schizophrenia Working Group. Results:, Suicidal patients (22%) scored significantly higher on the PANSS negative subscore, PANSS insight item and HAMD total score at admission and at discharge. They developed significantly more side effects. No differences were found concerning response and remission between the two patient subgroups. Conclusion:, Despite receiving significantly more antidepressants the suicidal patients suffered from significantly more depressive symptoms up to discharge, yet without differing regarding response and remission. [source]

Baseline profiles of adolescent vs. adult-onset first-episode psychosis in an early detection program

I. Joa
Objective:, Psychotic disorders often start in adolescence. We aim to investigate premorbid and baseline differences characterizing patients with an onset of psychosis in adolescence versus adulthood. Method:, We compare first-episode, DSM-IV non-affective psychosis with onset before (n = 43) and after (n = 189) 18 years on duration of untreated psychosis (DUP), level of symptoms, suicidal behaviour, and other baseline clinical and demographic characteristics. Results:, Adolescent onset patients had poorer premorbid functioning, a longer DUP, higher suicidality, and more depressive symptoms. They also had better cognition, fewer psychotic symptoms, and were more likely to be treated on an out-patient basis. Conclusion:, Adolescents with first-episode psychosis may have a slower and more silent, i.e. insidious onset, and are at risk of experiencing longer treatment delays than adults. They fit the description of what used to be labeled process (versus reactive) schizophrenia. [source]

Association between familial suicidal behavior and frequency of attempts among depressed suicide attempters

D. Lizardi
Objective:, Only a few studies have examined whether a family history of suicide influences the severity of suicidal acts and the results have been inconsistent. The current study aimed to examine whether a family history of suicidal acts predicts severity of suicide attempts. Method:, 190 suicide attempters aged 18,75 years with a lifetime history of major depression were assessed for first-degree family history of suicidality and severity of suicide attempts (number and lethality of prior suicide attempts and age at first attempt). Results:, Regression analyses indicate that a positive family history of suicidal behaviors predicts a greater number of suicide attempts. Reasons for living predict number and lethality of prior attempts. Conclusion:, It is critical to assess for family history of suicidal behavior when treating depressed suicide attempters as it may serve as an indicator of the risk of repeat suicide attempt and as a guide for treatment. [source]

Irritability is associated with anxiety and greater severity, but not bipolar spectrum features, in major depressive disorder

R. H. Perlis
Objective:, Irritability is common during major depressive episodes, but its clinical significance and overlap with symptoms of anxiety or bipolar disorder remains unclear. We examined clinical correlates of irritability in a confirmatory cohort of Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study participants with major depressive disorder (MDD). Method:, Logistic regression was used to identify features associated with presence of irritability on the clinician-rated Inventory of Depressive Symptomatology. Results:, Of 2307 study participants, 1067(46%) reported irritability at least half the time during the preceding week; they were more likely to be female, to be younger, to experience greater depression severity and anxiety, and to report poorer quality of life, prior suicide attempts and suicidal ideation. Bipolar spectrum features were not more common among those with irritability. Conclusion:, Irritable depression is not a distinct subtype of MDD, but irritability is associated with greater overall severity, anxiety comorbidity and suicidality. [source]

Antidepressants and suicidality in younger adults , is bipolar illness the missing link?

Florian Seemüller
No abstract is available for this article. [source]

Two studies on suicidality in the postpartum

R. T. Pinheiro
Objective:, Research in the prevalence of and risk factors for suicidality in the postpartum is extremely limited. We present here data on the prevalence of and factors associated with suicidality from two postpartum samples. Method:, The first sample (SC) comprised 317 women consecutively screened for a trial of psychotherapy for postpartum depression. The second sample was a population-based (PB) sample of 386 women. We used the Mini-International Neuropsychiatric Interview (MINI) to assess suicidality in the SC sample and the self-harm question of the Beck Depression Inventory (BDI9) in the PB sample. Results:, According to the MINI and the BDI9, prevalence of high suicide risk was 5.7% and 11.1%, respectively, in the SC sample. Previous suicide attempts and a positive BDI were retained as predictors of suicidality. The BDI9 indicated suicidality in 8.3% of the 386 women in the PB sample; a positive BDI was retained in the multivariate analysis as a risk of suicidality. Conclusion:, Clinicians should enquire vigorously about suicidality in women presenting with depressive symptoms or previous suicide attempts in the postpartum. [source]

Suicide, suicidality and suicide prevention in affective disorders

H. J. Möller
Objective:, It is well known that functional psychiatric disorders are one of the main causes of suicidal behaviour. This paper discusses the epidemiology and risk factors of suicidal behaviour in affective disorders and goes on to describe the treatment and prevention of such suicidal behaviour. Method:, A narrative overview of relevant epidemiological and drug studies. Results:, About 60,70% of patients with acute depression experience suicidal ideas. There is a high incidence of suicide (10,15%) in depressive patients. Psychopharmacological treatment with antidepressants and/or mood stabilizers is the most successful approach to avoid the risk of suicidal behaviour. In addition, psychotherapeutic and psychosocial interventions are of importance. Conclusion:, Suicidal behaviour and suicide must be considered when treating patients with affective disorders. The complex causation of suicidality has to be borne in mind when considering methods of suicide prevention. In order to obtain the best results, psychosocial, psychotherapeutic and psychopharmacological approaches should be combined, depending on the risk factors of each individual patient. [source]

Adolescent inhalant use, abuse and dependence

ADDICTION, Issue 7 2009
Brian E. Perron
ABSTRACT Aims To compare adolescent inhalant users without DSM-IV inhalant use disorders (IUDs) to youth with IUDs (i.e. abuse or dependence) across demographic, psychosocial and clinical measures. Design Cross-sectional survey with structured psychiatric interviews. Setting Facilities (n = 32) comprising the Missouri Division of Youth Services (MDYS) residential treatment system for juvenile offenders. Participants Current MDYS residents (n = 723); 97.7% of residents participated. Most youth were male (87%) and in mid-adolescence (mean = 15.5 years, standard deviation = 1.2, range = 11,20); more than one-third (38.6%, n = 279) reported life-time inhalant use. Measurements Antisocial behavior, temperament, trauma-exposure, suicidality, psychiatric symptoms and substance-related problems. Findings Among life-time inhalant users, 46.9% met criteria for a life-time DSM-IV IUD (inhalant abuse = 18.6%, inhalant dependence = 28.3%). Bivariate analyses showed that, in comparison to non-users, inhalant users with and without an IUD were more likely to be Caucasian, live in rural or small towns, have higher levels of anxiety and depressive symptoms, evidence more impulsive and fearless temperaments and report more past-year antisocial behavior and life-time suicidality, traumatic experiences and global substance use problems. A monotonic relationship between inhalant use, abuse and dependence and adverse outcomes was observed, with comparatively high rates of dysfunction observed among inhalant-dependent youth. Multivariate regression analyses showed that inhalant users with and without an IUD had greater levels of suicidal ideation and substance use problems than non-users. Conclusions Youth with IUDs have personal histories characterized by high levels of trauma, suicidality, psychiatric distress, antisocial behavior and substance-related problems. A monotonic relationship between inhalant use, abuse and dependence and serious adverse outcomes was observed. [source]

Depression and Anxiety Disorders in Pediatric Epilepsy

EPILEPSIA, Issue 5 2005
Rochelle Caplan
Summary:,Purpose: This study examined affective disorders, anxiety disorders, and suicidality in children with epilepsy and their association with seizure-related, cognitive, linguistic, family history, social competence, and demographic variables. Methods: A structured psychiatric interview, mood self-report scales, as well as cognitive and language testing were administered to 100 children with complex partial seizures (CPSs), 71 children with childhood absence epilepsy (CAE), and 93 normal children, aged 5 to 16 years. Parents provided behavioral information on each child through a structured psychiatric interview and behavior checklist. Results: Significantly more patients had affective and anxiety disorder diagnoses (33%) as well as suicidal ideation (20%) than did the normal group, but none had made a suicide attempt. Anxiety disorder was the most frequent diagnosis among the patients with a diagnosis of affective or anxiety disorders, and combined affective/anxiety and disruptive disorder diagnoses, in those with suicidal ideation. Only 33% received some form of mental health service. Age, verbal IQ, school problems, and seizure type were related to the presence of a diagnosis of affective or anxiety disorder, and duration of illness, to suicidal ideation. Conclusions: These findings together with the high rate of unmet mental health underscore the importance of early detection and treatment of anxiety disorders and suicidal ideation children with CPSs and CAE. [source]

The CRHR1 gene: a marker for suicidality in depressed males exposed to low stress

D. Wasserman
The risk of suicide, which causes about 1 million deaths each year, is considered to augment as the levels of stress increases. Dysregulation in the stress response of the hypothalamic-pituitary-adrenocortical (HPA) axis, involving the corticotrophin-releasing hormone (CRH) and its main receptor (CRHR1), is associated with depression, frequent among suicidal males. Here we have analyzed single nucleotide polymorphisms (SNPs) in these genes, in family trios with suicide attempter offspring (n = 542), by using the transmission disequilibrium test both in a two-staged screening/replication sample design and in detailed reanalysis in the entire sample. Stratification based on the levels of lifetime stress showed reproducible association and linkage of an SNP in the CRHR1 gene (rs4792887) to suicide attempters exposed to low levels of stress (P = 0.002), among whom most males were depressed (P = 0.001). The identified allele may represent a part of the genetic susceptibility for suicidality by increasing HPA axis activity upon exposure to low levels of stress. [source]

Mutations in human monoamine-related neurotransmitter pathway genes,

HUMAN MUTATION, Issue 7 2008
Jan Haavik
Abstract Biosynthesis and metabolism of serotonin and catecholamines involve at least eight individual enzymes that are mainly expressed in tissues derived from the neuroectoderm, e.g., the central nervous system (CNS), pineal gland, adrenal medulla, enterochromaffin tissue, sympathetic nerves, and ganglia. Some of the enzymes appear to have additional biological functions and are also expressed in the heart and various other internal organs. The biosynthetic enzymes are tyrosine hydroxylase (TH), tryptophan hydroxylases type 1 and 2 (TPH1, TPH2), aromatic amino acid decarboxylase (AADC), dopamine beta-hydroxylase (D,H), and phenylethanolamine N -methyltransferase (PNMT), and the specific catabolic enzymes are monoamine oxidase A (MAO-A) and catechol O -methyltransferase (COMT). For the TH, DDC, DBH, and MAOA genes, many single nucleotide polymorphisms (SNPs) with unknown function, and small but increasing numbers of cases with autosomal recessive mutations have been recognized. For the remaining genes (TPH1, TPH2, PNMT, and COMT) several different genetic markers have been suggested to be associated with regulation of mood, pain perception, and aggression, as well as psychiatric disturbances such as schizophrenia, depression, suicidality, and attention deficit/hyperactivity disorder. The genetic markers may either have a functional role of their own, or be closely linked to other unknown functional variants. In the future, molecular testing may become important for the diagnosis of such conditions. Here we present an overview on mutations and polymorphisms in the group of genes encoding monoamine neurotransmitter metabolizing enzymes. At the same time we propose a unified nomenclature for the nucleic acid aberrations in these genes. New variations or details on mutations will be updated in the Pediatric Neurotransmitter Disorder Data Base (PNDDB) database ( Hum Mutat 29(7), 891,902, 2008. © 2008 Wiley-Liss, Inc. [source]

Are antidepressants warranted in the treatment of patients who present suicidal behavior?,

Michele Raja
Abstract Objective The aim of the study was to ascertain the clinical course of patients admitted to a psychiatric intensive care unit (PICU) just after a suicide attempt (SA) and to evaluate the effectiveness of 2nd generation antipsychotics and mood stabilizers in these patients. Methods We examined all the 129 patients discharged in a three-year period, who had been admitted after a SA and considered in the analysis the 82 cases non-transferred (in the first 72 h) to other PICUs for administrative or logistic reasons. Among them, 47 received a complete neuropsychiatric assessment. We distinguished between patients who had been treated with Antidepressants (AD) or not in the three months preceding hospitalization. Results We treated all patients with mood stabilizers and 2nd generation antipsychotics. Only one patient was treated with AD in the course of current hospitalization. Both cases treated and not treated with AD before admission improved significantly, especially in symptoms of anxiety and depression, as well as in suicidality. The suicidal risk abated without AD treatment. Conclusions In patients with impending suicide risk, AD should not be considered standard treatment. Mood stabilizers and 2nd generation antipsychotics can be effective. Copyright © 2008 John Wiley & Sons, Ltd. [source]

Are there subgroups of bulimia nervosa based on comorbid psychiatric disorders?

Alexis E. Duncan MPH
Abstract Objective The current study sought to determine whether there are subtypes of bulimia nervosa (BN) differentiated by comorbid psychiatric disorders. Method Data on comorbid psychiatric diagnoses in female relatives of probands and controls in the Collaborative Study of the Genetics of Alcoholism (COGA) who met criteria for BN (as outlined in the 3rd Rev. ed. of the Diagnostic and Statistical Manual of Mental Disorders) were analyzed using latent class analysis. Resulting latent classes were compared on a variety of variables related to impulsive behaviors and psychological functioning. Results The best-fitting solution, a two-class model, yielded one class (72%) characterized by substance dependence, depression, antisocial personality disorder (ASPD), and anxiety disorders, and another characterized by depression. The highly comorbid class had more suicidality, more daily smokers, sought help for emotional problems, and had lower Global Assessment of Functioning (GAF) scores compared with those in the comorbid depression only class. Discussion Latent class findings suggest the existence of two classes of BN differentiated by substance dependence, impulsive behaviors, and poorer psychological functioning. © 2004 by Wiley Periodicals, Inc. [source]

The systematic assessment of depressed elderly primary care patients

Patrick J. Raue
Abstract Studies of the primary care treatment of depressed elderly patients are constrained by limited time and space and by subject burden. Research assessments must balance these constraints with the need for obtaining clinically meaningful information. Due to the wide-ranging impact of depression, assessments should also focus on suicidality, hopelessness, substance abuse, anxiety, cognitive functioning, medical comorbidity, functional disability, social support, personality, service use and satisfaction with services. This paper describes considerations concerning the assessment selection process for primary care studies, using the PROSPECT (Prevention of Suicide in Primary Care Elderly: Collaborative Trial) study as an example. Strategies are discussed for ensuring that data are complete, valid and reliable. Copyright © 2001 John Wiley & Sons, Ltd. [source]

How people live with or get over being suicidal: a review of qualitative studies

Richard Lakeman
Abstract Title.,How people live with or get over being suicidal: a review of qualitative studies Aim., To systematically review qualitative research which addresses how people live with suicidality or recover a desire to live. Background., Suicide is a pressing social and public health problem. Much emphasis in suicide research has been on the epidemiology of suicide and the identification of risk and protective factors. Relatively little emphasis has been given to the subjective experiences of suicidal people, but this is necessary to inform the care and help provided to individuals. Data sources., Electronic searches of CINAHL Plus with full text, Medline and PsychArticles (included PsycINFO, Social Services Abstracts and Sociological abstracts) were undertaken for the period from 1997 to April 2007. In addition, the following journals were hand searched (1997,2007): ,Mortality', ,Death Studies', ,Archives of Suicide Research' and ,Crisis: The Journal of Crisis Intervention and Suicide Prevention'. Method., A systematic review of the literature and thematic content analysis of findings. The findings were extracted from selected papers and synthesized by way of content analysis in narrative and tabular form. Findings., Twelve studies were identified. Analysis revealed a number of interconnected themes: the experience of suffering, struggle, connection, turning points and coping. Conclusions., Living with or overcoming suicidality involves various struggles, often existential in nature. Suicide may be seen as both a failure and a means of coping. People may turn away from suicide quite abruptly through experiencing, gaining or regaining the right kind of connection with others. Nurses working with suicidal individuals should aspire to be identified as people who can turn people's lives around. [source]

Suicidality among Finnish anaesthesiologists

Background: Suicide rates among physicians have constantly been reported to be higher than in the general population and anaesthesiologists appear to lead the suicide statistics among physicians. Methods: A cross-sectional questionnaire study was sent to all working Finnish anaesthesiologists (n=550) investigating their suicidality (ideation and/or planning and/or attempt). The response rate was 60%. Results: One in four had at some time seriously been thinking about suicide. Respondents with poor health (crude odds ratios 11.2 and 95% confidence interval 3.8,33.0), low social support (10.5, 4.0,27.9), and family problems (6.5, 3.4,12.5) had the highest risk of suicidality. The highest risks at work were conflicts with co-workers (4.1, 2.3,7.1) and superiors (2.1, 1.2,3.6), on-call-related stress symptoms (3.9, 1.9,8.3) and low organizational justice (1.9, 1.1,3.2). If a respondent had several risk factors, the risk of suicidality doubled with each cumulating factor. Conclusions: The reported level of suicidal ideation among Finnish anaesthesiologists is worth concern. It should be of utmost importance to screen the risk factors and recognize suicidal physicians in order to help them. Interpersonal relationships, decision-making procedures, and on-call-burden should be focused on when aiming to prevent suicidality among physicians. [source]

Combat experience and the acquired capability for suicide,

Craig J. Bryan
Abstract Rising suicide rates are an increasing concern among military personnel. The interpersonal-psychological theory of suicide proposes that three necessary factors are needed to die by suicide: feelings that one does not belong with other people, feelings that one is a burden on others or society, and an acquired capability to overcome the fear and pain associated with suicide. The current study tests the theory's proposal that acquired capability may be particularly influenced by military experience, because combat exposure may cause habituation to fear of painful experiences such as suicide. Utilizing clinical and nonclinical samples of military personnel deployed to Iraq, results of the current study indicate that a greater range of combat experiences predicts acquired capability above and beyond depression and post-traumatic stress disorder symptoms, previous suicidality, and other common risk factors for suicide. Combat experiences did not, however, predict perceived burdensomeness or thwarted belongingness. The authors discuss how combat experiences might serve as a mechanism for elevating suicide risk and implications for clinical interventions and suicide prevention efforts. © 2010 Wiley Periodicals, Inc. J Clin Psychol: 66:1,13, 2010. [source]

Integrative harm reduction psychotherapy: a case of substance use, multiple trauma, and suicidality

Andrew Tatarsky
Abstract Harm reduction is a new paradigm that seeks to reduce the harmful consequences of substance use and other risky behaviors without requiring abstinence. This article discusses integrative harm reduction psychotherapy, one application of harm reduction principles to psychotherapy. Seven therapeutic tasks are described with attention to clinical process, skills, and strategies. A case is presented that illustrates the application of this approach with life-threatening substance use that was related to multiple trauma and suicidal depression. © 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 66: 1,13, 2010. [source]

Presenting problems among treatment-seeking gay, lesbian, and bisexual youth

Trevor A. Hart
Gay, lesbian, and bisexual youth are at risk for a variety of clinical problems amenable to psychotherapeutic intervention. However, many psychotherapists may be unaware of the difficulties faced by this population. The purpose of this article is to familiarize therapists with presenting complaints common to psychotherapy-seeking gay, lesbian, and bisexual youth. Some of these problems include homophobia among family, peers, and authority figures (often expressed at school or at work), depression, suicidality, social anxiety, and body image disturbance. We illustrate these important issues via four case examples. © 2001 John Wiley & Sons, Inc. J Clin Psychol/In Session 57: 615,627, 2001. [source]

The effectiveness of family therapy and systemic interventions for child-focused problems

Alan Carr
This review updates a similar paper published in the Journal of Family Therapy in 2001. It presents evidence from meta-analyses, systematic literature reviews and controlled trials for the effectiveness of systemic interventions for families of children and adolescents with various difficulties. In this context, systemic interventions include both family therapy and other family-based approaches such as parent training. The evidence supports the effectiveness of systemic interventions either alone or as part of multimodal programmes for sleep, feeding and attachment problems in infancy; child abuse and neglect; conduct problems (including childhood behavioural difficulties, ADHD, delinquency and drug abuse); emotional problems (including anxiety, depression, grief, bipolar disorder and suicidality); eating disorders (including anorexia, bulimia and obesity); and somatic problems (including enuresis, encopresis, recurrent abdominal pain, and poorly controlled asthma and diabetes). [source]

Acute suicidality after commencing atomoxetine

Georgia Armat Paxton
Abstract: An 11 year old boy developed acute agitation and suicidal ideation after commencing atomoxetine shortly after it was approved for use in Australia. The clinical features were similar to reactions described in response to selective serotonin reuptake inhibitors. The case highlights the importance of close monitoring when starting newly registered medications. An increased risk of suicidal thinking was subsequently identified for this drug leading to a Food and Drug Administration alert and a boxed warning in September 2005, however there are still no other published case reports of acute suicidality. [source]