51
|
Szejko N, Jakubczyk A, Janik P. Prevalence and Clinical Correlates of Self-Harm Behaviors in Gilles de la Tourette Syndrome. Front Psychiatry 2019; 10:638. [PMID: 31543843 PMCID: PMC6739600 DOI: 10.3389/fpsyt.2019.00638] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/07/2019] [Indexed: 12/14/2022] Open
Abstract
Introduction: Major symptoms of Gilles de la Tourette syndrome (GTS) are tics, but in 90% of cases, psychiatric comorbidities occur. Self-harm behaviors (SHBs) could result from deliberate action and unintentional injury from tics. Methods: We examined 165 consecutive GTS patients aged 5 to 50 years (75.8% males). The median duration of GTS was 14 years (interquartile range, 9-22 years). The patients were evaluated for GTS and comorbid mental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Self-harm behavior was diagnosed during the interview. To determine a direct relationship between SHB and clinical variables, we conducted two analyses, at the time of evaluation and lifetime. We also compared the group of children and adults with SHB. We also tried to distinguish between deliberate (non-tic-related SHB) and accidental (tic-related SHB). Results: Lifetime SHB was reported by 65 patients (39.4%), and in 55 of the cases, it was present at the time of evaluation. The age at the onset of SHB was reported in 55 of the cases (84.6%), and the median was 10 years (interquartile range, 7-13 years). In 30 of the patients (46.2%), SHB was evaluated as mild; in 26 (40%), as moderate; and in only 9 cases (13.9%), as severe. In the multivariable analysis for the predictor of lifetime SHB, attention-deficit/hyperactivity disorder (p = 0.016) and obsessive-compulsive disorder (OCD; p = 0.042) were determined as risk factors, while for current SHB, only tic severity (p < 0.0001) was statistically significant. When comparing predictors of SHB for children and adults, tic severity was determined as predictor for lifetime SHB in children (p < 0.0001), while the anxiety disorder was associated with lifetime SHB in adults (p = 0.05). Similarly, tic severity was a predictor of current SHB in the children group (p = 0.001), but this was not confirmed for adults. The group of patients with tic-related and non-tic-related SHB did not differ. Conclusions: Self-harm behavior appears mostly in children and adolescents and rarely begins in adulthood. Self-harm behavior is associated mainly with tic severity, obsessive-compulsive disorder, and attention-deficit/hyperactivity disorder. Clinical correlates of SHB are age related and differ at different points of life. Tic severity is the main factor associated with SHB in children. In the adult group, anxiety disorder and other psychiatric comorbidities may play the most important role.
Collapse
Affiliation(s)
- Natalia Szejko
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
- Department of Bioethics, Medical University of Warsaw, Warsaw, Poland
| | - Andrzej Jakubczyk
- Department of Psychiatry, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Janik
- Department of Neurology, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
52
|
Pediatric Nonsuicidal Self-Injury: A Call to Action for Inpatient Staff Training. J Psychiatr Pract 2019; 25:395-401. [PMID: 31505528 DOI: 10.1097/pra.0000000000000417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The rising prevalence of nonsuicidal self-injury (NSSI) in pediatric populations along with the recent inclusion of NSSI as a condition for further study in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) have increased the focus on the assessment and treatment of NSSI among youth. Despite the frequent occurrence of NSSI in inpatient psychiatric treatment settings, there are no empirically based assessment protocols to guide clinical staff. This article presents findings from a needs assessment conducted with staff at a state-run child and adolescent inpatient treatment facility. The purpose was to assess the need for formalized NSSI training among staff. A questionnaire was developed to evaluate whether staff had received formal training in NSSI assessment and treatment as well as typical practice responses to patients engaging in NSSI behaviors. The questionnaire also evaluated staff comfort and confidence in their knowledge and skills concerning the assessment and treatment of NSSI among children and adolescents. Respondents were 126 clinical staff, most of whom were nursing staff. Only a minority of staff reported having received formal NSSI training, and a third of respondents indicated that they do not typically assess for NSSI at all. Although a substantial percentage of clinical staff self-reported comfort and confidence with assessing and treating NSSI, fewer than 10% demonstrated accurate skill. Formal training in NSSI is associated with positive outcomes for both patients and staff in general healthcare settings. These findings suggest that similar training for staff on pediatric inpatient psychiatric units will likely foster comfort, confidence, and accuracy, thereby improving outcomes for children and adolescents engaging in NSSI behaviors.
Collapse
|
53
|
Esposito C, Bacchini D, Affuso G. Adolescent non-suicidal self-injury and its relationships with school bullying and peer rejection. Psychiatry Res 2019; 274:1-6. [PMID: 30776706 DOI: 10.1016/j.psychres.2019.02.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 11/20/2022]
Abstract
The central goal of this study was to examine the associations of school bullying and peer rejection with non-suicidal self-injury (NSSI), as well as their interactive role in a sample of non-clinical adolescents. Six hundred and forty adolescents (253 Males, Mage = 15.60, SD = 1.65) self-reported measures of school bullying and NSSI and provided sociometric ratings of peer rejection. The results showed that being involved in bullying (as bullies, victims, or bully-victims) increases the likelihood to engage in NSSI; being rejected by peers amplifies the probability, for victims and bully-victims, of using NSSI at least once. The findings support the hypothesis that peer relationships play a key-role in determining NSSI and the importance to implement programs aimed to improve the school climate in order to avoid maladjusted behaviors in adolescence.
Collapse
Affiliation(s)
- Concetta Esposito
- Department of Humanistic Studies, University of Naples "Federico II", Via Porta di Massa, 1, 80133 Napoli, Italy.
| | - Dario Bacchini
- Department of Humanistic Studies, University of Naples "Federico II", Via Porta di Massa, 1, 80133 Napoli, Italy
| | - Gaetana Affuso
- Department of Psychology, University of Campania "Luigi Vanvitelli", Viale Ellittico, 31, 81100 Caserta, Italy
| |
Collapse
|
54
|
Social Representations About the Functions of Deliberate Self-Harm: Construction and Validation of a Questionnaire for Portuguese Adults. BEHAVIOUR CHANGE 2018. [DOI: 10.1017/bec.2018.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AbstractThe present article focuses on the validation of the Questionnaire of Social Representations about the Functions of Deliberate Self-Harm for adults. The understanding of the social representations about deliberate self-harm can be relevant for clinical intervention and prevention. However, there is still a lack of instruments to assess these representations. The basis for this instrument was the translation of the Inventory of Statements About Self-Injury. To complement this instrument, we conducted semi-directive interviews with adults without deliberate self-harm and analysed the Portuguese written press. Results from these studies complemented the questionnaire with new items and functions. Study 1 consisted of an exploratory factor analysis with a sample of 462 adults. Results revealed a two-factor structure of interpersonal and intrapersonal dimensions. After item reduction, the factorial analysis of the independent functions was also acceptable. This structure was then corroborated in Study 2 by a confirmatory factor analysis with a new sample of 474 adults, revealing an acceptable model fit. This questionnaire presents a relatively solid structure and is based on acceptable psychometric properties, which allows its use in future research.
Collapse
|
55
|
Rice T, Grasso J, Dembar A, Caplan O, Cohen A, Coffey B. Guanfacine as a Facilitator of Recovery from Conversion Disorder in a Young Girl. J Child Adolesc Psychopharmacol 2018; 28:571-575. [PMID: 30307762 DOI: 10.1089/cap.2018.29154.bjc] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Timothy Rice
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Jesse Grasso
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | | | - Oona Caplan
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Abi Cohen
- 1 Icahn School of Medicine at Mount Sinai , New York, New York
| | - Barbara Coffey
- 2 Department of Psychiatry and Behavioral Science, University of Miami Miller School of Medicine , Miami, Florida
| |
Collapse
|
56
|
Nonsuicidal self-injury in adolescents: current developments to help inform assessment and treatment. Curr Opin Pediatr 2018; 30:483-489. [PMID: 29846251 DOI: 10.1097/mop.0000000000000655] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the recent literature examining nonsuicidal self-injury (NSSI) in adolescents, with a particular focus on how primary care pediatricians (PCPs) might assess and intervene as a common first point of contact. This NSSI review is timely and relevant, given the prevalence rates among adolescents, as well as its link to suicidal behaviors. RECENT FINDINGS NSSI is most prevalent among adolescents, with lifetime prevalence rates between 17 and 60%. With evidence that the most common age of onset is between 12 and 14 years, evaluating NSSI is a challenging yet necessary aspect of a comprehensive adolescent medical examination. The function of NSSI behaviors may have implications for effective treatment and should be included in assessment. The majority of research has indicated that NSSI serves an emotion regulation function, in that the behavior results in a decrease in intensity of adverse emotional states in the absence of more effective coping strategies. SUMMARY Considering the prevalence of self-injury among adolescents, the likelihood that PCPs will encounter NSSI in their practice is quite high. Given that more than 50% of youth do not receive needed mental health services, it is critical that PCPs assess for NSSI and intervene accordingly.
Collapse
|
57
|
Horváth LO, Balint M, Ferenczi-Dallos G, Farkas L, Gadoros J, Gyori D, Kereszteny A, Meszaros G, Szentivanyi D, Velo S, Sarchiapone M, Carli V, Wasserman C, Hoven CW, Wasserman D, Balazs J. Direct Self-Injurious Behavior (D-SIB) and Life Events among Vocational School and High School Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:E1068. [PMID: 29795028 PMCID: PMC6025121 DOI: 10.3390/ijerph15061068] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Revised: 04/28/2018] [Accepted: 05/19/2018] [Indexed: 01/21/2023]
Abstract
Although several studies have recently assessed direct self-injurious behavior (D-SIB) among adolescents, it is still understudied in adolescents attending vocational schools: an educational setting generally associated with lower socioeconomic status. After extending the "Saving and Empowering Young Lives in Europe" (SEYLE) project to a vocational school population, we examined their D-SIB and life event characteristics compared to the high school population. SEYLE's Hungarian randomly selected high school sample (N = 995) was completed with a randomly selected vocational school sample (N = 140) in Budapest, Hungary. Participants aged 14⁻17 years completed the SEYLE project's self-administered questionnaires. D-SIB lifetime prevalence was significantly higher (29.4%) in the vocational school group compared to the high school group (17.2%) (Χ²(1) = 12.231, p< 0.001). D-SIB was associated with suicidal ideation in the vocational school group. Different life events were more frequent in the high school than in the vocational school group, and associations between D-SIB and life events differed in the vocational school group compared to the high school group. In conclusion, vocational school students are a vulnerable population with a higher prevalence of D-SIB compared to high school students. Life events and their association with D-SIB also differ in vocational school students compared to high school students. Taking all these into account might contribute to prevention/intervention designed for this population.
Collapse
Affiliation(s)
- Lili O Horváth
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Maria Balint
- Pedagogical Services, Budapest District 12, 1126 Budapest, Hungary.
| | | | - Luca Farkas
- West Hertfordshire Specialist CAMHS St Albans Clinic, AL3 5TL St Albans, UK.
| | - Julia Gadoros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| | - Dora Gyori
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Agnes Kereszteny
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Gergely Meszaros
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
- Semmelweis University, Mental Health Sciences Doctoral School, 1083 Budapest, Hungary.
| | - Dora Szentivanyi
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Szabina Velo
- Doctoral School of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
| | - Marco Sarchiapone
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
| | - Vladimir Carli
- Department of Health Sciences, University of Molise, 86100 Molise, Italy.
- Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Camilla Wasserman
- Global Psychiatric Epidemiology, Columbia University-New York State Psychiatric Institute, New York, NY 10032, USA.
| | - Christina W Hoven
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY 10032, USA.
| | | | - Judit Balazs
- Institute of Psychology, Eotvos Lorand University, 1075 Budapest, Hungary.
- Vadaskert Child and Adolescent Psychiatry Hospital and Outpatient Clinic, 1021 Budapest, Hungary.
| |
Collapse
|
58
|
Balázs J, Győri D, Horváth LO, Mészáros G, Szentiványi D. Attention-deficit hyperactivity disorder and nonsuicidal self-injury in a clinical sample of adolescents: the role of comorbidities and gender. BMC Psychiatry 2018; 18:34. [PMID: 29409473 PMCID: PMC5801900 DOI: 10.1186/s12888-018-1620-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/28/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The aim of the present study was to investigate the possible association between attention-deficit hyperactivity disorder (ADHD) and non-suicidal self-injury (NSSI) with special focus on the role of comorbidities and gender in a clinical sample of adolescents with both a dimensional and a categorical approach to psychopathology. METHODS Using a structured interview, the Mini International Neuropsychiatric Interview Kid and a self-rated questionnaire, the Deliberate Self-Harm Inventory, the authors examined 202 inpatient adolescents (aged: 13-18 years) in the Vadaskert Child and Adolescent Psychiatric Hospital and Outpatient Clinic, Budapest, Hungary. Descriptive statistics, Mann-Whitney U test, chi-square test and mediator model were used. RESULTS Fifty-two adolescents met full criteria for ADHD and a further 77 showed symptoms of ADHD at the subthreshold level. From the 52 adolescents diagnosed with ADHD, 35 (67.30%) had NSSI, of whom there were significantly more girls than boys, boys: n = 10 (28.60%), girls: n = 25 (71.40%) ((χ2(1) = 10.643 p < .001 ϕ = .452). Multiple mediation analyses resulted in a moderated mediation model in which the relationship between symptoms of ADHD and the prevalence of current NSSI was fully mediated by the symptoms of comorbid conditions in both sex. Significant mediators were the symptoms of affective and psychotic disorders and suicidality in both sexes and the symptoms of alcohol abuse/dependence disorders in girls. CONCLUSIONS ADHD symptoms are associated with an increased risk of NSSI in adolescents, especially in the case of girls. Our findings suggest that clinicians should routinely screen for the symptoms of ADHD and comorbidity, with a special focus on the symptoms of affective disorders and alcohol abuse/dependence psychotic symptoms to prevent NSSI.
Collapse
Affiliation(s)
- Judit Balázs
- Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064, Hungary. .,Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary.
| | - Dóra Győri
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary
| | - Lili Olga Horváth
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| | - Gergely Mészáros
- Vadaskert Child and Adolescent Psychiatry Hospital, Budapest, Hungary ,0000 0001 0942 9821grid.11804.3cSemmelweis University, School of Ph.D. Studies, Budapest, Hungary
| | - Dóra Szentiványi
- 0000 0001 2294 6276grid.5591.8Institute of Psychology, Eötvös Loránd University, Izabella str. 46, Budapest, 1064 Hungary ,0000 0001 2294 6276grid.5591.8Doctoral School of Psychology, Eötvös Loránd University, Budapest, Hungary
| |
Collapse
|
59
|
Liang SHY, Yang YH, Kuo TY, Liao YT, Lin TC, Lee Y, McIntyre RS, Kelsen BA, Wang TN, Chen VCH. Suicide risk reduction in youths with attention-deficit/hyperactivity disorder prescribed methylphenidate: A Taiwan nationwide population-based cohort study. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 72:96-105. [PMID: 29121517 DOI: 10.1016/j.ridd.2017.10.023] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Revised: 10/09/2017] [Accepted: 10/25/2017] [Indexed: 06/07/2023]
Abstract
BACKGROUND Attention-deficit/hyperactivity disorder (ADHD) youths have increased suicide risk. Nevertheless, the beneficial effects of methylphenidate (MPH) on suicide attempt have received relatively little attention. AIMS To investigate the MPH usage and the risk of suicide attempt among ADHD youths. METHODS We identified 84,898 youths less than 18 years old with ADHD diagnosis between 1997 and 2013 from National Health Insurance, and examined whether MPH use affected suicide attempt risk using Cox proportional-hazards models. OUTCOME AND RESULTS Among ADHD youths, reduction of suicide risk was found in patients prescribed 90-180days of MPH after adjusting for confounding factors (hazard ratio (HR): 0.41, 95% confidence interval (CI): 0.19-0.90) and a greater reduction in those prescribed more than 180days of MPH (HR: 0.28, 95% CI: 0.17-0.48). CONCLUSIONS AND IMPLICATIONS We observed a 59% suicide attempt risk reduction among ADHD youths prescribed between 90 and 180days and a 72% risk reduction in those prescribed more than 180days of MPH. The protective benefit observed by the group prescribed MPH for longer duration underscores the importance of psychoeducation and compliance enhancement as part of ADHD management. Indication bias is identified as a limitation of this study, and future self-case control study to investigate the association between suicide attempt and ADHD medication is suggested. WHAT THIS PAPER ADDS This nationwide population-based cohort study showed that among ADHD youths, reduction of suicide risk was observed in patients prescribed MPH for duration 90days and longer, underscoring the importance of appropriate ADHD pharmacotherapy and enhancing drug compliance.
Collapse
Affiliation(s)
- Sophie Hsin-Yi Liang
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Department of Child Psychiatry, Chang Gung Memorial Hospital at Taoyuan, Taoyuan, Taiwan, ROC
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC; School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC
| | - Ting-Yu Kuo
- Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC
| | - Yin-To Liao
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Tzu-Chin Lin
- Department of Psychiatry, Chung Shan Medical University Hospital, Taichung, Taiwan, ROC; Department of Psychiatry, School of Medicine, Chung Shan Medical University, Taichung, Taiwan, ROC
| | - Yena Lee
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, Toronto, Canada; Department of Psychiatry and Pharmacology, University of Toronto, Toronto, Canada
| | - Brent A Kelsen
- Language Center, National Taipei University, New Taipei City, Taiwan, ROC
| | - Tsu-Nai Wang
- Department of Public Health, College of Health Science, Kaohsiung Medical University, Kaohsiung, Taiwan, ROC
| | - Vincent Chin-Hung Chen
- Department of Medicine, Chang Gung University, Taoyuan, Taiwan, ROC; Chang Gung Medical Foundation, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan, ROC.
| |
Collapse
|