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Abstract
Suicidal behavior in older adults (65 years old and over) is a major public health issue in many countries. Suicide rates increase during the life course and are as high as 48.7/100,000 among older white men in the USA. Specific health conditions and stress factors increase the complexity of the explanatory model for suicide in older adults. A PubMed literature search was performed to identify most recent and representative studies on suicide risk factors in older adults. The aim of our narrative review was to provide a critical evaluation of recent findings concerning specific risk factors for suicidal thoughts and behaviors among older people: psychiatric and neurocognitive disorders, social exclusion, bereavement, cognitive impairment, decision making and cognitive inhibition, physical illnesses, and physical and psychological pain. We also aimed to approach the problem of euthanasia or physician-assisted suicide in older adults. Our main findings emphasize the need to integrate specific stress factors, such as feelings of social disconnectedness, neurocognitive impairment or decision making, as well as chronic physical illnesses and disability in suicide models and in suicide prevention programs in older adults. Furthermore, the chronic care model should be adapted for the treatment of older people with long-term conditions in order to improve the treatment of depressive disorders and the prevention of suicidal thoughts and acts.
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Affiliation(s)
- Ismael Conejero
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France
| | - Emilie Olié
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Philippe Courtet
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
| | - Raffaella Calati
- Institut National de la Santé Et de la Recherche Médicale (INSERM), University of Montpellier, Neuropsychiatry: Epidemiological and Clinical Research, Montpellier, France.,Department of Emergency Psychiatry and Post-Acute Care, Lapeyronie Hospital, Center Hospitalier Universitairere (CHU) Montpellier, Montpellier, France.,FondaMental Foundation, Créteil, France
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102
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Abstract
PURPOSE OF REVIEW The definition of psychological pain is complex. It is a lasting unpleasant and unsustainable feeling characterized by a perception of inability or deficiency of the self, as well as frustrated psychological needs and social disconnection. The aim of our review was to summarize the most recent and updated findings supporting the role of psychological pain in the pathophysiology of depression and suicidal behavior. We also explored the relationship between psychological and physical pain in depression and suicide. RECENT FINDINGS Psychological pain is a prominent dimension of depressive disorder and has been associated with higher risk of suicidal ideation and suicidal behavior. Sensitivity to psychological and physical pain is increased in depression. Conversely, higher tolerance to physical pain is associated with suicidal behavior. A better understanding of the pathophysiology of pain processing in depression and suicide offers new therapeutic options for the treatment of depression through the use of analgesic drugs.
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103
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Meerwijk EL, Weiss SJ. Tolerance for psychological pain and capability for suicide: Contributions to suicidal ideation and behavior. Psychiatry Res 2018; 262:203-208. [PMID: 29453039 PMCID: PMC5866778 DOI: 10.1016/j.psychres.2018.02.005] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Revised: 01/16/2018] [Accepted: 02/02/2018] [Indexed: 11/22/2022]
Abstract
Among people with suicide ideation most do not attempt suicide or die by suicide. In this online study of adult US Facebook users (n = 219), we examined capability for suicide, operationalized as fearlessness about death, and tolerance for psychological pain as potential variables that may explain why some people move from suicide ideation to suicidal behavior. Tolerance for psychological pain was significantly higher for participants who had never attempted suicide. Fearlessness about death was higher in participants who had attempted suicide, but not significantly. At high levels of psychological pain, one's belief in the ability to cope with psychological pain, a dimension of tolerance for psychological pain, was lower in participants with a history of suicide attempt than in participants who had never attempted suicide. The odds of suicidal desire were almost cut in half with each unit increase in participants' belief in their coping ability, whereas for each unit increase in fearlessness about death, the odds of suicidal desire increased by 65%. The Pearson correlation between tolerance for psychological pain and fearlessness about death was negligible. Our findings support a role for both tolerance for psychological pain and capability for suicide/fearlessness about death in the ideation-to-action framework of suicide.
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Affiliation(s)
- Esther L Meerwijk
- Department of Family Health Care Nursing, University of California, San Francisco, CA, USA; VA Health Services Research & Development, Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, CA, USA.
| | - Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco, CA, USA
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104
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D'Agata MT, Holden RR. Self-concealment and perfectionistic self-presentation in concealment of psychache and suicide ideation. PERSONALITY AND INDIVIDUAL DIFFERENCES 2018. [DOI: 10.1016/j.paid.2017.12.034] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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105
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Fava GA, Tomba E, Bech P. Clinical Pharmacopsychology: Conceptual Foundations and Emerging Tasks. PSYCHOTHERAPY AND PSYCHOSOMATICS 2018; 86:134-140. [PMID: 28490035 DOI: 10.1159/000458458] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/27/2017] [Indexed: 12/29/2022]
Abstract
The aim of this critical review was to outline emerging trends and perspectives of clinical pharmacopsychology, an area of clinical psychology that is concerned with the psychological effects of medications. The historical development of clinical pharmacopsychology is outlined, with discussion of its most representative expressions and reference to current challenges of clinical research, with particular reference to clinimetrics. The domains of clinical pharmacopsychology encompass the clinical benefits of psychotropic drugs, the characteristics that predict responsiveness to treatment, the vulnerabilities induced by treatment (side effects, behavioral toxicity, iatrogenic comorbidity), and the interactions between drug treatment and psychological variables. Its aim is to provide a comprehensive assessment of the clinical important changes that are concerned with (a) wanted and expected treatment effects, (b) treatment-induced unwanted side effects, and (c) the patient's own personal experience of a change in terms of well-being and/or quality of life. Clinical pharmacopsychology offers a unifying framework for the understanding of clinical phenomena in medical and psychiatric settings. Research in this area deserves high priority.
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Affiliation(s)
- Giovanni A Fava
- Department of Psychology, University of Bologna, Bologna, Italy
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106
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Rogers ML, Hagan CR, Joiner TE. Examination of interoception along the suicidality continuum. J Clin Psychol 2018; 74:1004-1016. [PMID: 29319196 DOI: 10.1002/jclp.22564] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 09/21/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Interoception deficits have been associated with various points on the suicidality continuum. Most research, however, has focused on general, rather than specific facets of, interoception. This study compared individuals with lifetime suicidal ideation, plans, and attempts using a multidimensional assessment of interoception. METHOD A total of 537 adults completed measures of their interoception and lifetime suicide histories. RESULTS Individuals with lifetime suicidal ideation reported more worry about their bodily sensations. Those with lifetime suicide attempts reported a greater tendency to distract themselves from bodily sensations and less self-regulation using bodily sensations. Individuals at all points of the suicidality continuum reported less trust of their bodily sensations. CONCLUSION These findings suggest that interoception may be impaired in those with a history of suicidal thoughts and behaviors. Longitudinal designs are needed to parse apart the interplay of these variables and directionality of these relationships.
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107
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Lopez-Morinigo JD, Fernandes AC, Shetty H, Ayesa-Arriola R, Bari A, Stewart R, Dutta R. Can risk assessment predict suicide in secondary mental healthcare? Findings from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Case Register. Soc Psychiatry Psychiatr Epidemiol 2018; 53:1161-1171. [PMID: 29860569 PMCID: PMC6208937 DOI: 10.1007/s00127-018-1536-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/28/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE The predictive value of suicide risk assessment in secondary mental healthcare remains unclear. This study aimed to investigate the extent to which clinical risk assessment ratings can predict suicide among people receiving secondary mental healthcare. METHODS Retrospective inception cohort study (n = 13,758) from the South London and Maudsley NHS Foundation Trust (SLaM) (London, UK) linked with national mortality data (n = 81 suicides). Cox regression models assessed survival from the last suicide risk assessment and ROC curves evaluated the performance of risk assessment total scores. RESULTS Hopelessness (RR = 2.24, 95% CI 1.05-4.80, p = 0.037) and having a significant loss (RR = 1.91, 95% CI 1.03-3.55, p = 0.041) were significantly associated with suicide in the multivariable Cox regression models. However, screening statistics for the best cut-off point (4-5) of the risk assessment total score were: sensitivity 0.65 (95% CI 0.54-0.76), specificity 0.62 (95% CI 0.62-0.63), positive predictive value 0.01 (95% CI 0.01-0.01) and negative predictive value 0.99 (95% CI 0.99-1.00). CONCLUSIONS Although suicide was linked with hopelessness and having a significant loss, risk assessment performed poorly to predict such an uncommon outcome in a large case register of patients receiving secondary mental healthcare.
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Affiliation(s)
- Javier-David Lopez-Morinigo
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, De Crespigny Park, PO Box 68, London, SE5 8AF, UK. .,CAS Behavioural Health, London, UK.
| | - Andrea C. Fernandes
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Hitesh Shetty
- 0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Rosa Ayesa-Arriola
- 0000 0004 1770 272Xgrid.7821.cDepartment of Psychiatry, Marqués de Valdecilla University Hospital, IFIMAV, School of Medicine, University of Cantabria, Santander, Spain ,grid.469673.9Centro Investigación Biomédica en Red de Salud Mental (CIBERSAM), Madrid, Spain
| | | | - Robert Stewart
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
| | - Rina Dutta
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK ,0000 0000 9439 0839grid.37640.36South London and Maudsley NHS Foundation Trust, London, UK
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108
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Mérida-López S, Extremera N, Rey L. Understanding the Links Between Self-Report Emotional Intelligence and Suicide Risk: Does Psychological Distress Mediate This Relationship Across Time and Samples? Front Psychiatry 2018; 9:184. [PMID: 29867607 PMCID: PMC5953343 DOI: 10.3389/fpsyt.2018.00184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Accepted: 04/19/2018] [Indexed: 11/15/2022] Open
Abstract
Objective: In the last decades, increasing attention has been paid to examining psychological resources that might contribute to our understanding of suicide risk. Although Emotional Intelligence (EI) is one dimension that has been linked with decreased suicidal ideation and behaviors, we detected several gaps in the literature in this area regarding the research designs and samples involved. In this research, we aimed to test a mediator model considering self-report EI, psychological distress and suicide risk across samples adopting both cross-sectional and prospective designs in two independent studies. Method: In Study 1, our purpose was to examine the potential role of psychological distress as a mediator in the relationship between self-report EI and suicide risk in a community sample comprised of 438 adults (270 women; mean age: 33.21 years). In Study 2, we sought to examine the proposed mediator model considering a 2-month prospective design in a sample of college students (n = 330 in T1; n = 311 in T2; 264 women; mean age: 22.22 years). Results: In Study 1, we found that psychological distress partially mediated the effect of self-report EI on suicide risk. More interestingly, findings from Study 2 showed that psychological distress fully mediated the relationship between self-report EI and suicide risk at Time 2. Conclusion: These results point out the role of psychological distress as a mediator in the association between self-report EI and suicide risk. These findings suggest an underlying process by which self-report EI may act as a protective factor against suicidal ideation and behaviors. In line with the limitations of our work, plausible avenues for future research and interventions are discussed.
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Affiliation(s)
| | - Natalio Extremera
- Department of Social Psychology, University of Málaga, Málaga, Spain
| | - Lourdes Rey
- Department of Personality, Assessment and Psychological Treatment, University of Málaga, Málaga, Spain
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109
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Abstract
INTRODUCTION Several lines of evidence suggest a perturbed sense of self in people who attempt suicide, but it has rarely been experimentally studied. Here, we aimed to explore in this population the narrative self through explicit self-perception and the self-reference effect in memory. METHODS Forty-seven patients with a mood disorder, including 20 with a personal history of suicide attempt, completed a self-referential task. During the encoding phase, they were presented with personality traits and had to successively judge whether each trait described themselves ("self condition") or was a desirable trait, in general ("general condition"). Then, they were unexpectedly asked to retrieve as many previously presented traits as possible (free recall phase). RESULTS Suicide attempters did not differ from non-attempter patients in any self-reference measures. Moreover, none of these measures correlated with current suicidal ideas. During the encoding phase, patients in both groups attributed negative traits to themselves more often than they considered them to be desirable, in general, with an opposite pattern for positive traits. The number of negative traits during the self but not the general condition was correlated with depression, anxiety, and mental pain levels, whereas depression and mental pain levels were correlated with suicidal ideas. No self-reference effect in memory was found. CONCLUSIONS Overall, measures of the narrative self were not directly associated with suicidality. However, biased self-perception was related to painful and depressive feelings, which were in turn related to suicidal ideas. More research on self-related processing during the suicidal process is warranted.
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Affiliation(s)
- Fabrice Jollant
- a Department of Psychiatry, Douglas Mental Health University Institute, McGill Group for Suicide Studies , McGill University , Montréal , Canada.,b Department of Psychiatry , Academic Hospital (CHU) Nîmes , Nîmes , France.,c Sainte-Anne Hospital , Paris , France.,d Faculty of Medicine , Paris-Descartes University , Paris , France.,e Centre de Psychiatrie et Neurosciences (CPN) , Université Paris Descartes , PRES Sorbonne Paris Cité, Paris , France
| | - Cédric Lemogne
- d Faculty of Medicine , Paris-Descartes University , Paris , France.,e Centre de Psychiatrie et Neurosciences (CPN) , Université Paris Descartes , PRES Sorbonne Paris Cité, Paris , France.,f AP-HP, Hôpitaux Universitaires Paris Ouest, Service de Psychiatrie de l'adulte et du sujet âgé , Paris , France
| | - Philippe Fossati
- g Faculté de Médecine , Université Pierre et Marie Curie , Paris , France.,h Equipe Neurosciences Sociales & Affectives , Institut du Cerveau et de la Moelle Épinière (ICM), UMR 7225/UMR_S 1127 , Paris , France.,i AP-HP, Hôpital Pitié-Salpétrière, Service de Psychiatrie d'Adultes , Paris , France
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110
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Campos RC, Holden RR, Santos S. Exposure to suicide in the family: Suicide risk and psychache in individuals who have lost a family member by suicide. J Clin Psychol 2017; 74:407-417. [DOI: 10.1002/jclp.22518] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/23/2017] [Accepted: 05/09/2017] [Indexed: 11/05/2022]
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111
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Abstract
OBJECTIVE Psychiatry has ignored history, anthropology, sociology and literature in the search for enlightenment regarding suicide. Our objective was to determine what, if anything, Aesop's fables had to teach us about suicide in around 600 BCE. Aesop's account is around two centuries older than the oldest text (Herodotus: The histories) previously examined by our group. METHOD We examined two translations of Aesop's fables, seeking accounts fitting the following categories: (1) suicidal thinking, (2) suicidal behaviour without fatal consequences, and (3) suicidal behaviour with fatal consequences. RESULTS One account fitting each of these categories was identified. The triggers were: (i) self-doubt and criticism, (ii) unpleasant predicament (constant fear), and (iii) inescapable physical pain. CONCLUSION Evidence indicates that around 600 BCE, suicide was practised as a means of coping with self-doubt and criticism, unpleasant predicaments and inescapable physical pain. Recent scientific evidence confirms these observations.
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Affiliation(s)
- Julian Davis
- Senior Psychiatrist, Tasmanian Mental Health Tribunal, Hobart, TAS, Australia
| | - Tammie T Money
- Post-Graduate Student, Australian National University Medical School, Garran, ACT, Australia
| | - Saxby Pridmore
- Professor, Discipline of Psychiatry, University of Tasmania, Hobart, TAS, Australia
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112
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Meerwijk EL, Weiss SJ. Utility of a time frame in assessing psychological pain and suicide ideation. PeerJ 2017; 5:e3491. [PMID: 28652940 PMCID: PMC5483035 DOI: 10.7717/peerj.3491] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 06/01/2017] [Indexed: 12/14/2022] Open
Abstract
Background Assessing psychological pain has been recommended as an integral part of a comprehensive suicide risk assessment. The Psychache Scale, an established measure of psychological pain, does not specify a time frame for when pain is experienced, which may inadvertently increase the likelihood of identifying individuals as being at elevated suicide risk when they complete the Psychache Scale based on psychological pain experienced at some undefined time in the past. Methods We conducted a national general population survey among United States adults to determine whether addition of a time frame to the instructions of the Psychache Scale would more accurately reflect current psychological pain and more effectively identify people with current suicide ideation. A between-subjects design was used where respondents were randomized to complete the original Psychache scale or a modified scale with time frame. Data were collected online from September 2015 to June 2016. A total of 242 respondents had complete psychological pain data: 133 completed the original Psychache Scale and 109 completed the Psychache Scale with time frame. Results Addition of a time frame did not result in differences in psychological pain scores. However, when screening for participants with current suicide ideation, 13% fewer false positives were observed with the modified scale at higher cut-off values than previously reported (38 vs. 24). The substantial increase in positive predictive value suggests that a time frame is a worthwhile addition to the Psychache Scale. Discussion We recommend using the Psychache Scale with a time frame and testing the cut-off score for suicide ideation in population samples that reflect the general population more accurately. Psychological pain cut-off scores in clinical samples have yet to be established.
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Affiliation(s)
- Esther L Meerwijk
- Department of Family Health Care Nursing, University of California, San Francisco, CA, United States of America.,Current affiliation: VA Health Services Research & Development (Center for Innovation to Implementation), VA Palo Alto Health Care System, Menlo Park, CA, United States of America
| | - Sandra J Weiss
- Department of Community Health Systems, University of California, San Francisco, CA, United States of America
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113
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Reist C, Mee S, Fujimoto K, Rajani V, Bunney WE, Bunney BG. Assessment of psychological pain in suicidal veterans. PLoS One 2017; 12:e0177974. [PMID: 28558020 PMCID: PMC5448740 DOI: 10.1371/journal.pone.0177974] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Accepted: 05/05/2017] [Indexed: 11/19/2022] Open
Abstract
Psychological pain is a relatively understudied and potentially important construct in the evaluation of suicidal risk. Psychological pain also referred to as 'mental pain' or 'psychache' can be defined as an adverse emotional reaction to a severe trauma (e.g., the loss of a child) or may be associated with an illness such as depression. When psychological pain levels reach intolerable levels, some individuals may view suicide as the only and final means of escape. To better understand psychological pain, we previously developed and validated a brief self-rating 10-item scale, Mee-Bunney Psychological Pain Assessment Scale [MBP] in depressed patients and non-psychiatric controls. Our results showed a significant increase in psychological pain in the depressed patients compared to controls. We also observed a significant linear correlation between psychological pain and suicidality in the depressed patient cohort. The current investigation extends our study of psychological pain to a diagnostically heterogeneous population of 57 US Veterans enrolled in a suicide prevention program. In addition to the MBP, we administered the Columbia Suicide Severity Rating Scale (C-SSRS), Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), and the Barratt Impulsiveness Scale (BIS-11). Suicidal patients scoring above a predetermined threshold for high psychological pain also had significantly elevated scores on all the other assessments. Among all of the evaluations, psychological pain accounted for the most shared variance for suicidality (C-SSRS). Stepwise regression analyses showed that impulsiveness (BIS) and psychological pain (MBP) contributed more to suicidality than any of the other combined assessments. We followed patients for 15 months and identified a subgroup (24/57) with serious suicide events. Within this subgroup, 29% (7/24) had a serious suicidal event (determined by the lethality subscale of the C-SSRS), including one completed suicide. Our results build upon our earlier findings and recent literature supporting psychological pain as a potentially important construct. Systematically evaluating psychological pain along with additional measures of suicidality could improve risk assessment and more effectively guide clinical resource allocation toward prevention.
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Affiliation(s)
- Christopher Reist
- VA Long Beach Healthcare System, Long Beach, California, United States of America
- Department of Psychiatry, University of California Irvine, Irvine, California, United States of America
| | - Steven Mee
- Applied Innovative Psychiatry, Los Alamitos, California, United States of America
| | - Ken Fujimoto
- Loyola University, Chicago, IIlinois, United States of America
| | - Vivek Rajani
- VA Long Beach Healthcare System, Long Beach, California, United States of America
| | - William E. Bunney
- Department of Psychiatry, University of California Irvine, Irvine, California, United States of America
| | - Blynn G. Bunney
- Department of Psychiatry, University of California Irvine, Irvine, California, United States of America
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Onofrj M, Carrozzino D, D’Amico A, Di Giacomo R, Delli Pizzi S, Thomas A, Onofrj V, Taylor JP, Bonanni L. Psychosis in parkinsonism: an unorthodox approach. Neuropsychiatr Dis Treat 2017; 13:1313-1330. [PMID: 28553118 PMCID: PMC5439966 DOI: 10.2147/ndt.s116116] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Psychosis in Parkinson's disease (PD) is currently considered as the occurrence of hallucinations and delusions. The historical meaning of the term psychosis was, however, broader, encompassing a disorganization of both consciousness and personality, including behavior abnormalities, such as impulsive overactivity and catatonia, in complete definitions by the International Classification of Diseases-10 (ICD-10) and the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). Our review is aimed at reminding that complex psychotic symptoms, including impulsive overactivity and somatoform disorders (the last being a recent controversial entity in PD), were carefully described in postencephalitic parkinsonism (PEP), many decades before dopaminergic treatment era, and are now described in other parkinsonisms than PD. Eminent neuropsychiatrists of the past century speculated that studying psychosis in PEP might highlight its mechanisms in other conditions. Yet, functional assessments were unavailable at the time. Therefore, the second part of our article reviews the studies of neural correlates of psychosis in parkinsonisms, by taking into account both theories on the narrative functions of the default mode network (DMN) and hypotheses on DMN modulation.
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Affiliation(s)
- Marco Onofrj
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Danilo Carrozzino
- Department of Psychological, Health, and Territorial Sciences, University “G. d’Annunzio” of Chieti-Pescara, Chieti, Italy
- Psychiatric Research Unit, Psychiatric Centre North Zealand, Copenhagen University Hospital, Hillerød, Denmark
| | - Aurelio D’Amico
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Roberta Di Giacomo
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Stefano Delli Pizzi
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
| | - Astrid Thomas
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
| | - Valeria Onofrj
- Department of Bioimaging, University Cattolica del Sacro Cuore, Rome, Italy
| | - John-Paul Taylor
- Institute of Neuroscience, Campus for Ageing and Vitality Newcastle University Newcastle upon Tyne, Newcastle upon Tyne, UK
| | - Laura Bonanni
- Department of Neuroscience Imaging and Clinical Sciences, University “G. d’Annunzio” of Chieti-Pescara
- CE.S.I. University Foundation
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115
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Campos RC, Gomes M, Holden RR, Piteira M, Rainha A. Does psychache mediate the relationship between general distress and suicide ideation? DEATH STUDIES 2017; 41:241-245. [PMID: 27824293 DOI: 10.1080/07481187.2016.1251510] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study evaluated whether psychache (i.e., mental pain) mediates the association between general distress, assessed as the frequency and the intensity of psychological symptoms in the previous week, and suicide ideation in community adults. For a sample of 202 adults, psychache fully mediated the relationship between suicide ideation and the frequency of psychological symptoms, and partially mediated the relationship between suicide ideation and the intensity of psychological symptoms. As such, mental pain fully or partially explains the process linking the frequency and the intensity of general distress to suicide ideation and, thus, mental pain is a target for potential intervention.
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Affiliation(s)
- Rui C Campos
- a Departamento de Psicologia, Escola de Ciências Sociais e Centro de Investigação em Educação e Psicologia , University of Évora , Évora , Portugal
| | - Margarida Gomes
- b Departamento de Psicologia, Escola de Ciências Sociais , University of Évora , Évora , Portugal
| | - Ronald R Holden
- c Department of Psychology , Queen's University , Kingston , Ontario , Canada
| | - Margarida Piteira
- b Departamento de Psicologia, Escola de Ciências Sociais , University of Évora , Évora , Portugal
| | - Ana Rainha
- b Departamento de Psicologia, Escola de Ciências Sociais , University of Évora , Évora , Portugal
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Falgares G, Marchetti D, De Santis S, Carrozzino D, Kopala-Sibley DC, Fulcheri M, Verrocchio MC. Attachment Styles and Suicide-Related Behaviors in Adolescence: The Mediating Role of Self-Criticism and Dependency. Front Psychiatry 2017; 8:36. [PMID: 28344562 PMCID: PMC5344916 DOI: 10.3389/fpsyt.2017.00036] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 02/24/2017] [Indexed: 01/19/2023] Open
Abstract
Insecure attachment and the personality dimensions of self-criticism and dependency have been proposed as risk factors for suicide in adolescents. The present study examines whether self-criticism and dependency mediate the relationship between insecure attachment styles and suicidality. A sample of 340 high-school students (73.2% females), ranging in age from 13 to 20 years (M = 16.47, SD = 1.52), completed the Depressive Experiences Questionnaire for Adolescents, the Depressive Experiences Questionnaire for Adolescents, the Attachment Style Questionnaire, and the Suicidal Behaviors Questionnaire-Revised. The results partially support the expected mediation effects. Self-criticism, but not dependency, mediates the link between insecure attachment (anxiety and avoidance) and suicide-related behaviors. Implications for suicide risk assessment and management are discussed.
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Affiliation(s)
- Giorgio Falgares
- Department of Psychological, Pedagogical and Educational Sciences, University of Palermo, Palermo, Italy
| | - Daniela Marchetti
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Sandro De Santis
- Azienda Provinciale per i Servizi Sanitari, Provincia Autonoma di Trento, Trento, Italy
| | - Danilo Carrozzino
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | - Mario Fulcheri
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Maria Cristina Verrocchio
- Department of Psychological, Health and Territorial Sciences, University of Chieti-Pescara, Chieti, Italy
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Psychological and physical pain as predictors of suicide risk: evidence from clinical and neuroimaging findings. Curr Opin Psychiatry 2017; 30:159-167. [PMID: 28067727 DOI: 10.1097/yco.0000000000000314] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
PURPOSE OF REVIEW Suicide is a multidimensional clinical phenomenon with complex biological, social and psychological risk factors. Therefore, it is imperative for studies to focus on developing a unified understanding of suicide risk that integrates current clinical and neurobiological findings. A recent line of research has implicated different classifications of pain in understanding suicide risk, including the concepts of psychache and pain tolerance. Although psychache is defined as the experience of unbearable psychological pain, pain tolerance refers to the greatest duration or intensity of painful stimuli that one is able to bear. This review will focus on integrating current clinical and neurobiological findings by which psychache and pain tolerance confer suicide risk. RECENT FINDINGS Results indicate that psychache has been identified as a significant risk factor for suicide and that psychache may be associated with the neurocircuitry involved in the modulation of physical pain. Converging evidence has also been found linking pain tolerance to self-injurious behaviours and suicide risk. The experience of psychache and physical pain in relation to other predictors of suicide, including reward processing, hopelessness and depression, are further discussed. SUMMARY Future research examining the pain-suicide connection is required to understand the mechanism behind clinically relevant risk factors for suicide, which can ultimately inform the construction of empirically supported suicide risk assessment and intervention techniques.
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Morales S, Barros J, Echávarri O, García F, Osses A, Moya C, Maino MP, Fischman R, Núñez C, Szmulewicz T, Tomicic A. Acute Mental Discomfort Associated with Suicide Behavior in a Clinical Sample of Patients with Affective Disorders: Ascertaining Critical Variables Using Artificial Intelligence Tools. Front Psychiatry 2017; 8:7. [PMID: 28210230 PMCID: PMC5289061 DOI: 10.3389/fpsyt.2017.00007] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2016] [Accepted: 01/11/2017] [Indexed: 12/30/2022] Open
Abstract
AIM In efforts to develop reliable methods to detect the likelihood of impending suicidal behaviors, we have proposed the following. OBJECTIVE To gain a deeper understanding of the state of suicide risk by determining the combination of variables that distinguishes between groups with and without suicide risk. METHOD A study involving 707 patients consulting for mental health issues in three health centers in Greater Santiago, Chile. Using 345 variables, an analysis was carried out with artificial intelligence tools, Cross Industry Standard Process for Data Mining processes, and decision tree techniques. The basic algorithm was top-down, and the most suitable division produced by the tree was selected by using the lowest Gini index as a criterion and by looping it until the condition of belonging to the group with suicidal behavior was fulfilled. RESULTS Four trees distinguishing the groups were obtained, of which the elements of one were analyzed in greater detail, since this tree included both clinical and personality variables. This specific tree consists of six nodes without suicide risk and eight nodes with suicide risk (tree decision 01, accuracy 0.674, precision 0.652, recall 0.678, specificity 0.670, F measure 0.665, receiver operating characteristic (ROC) area under the curve (AUC) 73.35%; tree decision 02, accuracy 0.669, precision 0.642, recall 0.694, specificity 0.647, F measure 0.667, ROC AUC 68.91%; tree decision 03, accuracy 0.681, precision 0.675, recall 0.638, specificity 0.721, F measure, 0.656, ROC AUC 65.86%; tree decision 04, accuracy 0.714, precision 0.734, recall 0.628, specificity 0.792, F measure 0.677, ROC AUC 58.85%). CONCLUSION This study defines the interactions among a group of variables associated with suicidal ideation and behavior. By using these variables, it may be possible to create a quick and easy-to-use tool. As such, psychotherapeutic interventions could be designed to mitigate the impact of these variables on the emotional state of individuals, thereby reducing eventual risk of suicide. Such interventions may reinforce psychological well-being, feelings of self-worth, and reasons for living, for each individual in certain groups of patients.
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Affiliation(s)
- Susana Morales
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Jorge Barros
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Orietta Echávarri
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Fabián García
- Independent researcher, Avenida José Manso de Velasco 6968, Santiago, Chile
| | - Alex Osses
- Independent researcher, Isla Darwin 8726, Santiago, Chile
| | - Claudia Moya
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Nursery, Universidad San Sebastián, Santiago, Chile
| | - María Paz Maino
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Ronit Fischman
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Catalina Núñez
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Tita Szmulewicz
- Facultad de Medicina, Departamento de Psiquiatría, Depression and Suicidality Research Group, Pontificia Universidad Católica de Chile, Santiago, Chile
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
| | - Alemka Tomicic
- Millennium Institute for Research in Depression and Personality (MIDAP), Depression and Suicidality Research Group, Santiago, Chile
- School of Psychology, Universidad Diego Portales, Santiago, Chile
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119
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Perry SA. Excruciating Mental States. EVOLUTIONARY PSYCHOLOGY 2017. [DOI: 10.1007/978-3-319-60576-0_8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Rajalin M, Hirvikoski T, Salander Renberg E, Åsberg M, Jokinen J. Family history of suicide and interpersonal functioning in suicide attempters. Psychiatry Res 2017; 247:310-314. [PMID: 27951478 DOI: 10.1016/j.psychres.2016.11.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 10/25/2016] [Accepted: 11/22/2016] [Indexed: 12/13/2022]
Abstract
Difficulties in interpersonal relationships are associated with a wide range of psychiatric diagnoses and have been reported as a trigger for suicidal behavior, too. The aim of this study was to examine the relationship between interpersonal problems and family history of suicide in suicide attempters and to describe relevant patterns of interpersonal problems in this patient group. The study involves 181 patients having their clinical follow-up after a suicide attempt. Family history of suicide was assessed by using the Karolinska Self Harm History Interview or retrieved in patient records. The Inventory of Interpersonal Problems was used to assess personal style in an interpersonal context. Suicide attempters with a family history of suicide had significantly more often an intrusive personal style. The results remained significant after adjustment for personality disorder. The specific interpersonal patterns associated with family history of suicide may interfere with the ability to create stable, long-lasting relationships. In regards to treatment, these personal qualities could cause difficulties in the alliance with health care personnel and make it harder for suicide attempters to accept or benefit from treatment. Attention to suicide attempters' interpersonal problems is of importance to lower their distress.
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Affiliation(s)
- Mia Rajalin
- Department of Clinical Sciences, Umeå University, Umeå, Sweden.
| | - Tatja Hirvikoski
- Department of Women's and Children's Health, Paediatric Neuropsychiatry Unit, Center of Neurodevelopmental Disorders at Karolinska Institutet (KIND), Karolinska Institutet, Stockholm, Sweden; Habilitation & Health, Stockholm County Council, Stockholm, Sweden
| | | | - Marie Åsberg
- Department of Clinical Sciences, Danderyd Hospital (KI DS), Stockholm, Sweden
| | - Jussi Jokinen
- Department of Clinical Sciences, Umeå University, Umeå, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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Khanra S, Mahintamani T, Bose S, Khess CRJ, Umesh S, Ram D. Inpatient Suicide in a Psychiatric Hospital: A Nested Case-control Study. Indian J Psychol Med 2016; 38:571-576. [PMID: 28031595 PMCID: PMC5178043 DOI: 10.4103/0253-7176.194914] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE Risk factors for inpatient suicide are different from those in the general population. We examined sociodemographic and clinical variables of patients who committed suicide as an inpatient in a psychiatric hospital in India. METHODS Matched retrospective nested case-control design was adopted. Ten patients who died by suicide as inpatients between 2000 and 2013 were included, along with fifty controls, matched with respect to age, sex, diagnosis, and period of admission. RESULTS Suicide completers were mostly unskilled in occupation (P = 0.03), had a history of past suicide attempts (P < 0.001), shorter duration of hospital stay (P = 0.001), poorer improvement on psychopathology (P = 0.02), and were having more suicidal ideation (P = 0.02). Significantly more completers were receiving antidepressants (P = 0.04). CONCLUSION This study adds to the existing sparse literature on inpatient suicides from Asia. Strength of the study was close matching between case and controls and blindedness. Limitations were retrospective design, and variations in prescription behavior and treatment decisions.
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Affiliation(s)
- Sourav Khanra
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Swarnali Bose
- Department of Clinical Psychology, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | | | - Shreekantiah Umesh
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
| | - Daya Ram
- Department of Psychiatry, Central Institute of Psychiatry, Ranchi, Jharkhand, India
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Jollant F, Near J, Turecki G, Richard-Devantoy S. Spectroscopy markers of suicidal risk and mental pain in depressed patients. Prog Neuropsychopharmacol Biol Psychiatry 2016; 73:S0278-5846(16)30167-1. [PMID: 27984159 DOI: 10.1016/j.pnpbp.2016.10.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE Suicidal behavior has been associated with structural and functional impairments in neuroimaging studies, mainly localized in the prefrontal cortex. However, little is known of the in vivo biochemical alterations that could be markers of suicidal risk. METHODS Proton magnetic resonance spectroscopy was used to measure at-rest levels of 9 metabolites (glutamate, glutamine, glutathione, GABA, N-acetylaspartate (NAA), N-acetylaspartylglutamate, myo-inositol, aspartate, total choline), in the right dorsal prefrontal cortex of 25 unmedicated depressed patients, including 15 with a history of suicidal behavior, and 33 healthy controls. We compared metabolite levels between groups, and run correlations with 9 clinical variables relevant for suicide risk. RESULTS We found very significant associations between NAA levels and psychological pain measured by a simple analog scale (r=-0.47, p<10-3), and between choline levels and current suicidal ideas (r=0.53, p<10-3). These associations were independent from group, gender, age or depression level. While psychological pain and suicidal ideas were highly inter-correlated (r=0.61, p<10-3), the above-mentioned associations with compounds were independent. Mental pain was also correlated with Stroop interference, verbal fluency and (indirectly) decision-making, all cognitive measures previously associated with suicidal risk. Lower NAA levels, and higher glutamine levels were found in suicide attempters and in all patients relative to healthy controls, but these differences did not survive co-variation with age or Bonferroni's correction. CONCLUSION This preliminary study suggests that markers of impaired neuronal and glial functioning in right dorsal prefrontal cortex underlie cardinal symptoms of the suicidal crisis. Targeting this region may be relevant for the short-term suicidal prevention. This study also supports a dimensional perspective in research on suicidal behavior.
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Affiliation(s)
- Fabrice Jollant
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; Department of Psychiatry, Academic Hospital (CHU) Nîmes, France.
| | - Jamie Near
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, Montréal, Québec, Canada
| | - Gustavo Turecki
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
| | - Stéphane Richard-Devantoy
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada
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