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Greydanus DE, Nazeer A, Qayyum Z, Patel DR, Rausch R, Hoang LN, Miller C, Chahin S, Apple RW, Saha G, Prasad Rao G, Javed A. Pediatric suicide: Review of a preventable tragedy. Dis Mon 2024; 70:101725. [PMID: 38480023 DOI: 10.1016/j.disamonth.2024.101725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024]
Abstract
Concepts of suicide are explored in this issue with a focus on suicide in children and adolescents. The epidemiology of pediatric suicide in the United States is reviewed; also, risk and protective factors, as well as prevention strategies, are discussed. Suicide in the pediatric athlete and the potential protective effect of exercise are examined. In addition, this analysis addresses the beneficial role of psychological management as well as current research on pharmacologic treatment and brain stimulation procedures as part of comprehensive pediatric suicide prevention. Though death by suicide in pediatric persons has been and remains a tragic phenomenon, there is much that clinicians, other healthcare professionals, and society itself can accomplish in the prevention of pediatric suicide as well as the management of suicidality in our children and adolescents.
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Affiliation(s)
- Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Ahsan Nazeer
- Division of Child and Adolescent Psychiatry, Sidra Medicine/Weill Cornell Medicine, Doha, Qatar
| | - Zheala Qayyum
- Harvard Medical School, Boston, Massachusetts, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Rebecca Rausch
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Linh-Nhu Hoang
- Western Michigan University, Kalamazoo, MI, United States
| | - Caroline Miller
- Fielding Graduate University, Santa Barbara, CA, United States
| | - Summer Chahin
- Mott Children's Hospital, University of Michigan, Ann Arbor, MI, United States
| | - Roger W Apple
- Division of Pediatric Psychology, Department of Pediatric and Adolescent Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Gautam Saha
- Immediate Past President of the SAARC (South Asian Association for Regional Cooperation) Psychiatric Federation (SPF), India
| | - G Prasad Rao
- President, Asian Federation of Psychiatric Association (AFPA), India
| | - Afzal Javed
- Chairman Pakistan Psychiatric Research Centre, Immediate Past President of the World Psychiatric Association (WPA), Pakistan
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Lee SE, Shin H, Kim G, Moon H, Hur JW. Decreased gray matter volume in regions associated with affective pain processing in unmedicated individuals with nonsuicidal self-injury. Psychiatry Res 2023; 326:115314. [PMID: 37406398 DOI: 10.1016/j.psychres.2023.115314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Revised: 06/14/2023] [Accepted: 06/15/2023] [Indexed: 07/07/2023]
Abstract
Nonsuicidal self-injury (NSSI) has been consistently associated with a reduced aversion to physical pain. Yet, little research has been done to investigate the brain structures related to pain in individuals with NSSI. This study examined gray matter volume patterns of pain processing regions in participants engaging in NSSI (n = 63) and age-, sex-, and handedness-matched healthy controls (n = 63). Voxel-based morphometry was performed to explore gray matter volume in regions of interest (ROIs) and partial correlation analyses were conducted to identify their associations with the frequency, versatility, duration, functions, and pain intensity of self-injury. As a result, significant volume decreases were found in the right anterior insula, bilateral secondary somatosensory cortex (SII), and left inferior frontal gyrus. Moreover, individuals with smaller anterior insula and SII volume showed a higher likelihood of endorsing affect-regulation and sensation-seeking functions of NSSI, as well as engaging in self-injury with a greater perceived intensity of pain. Our results provide the first empirical evidence that individuals with NSSI may exhibit distinct characteristics in brain regions associated with the affective component of pain processing. These neurobiological changes may be associated with their maladaptive response to noxious and painful NSSI experiences.
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Affiliation(s)
- Soo-Eun Lee
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyemin Shin
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Gyumyoung Kim
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Hyeri Moon
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea
| | - Ji-Won Hur
- School of Psychology, Korea University, 145 Anam-ro, Seoul, South Korea.
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Zhao K, Tong S, Hong L, Yang S, Yang W, Xu Y, Fan Z, Zheng J, Yao K, Zheng T. Childhood trauma, peer victimization, and non-suicidal self-injury among Chinese adolescents: a latent variable mediation analysis. BMC Psychiatry 2023; 23:436. [PMID: 37322505 PMCID: PMC10268482 DOI: 10.1186/s12888-023-04848-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 05/05/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Childhood and peer experiences can influence adolescents' perceptions of interpersonal relationships, which can, in turn, influence their emotional states and behavior patterns. Non-suicidal self-injury (NSSI) is now a common problem behavior among adolescents. The present study examined the role of childhood trauma and peer victimization in adolescents' NSSI. METHODS A cross-sectional survey was conducted among 1783 adolescents (1464 girls and 318 boys) in the psychiatric outpatient clinics or wards of 14 psychiatric hospitals or general hospitals in nine provinces in China. Data were collected using the Multidimensional Peer Victimization Scale (MPVS), Short-form Childhood Trauma Questionnaire(CTQ-SF), and Functional Assessment of Self-Mutilation (FASM). Structural equation modeling (SEM) with latent variables was used to demonstrate the mediating role of peer victimization in the association between childhoodtrauma and NSSI. RESULTS The SEM analysis demonstrated that peer victimization plays a partial mediating role in the relationship between childhood trauma and NSSI. In addition, several covariates (such as age, gender, education level, and place of residence) effectively regulated the relationship between peer victimization and NSSI. CONCLUSION In future studies of NSSI among Chinese adolescents, attention should be paid to the roles of childhood trauma and peer bullying; there is a temporal sequence between these two variables and, to some extent, childhood trauma can have an impact on bullying during adolescence which, in turn, influences NSSI behavior.
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Affiliation(s)
- Ke Zhao
- Lishui Second People’s Hospital Afliated to Wenzhou Medical University, Lishui, 323000 China
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, 325000 China
| | - Siyu Tong
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Lan Hong
- The Third Hospital of Quzhou, Quzhou, 324000 China
| | - Shang Yang
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Wenyun Yang
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Yao Xu
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Zilin Fan
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Jiaqi Zheng
- School of Mental Health, Wenzhou Medical University, Wenzhou, 325000 China
| | - Keqing Yao
- Shenzhen Mental Health Center, Shenzhen, Guangdong China
- Shenzhen Kangning Hospital, 77 Zhenbi Road, Pingshan District, Shenzhen, Guangdong 518118 China
| | - Tiansheng Zheng
- The Affiliated Kangning Hospital of Wenzhou Medical University Zhejiang Provincial Clinical Research Center for Mental Disorder, Wenzhou, 325000 China
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姚 珂, 司 夏, 叶 兰. [Advances in the electrophysiological research on neurocognitive function in adolescents with non-suicidal self-injury]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:653-657. [PMID: 37382137 PMCID: PMC10321429 DOI: 10.7499/j.issn.1008-8830.2302080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/10/2023] [Indexed: 06/30/2023]
Abstract
Non-suicidal self-injury (NSSI) is becoming increasingly common in adolescents and seriously affects their physical and mental health, and it is also a major risk factor for suicide among adolescents. NSSI has now become a public health issue of general concern; however, the identification of cognitive dysfunction in NSSI is still based on neuropsychological cognitive assessment and subjective questionnaire assessment, with a lack of objective evaluation indicators. As a method for studying the cognitive neural mechanism of NSSI, electroencephalography is a reliable tool for finding objective biomarkers of NSSI. This article reviews the recent research on electrophysiology associated with cognitive dysfunction in adolescents with NSSI.
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Ho TC, Walker JC, Teresi GI, Kulla A, Kirshenbaum JS, Gifuni AJ, Singh MK, Gotlib IH. Default mode and salience network alterations in suicidal and non-suicidal self-injurious thoughts and behaviors in adolescents with depression. Transl Psychiatry 2021; 11:38. [PMID: 33436537 PMCID: PMC7804956 DOI: 10.1038/s41398-020-01103-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 10/23/2020] [Accepted: 11/10/2020] [Indexed: 12/27/2022] Open
Abstract
Suicidal ideation (SI) and non-suicidal self-injury (NSSI) are two distinct yet often co-occurring risk factors for suicide deaths in adolescents. Elucidating the neurobiological patterns that specifically characterize SI and NSSI in adolescents is needed to inform the use of these markers in intervention studies and to develop brain-based treatment targets. Here, we clinically assessed 70 adolescents-49 adolescents with depression and 21 healthy controls-to determine SI and NSSI history. Twenty-eight of the depressed adolescents had a history of SI and 29 had a history of NSSI (20 overlapping). All participants underwent a resting-state fMRI scan. We compared groups in network coherence of subdivisions of the central executive network (CEN), default mode network (DMN), and salience network (SN). We also examined group differences in between-network connectivity and explored brain-behavior correlations. Depressed adolescents with SI and with NSSI had lower coherence in the ventral DMN compared to those without SI or NSSI, respectively, and healthy controls (all ps < 0.043, uncorrected). Depressed adolescents with NSSI had lower coherence in the anterior DMN and in insula-SN (all ps < 0.030, uncorrected), and higher CEN-DMN connectivity compared to those without NSSI and healthy controls (all ps < 0.030, uncorrected). Lower network coherence in all DMN subnetworks and insula-SN were associated with higher past-month SI and NSSI (all ps < 0.001, uncorrected). Thus, in our sample, both SI and NSSI are related to brain networks associated with difficulties in self-referential processing and future planning, while NSSI specifically is related to brain networks associated with disruptions in interoceptive awareness.
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Affiliation(s)
- Tiffany C Ho
- Department of Psychiatry and Behavioral Sciences; Weill Institute for Neurosciences, University of California, San Francisco, San Francisco, CA, USA.
| | - Johanna C Walker
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Giana I Teresi
- Department of Psychology, Stanford University, Stanford, CA, USA
| | - Artenisa Kulla
- Department of Psychology, Stanford University, Stanford, CA, USA
| | | | - Anthony J Gifuni
- Department of Psychology, Stanford University, Stanford, CA, USA
- Department of Psychiatry and Douglas Mental Health University Institute, McGill University, Montreal, QC, Canada
| | - Manpreet K Singh
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, USA
| | - Ian H Gotlib
- Department of Psychology, Stanford University, Stanford, CA, USA
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Santamarina-Perez P, Romero S, Mendez I, Leslie SM, Packer MM, Sugranyes G, Picado M, Font E, Moreno E, Martinez E, Morer A, Romero M, Singh MK. Fronto-Limbic Connectivity as a Predictor of Improvement in Nonsuicidal Self-Injury in Adolescents Following Psychotherapy. J Child Adolesc Psychopharmacol 2019; 29:456-465. [PMID: 31225733 DOI: 10.1089/cap.2018.0152] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objectives: Key neurobiological factors contribute to vulnerability to nonsuicidal self-injury (NSSI) among adolescents and how they respond to treatment targeted to reduce such behaviors. This study aims to examine differences in intrinsic functional connectivity between adolescents with NSSI and healthy controls (HCs) and to identify baseline connectivity markers that predict improvements in NSSI after psychotherapy. Methods: Adolescents aged 12-17 (n = 24) with repetitive NSSI along with demographically similar HCs (n = 16) underwent resting-state functional MRI scanning after which patients received up to 4 months of psychological treatment. A seed-based approach was used to examine baseline between-group differences in intrinsic functional connectivity of the amygdala and the medial prefrontal cortex (mPFC). Further analyses examined the associations between intrinsic functional connectivity at baseline and improvement in NSSI after psychological treatment. Results: Compared with HCs, adolescents with NSSI showed significantly reduced connectivity between the amygdala and the anterior cingulate cortex, subcallosal cortex, and paracingulate gyrus, as well as between the amygdala and a cluster encompassing the right planum temporale and right insula. Adolescents with NSSI, compared with HCs, also showed reduced connectivity between the mPFC and two clusters: one located in the precentral and postcentral gyri and another in the left insula. After treatment, 50% of patients reported fewer NSSI episodes compared to baseline, which was considered as improvement. Stronger negative amygdala-prefrontal connectivity was associated with greater posttreatment improvement in NSSI. Conclusions: Adolescents with NSSI may have aberrant amygdala and mPFC connectivity compared with HCs. Furthermore, stronger baseline negative amygdala-prefrontal connectivity may predict greater improvement in NSSI after psychological intervention. Given that no prior study has used resting-state functional connectivity to predict response to psychological treatment in adolescents with NSSI, replication of these findings is needed.
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Affiliation(s)
- Pilar Santamarina-Perez
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Soledad Romero
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- 2Biomedical Research Networking Centre Consortium (CIBERSAM), Madrid, Spain
| | - Iria Mendez
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Sara M Leslie
- 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Mary M Packer
- 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
| | - Gisela Sugranyes
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- 2Biomedical Research Networking Centre Consortium (CIBERSAM), Madrid, Spain
- 4August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Marisol Picado
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Elena Font
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Elena Moreno
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Esteve Martinez
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Astrid Morer
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
- 2Biomedical Research Networking Centre Consortium (CIBERSAM), Madrid, Spain
- 4August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Miguel Romero
- 1Department of Child and Adolescent Psychiatry and Psychology, 2017SGR88, Institute of Neurosciences, Hospital Clinic, Barcelona, Spain
| | - Manpreet K Singh
- 3Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California
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Kaniuka AR, Kelliher-Rabon J, Chang EC, Sirois FM, Hirsch JK. Symptoms of Anxiety and Depression and Suicidal Behavior in College Students: Conditional Indirect Effects of Non-Suicidal Self-Injury and Self-Compassion. JOURNAL OF COLLEGE STUDENT PSYCHOTHERAPY 2019. [DOI: 10.1080/87568225.2019.1601048] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
| | | | - Edward C. Chang
- Department of Psychology, University of Sheffield, Sheffield, UK
| | - Fuschia M. Sirois
- Department of Psychology, University of Michigan, Ann Arbor, Michigan, USA
| | - Jameson K. Hirsch
- Department of Psychology, East Tennessee State University, Johnson City, Tennessee
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Brown RC, Plener PL, Braehler E, Fegert JM, Huber-Lang M. Associations of adverse childhood experiences and bullying on physical pain in the general population of Germany. J Pain Res 2018; 11:3099-3108. [PMID: 30584352 PMCID: PMC6287510 DOI: 10.2147/jpr.s169135] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Background Chronic pain is a frequent burden in the general population. Child maltreatment and bullying are risk factors for the development of chronic pain. Aim of this cross-sectional study was to investigate the association of child maltreatment and bullying and pain experiences in a representative sample of the general population. Materials and methods A total of N=2,491 people from the general population of Germany participated in the study (Mage=48.3 years [SD=18.2], 53.2 % female). Child maltreatment was assessed with the Childhood Trauma Questionnaire (CTQ), pain was rated with the Polytrauma Outcome (POLO)-physical state domain, depression scores were assessed with the Patient Health Questionnaire, and anxiety scores via the General Anxiety Disorder Questionnaire. Regression analyses were calculated to investigate the effect of bullying and child maltreatment, as well as depression, anxiety, and gender on pain experiences. Results A significant correlation between increasing pain levels and number of adverse childhood experiences was found. With regard to specific types of maltreatment, largest effect sizes were found for emotional abuse. Bullying was significantly, but overall rather moderately, related to pain suffering. In women, all forms of maltreatment were associated with pain, while in men only sexual and physical abuse revealed significant effects. Although depression and anxiety scores were significantly associated with the experience of current pain, they did not change the effect of child maltreatment on pain significantly. Conclusion In this sample of the general population, adverse childhood experiences were significantly associated with pain and showed cumulative effects, over and above depressive and anxiety symptoms.
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Affiliation(s)
- Rebecca C Brown
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany,
| | - Paul L Plener
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany, .,Department of Child and Adolescent Psychiatry, Medical University of Vienna, Vienna, Austria
| | - Elmar Braehler
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center of The Johannes Gutenberg University of Mainz, Mainz, Germany.,University of Leipzig, Department of Medical Psychology and Medical Sociology, Leipzig, Germany
| | - Joerg M Fegert
- Department of Child and Adolescent Psychiatry/Psychotherapy, University of Ulm, Ulm, Germany,
| | - Markus Huber-Lang
- Institute of Clinical and Experimental Trauma-Immunology, University of Ulm, Ulm, Germany
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Few LR, Grant JD, Nelson EC, Trull TJ, Grucza RA, Bucholz KK, Verweij KJH, Martin NG, Statham DJ, Madden PAF, Heath AC, Lynskey MT, Agrawal A. Cannabis Involvement and Nonsuicidal Self-Injury: A Discordant Twin Approach. J Stud Alcohol Drugs 2017; 77:873-880. [PMID: 27797688 DOI: 10.15288/jsad.2016.77.873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE Cannabis use, particularly at an early age, has been linked to suicidal thoughts and behavior, but minimal work has examined the association between cannabis use and lifetime nonsuicidal self-injury (NSSI). The current study aims to characterize the overlap between lifetime and early cannabis use and NSSI and to examine genetic and environmental mechanisms of this association. METHOD Adult male and female twins from the Australian Twin Registry (N = 9,583) were used to examine the odds of NSSI associated with lifetime cannabis use and early cannabis use (i.e., <17 years of age). These associations were also examined within monozygotic (MZ) twins discordant for cannabis use and MZ twins discordant for early cannabis use. Analyses were replicated in an independent sample of female twins (n = 3,787) accounting for the age at onset of cannabis use and NSSI. RESULTS Lifetime cannabis use (odds ratio [OR] = 2.84, 95% CI [2.23, 3.61]) and early cannabis use were associated with increased odds of NSSI (OR = 2.15, 95% CI [1.75, 2.65]), and this association remained when accounting for covariates. The association was only significant, however, in MZ twin pairs discordant for early cannabis use (OR = 3.20, 95% CI [1.17, 8.73]). Replication analyses accounting for the temporal ordering of cannabis use and NSSI yielded similar findings of nominal significance. CONCLUSIONS Results suggest that NSSI is associated with cannabis involvement via differing mechanisms. For lifetime cannabis use, the lack of association in discordant pairs suggests the role of shared genes and family environment. However, in addition to such shared familial influences, person-specific and putatively causal factors contribute to the relationship between early cannabis use and NSSI. Therefore, delaying the onset of cannabis use may reduce exposure to influences that exacerbate vulnerabilities to NSSI.
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Affiliation(s)
- Lauren R Few
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Julia D Grant
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Elliot C Nelson
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Timothy J Trull
- Department of Psychological Sciences, University of Missouri, Columbia, Missouri
| | - Richard A Grucza
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Kathleen K Bucholz
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Karin J H Verweij
- Department of Biological Psychology, VU University Amsterdam, Amsterdam, The Netherlands
| | - Nicholas G Martin
- QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Dixie J Statham
- School of Social Sciences, University of the Sunshine Coast, Sippy Downs, Queensland, Australia
| | - Pamela A F Madden
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Andrew C Heath
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
| | - Michael T Lynskey
- Addictions Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Arpana Agrawal
- Department of Psychiatry, Washington University School of Medicine, St. Louis, Missouri
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Abstract
Nonsuicidal self-injury (NSSI) is more common in adolescent and young adult populations than in the past. NSSI is typically used to deal with distressing negative affective states, especially anger and depression, and mixed emotional states. Pediatricians; primary care, family medicine, and emergency room physicians; and mental health professionals are faced with the charge of responding to NSSI behaviors among patients. Physicians in family medicine, pediatrics, and primary care settings play an essential role in initiating the beginning step in the treatment process for those who self-injure. All providers can strengthen the care provided to those who engage in NSSI via assessing the risk accurately, understanding the functions of the behavior, and assisting the patient in connecting with treatment. This article provides medical and mental health professionals with an overview of intervention strategies that may be useful when counseling adolescents and their families. In addition, areas for continued research are discussed.
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Affiliation(s)
- Shannon Lovell
- Ochsner Medical Center Psychiatry Department, New Orleans, LA, USA Tulane School of Social Work, New Orleans, LA, USA
| | - Marvin Clifford
- Ochsner Medical Center Psychiatry Department, New Orleans, LA, USA Tulane School of Social Work, New Orleans, LA, USA
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Osuch E, Ford K, Wrath A, Bartha R, Neufeld R. Functional MRI of pain application in youth who engaged in repetitive non-suicidal self-injury vs. psychiatric controls. Psychiatry Res 2014; 223:104-12. [PMID: 24882678 DOI: 10.1016/j.pscychresns.2014.05.003] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2013] [Revised: 02/19/2014] [Accepted: 05/04/2014] [Indexed: 02/08/2023]
Abstract
Non-suicidal self-injury (NSSI) is increasingly common in young psychiatric patients. It is unclear why pain, which should be aversive, becomes reinforcing in this context. We hypothesized that pain- and/or reward-processing neurocircuitry would be abnormal in NSSI patients compared with non-NSSI patients. Using functional magnetic resonance imaging, we administered a painfully cold and comparison cool stimulus under two conditions: self-administered and experimenter-administered (as a control). Participants comprised 13 NSSI patients and 15 non-NSSI control patients, who were matched for sex, age, medications, symptoms, and diagnoses. Whole-brain analyses of main effects, as well as correlational analyses with subjective pain and "relief" (suggesting reward), were performed. Significant main effects of group showed greater blood oxygenation level-dependent (BOLD) response for NSSI than controls in right midbrain/pons; culmen; amygdala; and parahippocampal, inferior frontal and superior temporal gyri; as well as orbital frontal cortex (OFC). The correlation between BOLD signal and "relief" was greater in NSSI patients in areas associated with reward/pain and addiction including thalamus, dorsal striatum and anterior precuneus. Post hoc analysis showed reduced functional connectivity between right OFC and anterior cingulate cortex in NSSI youth, implying possible deficits in the neuroregulation of emotional behavior. These findings help inform how pain is associated with reward for NSSI patients but not for non-NSSI patients.
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Affiliation(s)
- Elizabeth Osuch
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada N6A 4G5; Department of Medical Biophysics, University of Western Ontario, London, ON, Canada.
| | - Kristen Ford
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada N6A 4G5
| | - Andrew Wrath
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada N6A 4G5
| | - Robert Bartha
- Department of Medical Biophysics, University of Western Ontario, London, ON, Canada
| | - Richard Neufeld
- Department of Psychiatry, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada N6A 4G5; Department of Psychology, University of Western Ontario, London, ON, Canada; Program in Neuroscience, University of Western Ontario, London, ON, Canada
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Bheamadu C, Fritz E, Pillay J. The Experiences of Self-Injury Amongst Adolescents and Young Adults within a South African Context. JOURNAL OF PSYCHOLOGY IN AFRICA 2014. [DOI: 10.1080/14330237.2012.10820528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Plener PL, Bubalo N, Fladung AK, Ludolph AG, Lulé D. Prone to excitement: adolescent females with Non-suicidal self-injury (NSSI) show altered cortical pattern to emotional and NSS-related material. Psychiatry Res 2012; 203:146-52. [PMID: 22901627 DOI: 10.1016/j.pscychresns.2011.12.012] [Citation(s) in RCA: 69] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 11/16/2011] [Accepted: 12/18/2011] [Indexed: 10/28/2022]
Abstract
Emotion-regulation difficulties have been identified as one of the core components in Non-suicidal self-injury (NSSI), a behaviour often beginning in adolescence. This pilot study evaluated differences in emotion processing between 18 female adolescents with and without NSSI by using verbal responses and functional magnetic resonance imaging (fMRI). Responses to pictures taken from the International Affective Picture System and slides with reference to NSSI were recorded both by verbal rating of valence and arousal and by fMRI. The NSSI group rated pictures with self-injurious reference as significantly more arousing than controls. For emotional pictures, the NSSI group showed a significantly stronger brain response in the amygdala, hippocampus and anterior cingulate cortex bilaterally. Depression explained differences between groups in the limbic area. Furthermore, the NSSI group also showed increased activity in the middle orbitofrontal cortex, and inferior and middle frontal cortex when viewing NSSI picture material. Participants with NSSI showed decreased activity in correlation to arousal in the occipital cortex and to valence in inferior frontal cortex when watching emotional pictures. The fMRI data support the notion that individuals with NSSI show an altered neural pattern for emotional and NSSI pictures. Behavioural data highlight proneness to excitement regarding NSSI topics. This fMRI study provides evidence for emotion-regulation deficits in the developing brain of adolescents with NSSI.
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Affiliation(s)
- Paul L Plener
- Department of Child and Adolescent Psychiatry and Psychotherapy, University of Ulm, Ulm, Germany
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Symons FJ. Self-injurious behavior in neurodevelopmental disorders: relevance of nociceptive and immune mechanisms. Neurosci Biobehav Rev 2011; 35:1266-74. [PMID: 21237197 PMCID: PMC3086601 DOI: 10.1016/j.neubiorev.2011.01.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Revised: 01/03/2011] [Accepted: 01/05/2011] [Indexed: 01/09/2023]
Abstract
Self-injurious behavior (SIB) among individuals with intellectual and related neurodevelopmental disorders (IDD) is a clinical challenge and scientific puzzle. The physiological mechanisms regulating the sensory components of SIB remain a mystery with no clear understanding of the underlying pathophysiology. The central dogma regarding sensory processing in general and pain in particular among individuals with IDD and chronic SIB is that sensory processing is reduced and pain is absent or blunted. In this paper, recent findings challenging some of the conventional wisdom regarding pain and sensory function among individuals with IDD and SIB are reviewed. It seems that at least a subgroup of individuals with IDD and chronic SIB may be in a physiological state similar to neuropathic pain in which hyperalgesia is mediated by plasticity mechanisms regulating inflammatory, immune, and nociceptive systems. In response to repeated tissue damage associated with chronic self-injury, innate immune cells may be producing pro-inflammatory and pro-nociceptive cytokines that act on the brain to cause sickness-like behavior and sensitize primary sensory nerve afferents contributing to pain hypersensitivity (i.e., hyperalgesia).
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Affiliation(s)
- Frank J Symons
- Center for Neurobehavioral Development, Department of Educational Psychology, 56 River Road Education Sciences Building, University of Minnesota, Minneapolis, MN 55455, USA.
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