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Petersén E, Augustsson H, Berman AH. Problematic substance use among patients in a Swedish outpatient psychiatry setting: staff and manager perceptions of digital options for increased intervention access. Addict Sci Clin Pract 2023; 18:65. [PMID: 37875999 PMCID: PMC10594773 DOI: 10.1186/s13722-023-00421-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 10/16/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND Approximately 50% of the patients who globally seek help in psychiatry have been assessed with problematic substance use or been diagnosed with substance use disorder (SUD). Given the high treatment gap for mental health care, in particular SUD, these individuals risk poorer treatment outcomes in psychiatry. Integrated treatment for psychiatric and SUD disorders has been proposed to reduce the treatment gap for SUD, but access to integrated treatment is low. Digital interventions addressing SUD in psychiatry could potentially make treatment available to patients who otherwise would not have access. In this study "digital interventions" comprise an umbrella term covering all kinds of interventions from minimal motivational app-based interventions to internet-based interventions with and without human guidance, up to remote sessions in telepsychiatry. This study aims to explore healthcare staff perceptions of referring patients to digital interventions for reducing problematic substance use, whether or not diagnosed as SUD, in the psychiatric outpatient setting. METHOD The study was exploratory with a qualitative design. Data were collected in the Swedish outpatient psychiatry setting, via individual semi-structured interviews with managers, and focus groups with healthcare staff. An adapted form of phenomenological hermeneutical analysis was used to analyze the data. RESULTS Three themes emerged from the analysis. The first theme was Encountering obstacles on the path to future implementation of digital interventions, with sub-themes: Lacking resources and Feeling concerned about technical solutions. The second theme was Searching for ways forward to achieve increased access to care, with sub-themes: Blended care could facilitate integrated care and Addressing variations in patients' technical skills. The third theme was Taking steps towards the future, with sub-themes: Wanting to know more about digital interventions and Formulating a vision for the future. CONCLUSIONS The study reveals a concern that implementing digital interventions in psychiatry will create additional work or be technically challenging. The staff see significant advantages from the patient perspective, but they feel that they themselves need training in implementing digital interventions. In order to establish constructive implementation of digital interventions for SUD in psychiatry, staff attitudes and concerns need to be considered and addressed. This study was conducted within the Swedish healthcare system and the findings may not generalize to other countries with differing healthcare systems.
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Affiliation(s)
- Elisabeth Petersén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm, Sweden.
| | - Hanna Augustsson
- Procome Research Group, Medical Management Centre, Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
| | - Anne H Berman
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden
- Department of Psychology, Uppsala University, Uppsala, Sweden
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Xu X, Xu Z, Zhou F, Chen L, Li H, Niculescu M, Shen G, Wu L, Wang W, Chen L, Liu Y, He J, Wang F, Yang F. RETN gene polymorphisms interact with alcohol dependence in association with depression. J Clin Lab Anal 2023; 37:e24933. [PMID: 37387262 PMCID: PMC10431411 DOI: 10.1002/jcla.24933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 03/27/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Previous studies suggest that alcohol dependence is associated with increased risk of depression. The occurrence of depressive symptoms is related to polymorphisms in various genetic regions. This study aimed to investigate the interaction of RETN gene polymorphisms (rs1477341, rs3745368) with alcohol dependence on depressive symptoms in adult male during acute alcohol withdrawal. METHODS A total of 429 male adults were recruited in this study. Alcohol dependence was assessed using the Michigan alcoholism screening test (MAST). Depression was assessed using the 20-item self-rating depression scale (SDS). Hierarchical regression analysis was used to evaluate the interaction between genes and alcohol dependence on depression. Region of significance (ROS) test was used to explain the interaction effect. The strong and weak forms of the differential susceptibility and diathesis models were used to determine which fits the data better. RESULTS Our results showed that MAST scores were significantly positively associated with SDS scores (r = 0.23, p < 0.01) in alcohol-dependent patients during alcohol withdrawal. The interaction between genotype and alcohol dependence was significant (β = -0.14, p < 0.05) in a strong diathesis-stress model. Susceptibility for depression symptoms was associated with alcohol dependence in RETN rs1477341 A carriers. Specifically, those that showed more alcohol dependence and the A allele of RETN rs1477341 exhibited more depression symptoms. However, RETN rs3745368 had no significant interaction with alcohol dependence. CONCLUSIONS The A allele of RETN rs1477341 may correlate with susceptibility to depression symptoms in alcohol-dependent individuals during acute alcohol withdrawal.
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Affiliation(s)
- Xiaoyan Xu
- Huzhou Third People's HospitalZhejiangChina
| | - Zeping Xu
- Department of Pharmacy, Ningbo Medical Treatment CenterLi Huili HospitalNingboChina
| | - Fan Zhou
- Department of PediatricsThe Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical UniversityWenzhouChina
| | - Lijing Chen
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Huai Li
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Michelle Niculescu
- Department of Social SciencesChatham UniversityPittsburghPennsylvaniaUSA
| | - Guanghui Shen
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Liujun Wu
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
- Applied Psychology (Ningbo) Research CenterWenzhou Medical UniversityNingboChina
| | - Wei Wang
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Li Chen
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Yanlong Liu
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Jue He
- School of Mental HealthWenzhou Medical UniversityWenzhouChina
| | - Fan Wang
- Beijing Hui‐Long‐Guan HospitalPeking UniversityBeijingChina
- Medical Neurobiology LabInner Mongolia Medical UniversityHuhhotChina
| | - Fan Yang
- The Affiliated Kangning HospitalWenzhou Medical UniversityWenzhouChina
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3
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Sher L, Challman KN, Smith EC, New AS, Perez-Rodriguez MM, McClure MM, Goodman M, Kahn RS, Hazlett EA. Clinical features of individuals with schizotypal personality disorder with and without suicidal ideation. Psychiatry Res 2023; 322:115132. [PMID: 36841053 DOI: 10.1016/j.psychres.2023.115132] [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: 12/13/2022] [Revised: 02/17/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
This study compared demographic and clinical features in a sample of 384 participants: healthy controls (HC; n = 166) and individuals with schizotypal personality disorder (SPD) with (n = 50) and without (n = 168) suicidal ideation (SI) to examine specific risk factors for suicidality in SPD. Compared to the non-SI group, the SI group showed significantly greater severity of depression, aggression, impulsivity, affective lability, schizotypal features, poorer social adjustment, and had fewer social contacts. Individuals in the SI group were also more likely to have a history of a suicide attempt and comorbid borderline personality disorder in comparison to the non-SI group. Logistic regression analysis indicated that severity of depression and the number of social contacts drove the difference between the SI and non-SI groups. Compared with both SPD subgroups, the HC group was significantly less depressed, aggressive, impulsive, affectively labile, had fewer schizotypal features, was better socially adjusted, and had more social contacts. This study indicates that overall, the SI group is a more severely impaired group of individuals with SPD compared to the non-SI group. Better educating medical professionals about the diagnosis and management of SPD and its associations with suicidality is warranted.
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Affiliation(s)
- Leo Sher
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States.
| | - Katelyn N Challman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Emma C Smith
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Antonia S New
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | | | | | - Marianne Goodman
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - René S Kahn
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Erin A Hazlett
- James J. Peters VA Medical Center, Bronx, NY, United States; Icahn School of Medicine at Mount Sinai, New York, NY, United States
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Lee MS, Lee H. Associations between binge drinking experience, depressive mood, and suicidality in adolescents: Based on the 2021 Korea Youth Risk Behavior Web-based Survey. J Affect Disord 2023; 323:386-391. [PMID: 36462612 DOI: 10.1016/j.jad.2022.11.086] [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: 09/27/2022] [Revised: 11/21/2022] [Accepted: 11/25/2022] [Indexed: 12/02/2022]
Abstract
BACKGROUND This study aimed to investigate the associations between binge drinking experience (BDE), depressive mood, and suicidality among Korean adolescents. METHODS We analyzed the 17th population-based and cross-sectional data from the Korean Youth Risk Behavior Web-based Survey. Multiple logistic regression analysis was performed to compare BDE, depressive mood, and suicidality by sex. RESULTS In 54,848 adolescents, the prevalence of BDE was 5.3 % in boys and 4.4 % in girls. The prevalence of suicidal ideation, plans, and attempts among girls was 7.8 %, 2.4 %, and 1.4 %, respectively. The prevalence of suicide attempts among girls with both BDE and depressive moods was higher than that among boys. Boys with both BDE and depressive mood had 12.60 times and 14.50 times higher adjusted odds ratio (aOR) of suicide ideation and plan, respectively, compared with the non-drinking/non-depressed group. Girls with both BDE and depressive mood had 22.06 times higher aOR of suicide attempts than the non-drinking/non-depressed group. LIMITATIONS The study has few limitations including the use of self-report questionnaires, participants' response bias, and lack of diagnosis by mental health professionals. CONCLUSIONS These findings represent the prevalence of suicidality among South Korean adolescents with BDE or depressive mood. Since adolescents with both BDE and depressive mood showed particularly high suicidality, it is necessary to establish mental health services, such as proper prevention strategies and targeted interventions.
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Affiliation(s)
- Mi-Sun Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea
| | - Hooyeon Lee
- Department of Preventive Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, Republic of Korea.
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Saunders JM, Muguruza C, Sierra S, Moreno JL, Callado LF, Meana JJ, Beardsley PM, González-Maeso J. Glucocorticoid receptor dysregulation underlies 5-HT 2AR-dependent synaptic and behavioral deficits in a mouse neurodevelopmental disorder model. J Biol Chem 2022; 298:102481. [PMID: 36100039 DOI: 10.1016/j.jbc.2022.102481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/01/2022] [Accepted: 09/03/2022] [Indexed: 11/25/2022] Open
Abstract
Prenatal environmental insults increase the risk of neurodevelopmental psychiatric conditions in the offspring. Structural modifications of dendritic spines are central to brain development and plasticity. Using maternal immune activation (MIA) as a rodent model of prenatal environmental insult, previous results have reported dendritic structural deficits in the frontal cortex. However, very little is known about the molecular mechanism underlying MIA-induced synaptic structural alterations in the offspring. Using prenatal (E12.5) injection with poly-(I:C) as a mouse MIA model, we show here that upregulation of the serotonin 5-HT2A receptor (5-HT2AR) is at least in part responsible for some of the effects of prenatal insults on frontal cortex dendritic spine structure and sensorimotor gating processes. Mechanistically, we report that this upregulation of frontal cortex 5-HT2AR expression is associated with MIA-induced reduction of nuclear translocation of the glucocorticoid receptor (GR) and, consequently, a decrease in the enrichment of GR at the 5-HT2AR promoter. The translational significance of these preclinical findings is supported by data in postmortem human brain samples suggesting dysregulation of GR translocation in frontal cortex of schizophrenia subjects. We also found that repeated corticosterone administration augmented frontal cortex 5-HT2AR expression and reduced GR binding to the 5-HT2AR promoter. However, virally (AAV)-mediated augmentation of GR function reduced frontal cortex 5-HT2AR expression and improved sensorimotor gating processes via 5-HT2AR. Together, these data support a negative regulatory relationship between GR signaling and 5-HT2AR expression in the mouse frontal cortex that may carry implications for the pathophysiology underlying 5-HT2AR dysregulation in neurodevelopmental psychiatric disorders.
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Affiliation(s)
- Justin M Saunders
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Carolina Muguruza
- Department of Pharmacology, University of the Basque Country UPV/EHU, CIBERSAM, Biocruces Bizkaia Health Research Institute, E-48940 Leioa, Bizkaia, Spain
| | - Salvador Sierra
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - José L Moreno
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA
| | - Luis F Callado
- Department of Pharmacology, University of the Basque Country UPV/EHU, CIBERSAM, Biocruces Bizkaia Health Research Institute, E-48940 Leioa, Bizkaia, Spain
| | - J Javier Meana
- Department of Pharmacology, University of the Basque Country UPV/EHU, CIBERSAM, Biocruces Bizkaia Health Research Institute, E-48940 Leioa, Bizkaia, Spain
| | - Patrick M Beardsley
- Department of Pharmacology and Toxicology, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA; Center for Biomarker Research and Precision Medicine, Virginia Commonwealth University School of Pharmacy, Richmond, VA 23298, USA
| | - Javier González-Maeso
- Department of Physiology and Biophysics, Virginia Commonwealth University School of Medicine, Richmond, VA 23298, USA.
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Karabatsiakis A, de Punder K, Salinas-Manrique J, Todt M, Dietrich DE. Hair cortisol level might be indicative for a 3PM approach towards suicide risk assessment in depression: comparative analysis of mentally stable and depressed individuals versus individuals after completing suicide. EPMA J 2022; 13:383-395. [PMID: 36061827 PMCID: PMC9425778 DOI: 10.1007/s13167-022-00296-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 08/10/2022] [Indexed: 11/24/2022]
Abstract
Depression and suicidal behavior are interrelated, stress-associated mental health conditions, each lacking biological verifiability. Concepts of predictive, preventive, and personalized medicine (3PM) are almost completely missing for both conditions but are of utmost importance. Prior research reported altered levels of the stress hormone cortisol in the scalp hair of depressed individuals, however, data on hair cortisol levels (HCL) for suicide completers (SC) are missing. Here, we aimed to identify differences in HCL between subject with depression (n = 20), SC (n = 45) and mentally stable control subjects (n = 12) to establish the usage of HCL as a new target for 3PM. HCL was measured in extracts of pulverized hair (1-cm and 3-cm hair segments) using ELISA. In 3-cm hair segments, an average increase in HCL for depressed patients (1.66 times higher; p = .011) and SC (5.46 times higher; p = 1.65 × 10−5) compared to that for controls was observed. Furthermore, the average HCL in SC was significantly increased compared to that in the depressed group (3.28 times higher; p = 1.4 × 10−5). A significant correlation between HCL in the 1-cm and the 3-cm hair segments, as well as a significant association between the severity of depressive symptoms and HCL (3-cm segment) was found. To conclude, findings of increased HCL in subjects with depression compared to that in controls were replicated and an additional increase in HCL was seen in SC in comparison to patients with depression. The usage of HCL for creating effective patient stratification and predictive approach followed by the targeted prevention and personalization of medical services needs to be validated in follow-up studies.
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Affiliation(s)
- Alexander Karabatsiakis
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Karin de Punder
- Department of Clinical Psychology II, Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | | | - Melanie Todt
- Institutes for Forensic Medicine, Hannover Medical School, Hannover, Germany
| | - Detlef E. Dietrich
- AMEOS Clinic for Psychiatry and Psychotherapy, Hildesheim, Germany
- Department of Psychiatry, Social Psychiatry and Psychotherapy, Hannover Medical School, Hannover, Germany
- Center for Systems Neuroscience Hannover, Hannover Medical School, Hannover, Germany
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Ramos-Rosales D, Méndez-Hernández E, Salas-Pacheco J, Salas-Leal A, Urtiz-Estrada N, Barraza-Salas M. Differential Expression of HTR2A and MAOA Genes in the Prefrontal Cortex and Hypothalamus of Suicide Victims from Mexican Population. Neurosci Lett 2022; 778:136611. [DOI: 10.1016/j.neulet.2022.136611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 03/23/2022] [Accepted: 03/28/2022] [Indexed: 11/16/2022]
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8
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Wiström ED, O'Connell KS, Karadag N, Bahrami S, Hindley GFL, Lin A, Cheng W, Steen NE, Shadrin A, Frei O, Djurovic S, Dale AM, Andreassen OA, Smeland OB. Genome-wide analysis reveals genetic overlap between alcohol use behaviours, schizophrenia and bipolar disorder and identifies novel shared risk loci. Addiction 2022; 117:600-610. [PMID: 34472679 DOI: 10.1111/add.15680] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 08/18/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM Schizophrenia (SCZ) and bipolar disorder (BD) have a high comorbidity of alcohol use disorder (AUD), and both comorbid AUD and excessive alcohol consumption (AC) have been linked to greater illness severity. We aimed to identify genomic loci jointly associated with SCZ, BD, AUD and AC to gain further insights into their shared genetic architecture. DESIGN We analysed summary data (P values and Z scores) from genome-wide association studies (GWAS) using conjunctional false discovery rate (conjFDR) analysis, which increases power to discover shared genomic loci. We functionally characterized the identified loci using publicly available biological resources. SETTING AUD and AC data provided by the Million Veteran Program, derived from the United States Department of Veterans Affairs Healthcare System. SCZ and BD data provided by the Psychiatric Genomics Consortium, based on cohorts from countries in Europe, North America and Australia. PARTICIPANTS AUD (34 658 cases, 167 346 controls), AC (n = 200 680), SCZ (31 013 cases and 38 918 controls), BD (20 352 cases and 31 358 controls). All participants were of European ancestry. MEASUREMENTS Genomic loci shared between alcohol traits, SCZ and BD at conjFDR <0.05. FINDINGS Conditional Q-Q plots showed single-nucleotide polymorphism (SNP) enrichment for both alcohol traits across different levels of significance with SCZ and BD, and vice versa. Using conjFDR analysis we leveraged this genetic enrichment and identified several loci shared between SCZ and AUD (n = 28) and AC (n = 24), BD and AUD (n = 2) and AC (n = 8) at conjFDR <0.05. Among these loci, 24 are novel for AUD, 15 are novel for AC, three are novel for SCZ and one is novel for BD. There was a mixture of same and opposite effect directions among the shared loci. CONCLUSIONS Alcohol use disorder and alcohol consumption share genomic loci with the psychiatric disorders schizophrenia and bipolar disorder with a mixed pattern of effect directions, indicating a complex genetic relationship between the phenotypes.
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Affiliation(s)
- Erik D Wiström
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kevin S O'Connell
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Naz Karadag
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Shahram Bahrami
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Guy F L Hindley
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Aihua Lin
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Weiqiu Cheng
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Alexey Shadrin
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Oleksandr Frei
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Center for Bioinformatics, Department of Informatics, University of Oslo, Oslo, Norway
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway.,NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Anders M Dale
- Department of Radiology, University of California San Diego, La Jolla, CA, USA.,Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, USA.,Department of Psychiatry, University of California, La Jolla, CA, USA.,Department of Neurosciences, University of California San Diego, La Jolla, CA, USA
| | - Ole A Andreassen
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Olav B Smeland
- NORMENT, Centre for Mental Disorders Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,NORMENT, Centre for Mental Disorders Research, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Girasek H, Nagy VA, Fekete S, Ungvari GS, Gazdag G. Prevalence and correlates of aggressive behavior in psychiatric inpatient populations. World J Psychiatry 2022; 12:1-23. [PMID: 35111577 PMCID: PMC8783168 DOI: 10.5498/wjp.v12.i1.1] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/18/2021] [Accepted: 11/25/2021] [Indexed: 02/06/2023] Open
Abstract
Aggressive behavior in patients with psychiatric disorders is attracting increasing research interest. One reason for this is that psychiatric patients are generally considered more likely to be aggressive, which raises a related question of whether diagnoses of psychiatric disorders predict the prevalence of aggressive behavior. Predicting aggression in psychiatric wards is crucial, because aggressive behavior not only endangers the safety of both patients and staff, but it also extends the hospitalization times. Predictions of aggressive behavior also need careful attention to ensure effective treatment planning. This literature review explores the relationship between aggressive behavior and psychiatric disorders and syndromes (dementia, psychoactive substance use, acute psychotic disorder, schizophrenia, bipolar affective disorder, major depressive disorder, obsessive-compulsive disorder, personality disorders and intellectual disability). The prevalence of aggressive behavior and its underlying risk factors, such as sex, age, comorbid psychiatric disorders, socioeconomic status, and history of aggressive behavior are discussed as these are the components that mostly contribute to the increased risk of aggressive behavior. Measurement tools commonly used to predict and detect aggressive behavior and to differentiate between different forms of aggressive behavior in both research and clinical practice are also reviewed. Successful aggression prevention programs can be developed based on the current findings of the correlates of aggressive behavior in psychiatric patients.
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Affiliation(s)
- Hunor Girasek
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Vanda Adél Nagy
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
| | - Szabolcs Fekete
- Department of Psychiatry, National Institute of Forensic Psychiatry, Budapest 1108, Hungary
- School of PhD Studies, Semmelweis University, Budapest 1085, Hungary
| | - Gabor S Ungvari
- Division of Psychiatry, School of Medicine, University of Western Australia, Crawley 6009, Australia
- Section of Psychiatry, University of Notre Dame, Fremantle 6160, Australia
| | - Gábor Gazdag
- Department of Psychiatry and Psychiatric Rehabilitation, Jahn Ferenc South Pest Hospital, Budapest 1204, Hungary
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest 1083, Hungary
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10
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Characteristics of depressed suicide attempters with remitted substance use disorders. J Psychiatr Res 2021; 137:572-578. [PMID: 33158553 PMCID: PMC8084874 DOI: 10.1016/j.jpsychires.2020.10.041] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 10/06/2020] [Accepted: 10/28/2020] [Indexed: 01/26/2023]
Abstract
Substance use disorder (SUD) comorbidity in mood disorders increases suicide risk. Suicide attempters with active SUD appear to have distinct characteristics but little is known whether these characteristics persist during remission and if they are related to different aspects of suicidal behavior. In this study, suicide attempters with a DSM mood disorder and remitted SUD (AT+SUD) (N = 135) were compared to those without lifetime SUD (AT-SUD) (N = 219) in terms of demographic, clinical and suicidal behavioral characteristics. Factor analyses were conducted to generate subjective distress and impulsivity/aggression factors - previously identified by our group to predict suicide risk in mood disorders. Associations between these traits and SUD history and suicidal behavior characteristics were then tested. Compared with AT-SUD, AT+SUD were more likely to be male, less educated and to have a Cluster B personality disorder. AT+SUD individuals had greater impulsivity/aggression factor scores, but comparable subjective distress scores. AT+SUD made a greater number of suicide attempts, with higher lethality, despite comparable suicide intent and degree of planning with AT-SUD. Impulsivity/aggression was higher in multiple versus single attempters, but did not correlate with suicide attempt lethality. Among suicide attempters with mood disorders, a history of lifetime SUD was associated with more frequent and more lethal suicide attempts. Among other correlates of lifetime SUD in this sample, impulsive/aggressive traits may explain greater frequency of suicide attempts. The results underscore that persons with mood disorders and lifetime SUD are at particularly high risk of frequent and lethal suicide attempts where more intensive prevention efforts are warranted.
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11
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Coughlin LN, Pfeiffer P, Ganoczy D, Lin LA. Quality of Outpatient Depression Treatment in Patients With Comorbid Substance Use Disorder. Am J Psychiatry 2021; 178:414-423. [PMID: 33115247 PMCID: PMC8776315 DOI: 10.1176/appi.ajp.2020.20040454] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Clinical practice guidelines recommend concurrent treatment of co-occurring depression and substance use disorders; however, the degree to which patients with substance use disorders receive guideline-concordant treatment for depression is unknown. The authors investigated the provision of guideline-concordant depression treatment to patients with and without substance use disorders in a large integrated health care system. METHODS In a retrospective cohort study of 53,034 patients diagnosed with a depressive disorder in fiscal year 2017 in the U.S. Veterans Health Administration, the authors assessed the association of comorbid substance use disorders with guideline-concordant depression treatment, including both medication and psychotherapy, while adjusting for patient demographic and clinical characteristics. RESULTS Guideline-concordant depression treatment was lower across metrics for patients with co-occurring depression and substance use disorders compared to those without substance use disorders. Consistent findings emerged in covariate-adjusted models of antidepressant treatment, such that patients with substance use disorders had 21% lower odds of guideline-concordant acute treatment (adjusted odds ratio=0.79, 95% CI=0.73, 0.84) and 26% lower odds of continuation of treatment (adjusted odds ratio=0.74, 95% CI=0.69, 0.79). With regard to psychotherapy, patients with co-occurring depression and substance use disorders had 13% lower odds (adjusted odds ratio=0.87, 95% CI=0.82, 0.91) of adequate acute-phase treatment and 19% lower odds (adjusted odds ratio=0.81; 95% CI=0.73, 0.89) of psychotherapy continuation. CONCLUSIONS Despite the availability of effective treatments for depression, patients with co-occurring substance use disorders are less likely to receive guideline-concordant depression treatment. Efforts to improve the provision of care to those with co-occurring substance use disorders should focus on clinician-based interventions and use of integrated care models to improve the quality of depression treatment.
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Affiliation(s)
- Lara N Coughlin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Paul Pfeiffer
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Dara Ganoczy
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
| | - Lewei A Lin
- Addiction Center, Department of Psychiatry, University of Michigan, Ann Arbor (Coughlin, Lin); VA Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor (Pfeiffer, Ganoczy, Lin)
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Armoon B, SoleimanvandiAzar N, Fleury MJ, Noroozi A, Bayat AH, Mohammadi R, Ahounbar E, Fattah Moghaddam L. Prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among people with substance use disorders: a systematic review and meta-analysis. J Addict Dis 2021; 39:550-569. [PMID: 33896407 DOI: 10.1080/10550887.2021.1912572] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
We assessed the prevalence, sociodemographic variables, mental health condition, and type of drug use associated with suicide behaviors among patients with substance use disorders (SUD). Studies in English published from January 1, 1995 to December 31, 2020 were searched on PubMed, Scopus, Cochrane and Web of Science to identify studies on variables associated with suicidal behaviors (ideations and attempts) among patients with SUD. After reviewing for study duplicates, the full-text of selected articles were assessed for eligibility using Population, Intervention, Comparator, Outcomes (PICO) criteria: (i) population: patients with SUD; (ii) intervention: suicide behaviors in the past year; (iii) comparator: SUD who had not suicide behaviors; (iv) outcome: suicide ideations or attempts in the last year; and (v) study type: cross-sectional, cohort, and case-control studies. Out of 10,810 articles, 48 studies met eligibility criteria. Our findings showed a pooled prevalence rate of suicide ideations of 35% (95% CI, 22% 48%) and suicide attempts of 20% (95% CI, 17% 23%) in the last year among patients with SUD. Smoking, previous history of sexual abuse, depression, and alcohol and cannabis use disorders were significantly associated with suicide ideations. Study findings also showed that being female, smoking, history of physical and sexual abuse, depression and alcohol, cannabis, cocaine, amphetamine use disorders, and polysubstance abuse were significantly associated with suicide attempts among patients with SUD. These findings have implications for developing prevention programs. Appropriate initiatives for reducing the risk of suicide behaviors like systematic assessments of changes in drug use pattern at the emergency departments or at other key health providers may be more broadly implemented. Motivational therapy to improve help-seeking, increased information on adverse consequences of heavy substance use, and crisis plan resolutions to face suicide behaviors could also be consolidated.
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Affiliation(s)
- Bahram Armoon
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Neda SoleimanvandiAzar
- Preventive Medicine and Public Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran
| | - Marie-Josée Fleury
- Douglas Hospital Research Centre, Douglas Mental Health University Institute, Montreal, Quebec, Canada.,Department of Psychiatry, McGill University, Montreal, Quebec, Canada
| | - Alireza Noroozi
- Iranian National Center for Addiction Studies, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir-Hossein Bayat
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elahe Ahounbar
- Substance Abuse and Dependence Research Center, the University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Ladan Fattah Moghaddam
- Department of Nursing, Faculty of Nursing and Midwifery, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
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Roy B, Dwivedi Y. Modeling endophenotypes of suicidal behavior in animals. Neurosci Biobehav Rev 2021; 128:819-827. [PMID: 33421543 DOI: 10.1016/j.neubiorev.2020.12.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 11/25/2020] [Accepted: 12/31/2020] [Indexed: 12/26/2022]
Abstract
Suicide is a major public health concern. One of the common contributors to the increased risk for suicide is the genetic constitution of individuals, which determines certain endophenotypic traits used as quantifiable measure of neurobiological functions. Therefore, a logical deconstruction of the originating endophenotypes associated with suicidal risk could provide a better understanding of this complex disorder. In this regard, non-human animals can be a useful resource to test endophenotypes of suicidal behavior and the neurobiology underlying these endophenotypes. In this review, we have focused on the neurobiological abnormalities, primarily genetic and epigenetic abnormalities, associated with suicidal behavior and the scope of their modeling in animals. This can substantially advance the current understanding of suicidal behavior manifested with certain trait-based endophenotypes and may provide an opportunity to test novel hypotheses as well as aid in the development of treatment opportunities and risk assessment.
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Affiliation(s)
- Bhaskar Roy
- Department of Psychiatry and Behavioral Neurobiology, 1720 7(th) Avenue South, University of Alabama at Birmingham, Birmingham, AL, 35294, USA
| | - Yogesh Dwivedi
- Department of Psychiatry and Behavioral Neurobiology, 1720 7(th) Avenue South, University of Alabama at Birmingham, Birmingham, AL, 35294, USA.
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Prevalence of comorbid substance use in major depressive disorder in community and clinical settings, 1990-2019: Systematic review and meta-analysis. J Affect Disord 2020; 266:288-304. [PMID: 32056890 DOI: 10.1016/j.jad.2020.01.141] [Citation(s) in RCA: 92] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 12/09/2019] [Accepted: 01/25/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Comorbidity between Substance Use Disorders (SUDs) and major depression is highly prevalent. This systematic review and meta-analysis aimed to estimate the prevalence of SUDs in subjects diagnosed with a major depressive disorder (MDD) in community, inpatient and outpatient settings. METHODS A comprehensive literature search of Medline, EMBASE, PsycINFO and CINAHL databases was conducted from 1990 to 2019. Prevalence of co-morbid SUDs and MDD were extracted and odds ratios (ORs) were calculated using random effects meta-analysis. RESULTS There were 48 articles identified by electronic searches with a total sample size of 348,550 subjects that yielded 14 unique epidemiological studies, 2 national case registry studies, 7 large cohort studies and 20 clinical studies using in- or out-patients. The prevalence of any SUD in individuals with MDD was 0.250. Maximum prevalence was found with alcohol use disorder (0.208), followed by illicit drug use disorder (0.118) and cannabis use disorder (0.117). Meta-analysis showed the pooled variance of any AUD in men with MDD was 36%, which was significantly higher than that for females with MDD (19%, OR 2.628 95% CI 2.502, 2.760). CONCLUSIONS Few studies were published over the last decade so current prevalence rates of SUD in MDD are needed. Meta-analysis revealed that SUDs in MDD are highly prevalent and rates have not changed over time. The persistently high prevalence suggests there is an urgent need for more informative studies to help develop better prevention and treatment options for reducing prevalence of SUDs in persons with major depression and co-morbid disorders.
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Impulsivity and Impulsivity-Related Endophenotypes in Suicidal Patients with Substance Use Disorders: an Exploratory Study. Int J Ment Health Addict 2020. [DOI: 10.1007/s11469-020-00259-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
AbstractSuicidal behavior (SB) is a major problem in patients with substance use disorders (SUDs). However, little is known about specific SB risk factors in this population, and pathogenetic hypotheses are difficult to disentangle. This study investigated some SB and SUD-related endophenotypes, such as impulsivity, aggression, trait anger, and risk-taking behaviors (RTBs), in forty-eight patients with SUDs in relation to lifetime history of suicide attempts (SAs). Disorders related to alcohol, cannabis, cocaine, opiates, and hallucinogenic drugs were included. Lifetime SAs was significantly associated with both higher impulsivity and higher aggression, but not with trait anger. A higher number of RTBs were associated with lifetime SAs and higher impulsivity, but not with aggression and trait anger. Assessing these endophenotypes could refine clinical SB risk evaluation in SUDs patients by detecting higher-risk subgroups. An important limitation of this study is exiguity of its sample size. Its primary contribution is inclusion of all SUD types.
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The longitudinal relationship of alcohol problems and depressive symptoms and the impact of externalising symptoms: findings from the Belfast Youth Developmental Study. Soc Psychiatry Psychiatr Epidemiol 2019; 54:1231-1241. [PMID: 30903238 DOI: 10.1007/s00127-019-01696-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 03/09/2019] [Indexed: 10/27/2022]
Abstract
PURPOSE The aim of the present study was to contribute to the inconsistent literature on the comorbid relationship of alcohol problems and depressive symptoms from late adolescent to emerging adulthood by accounting for their trajectories and their conjoint relationship while controlling for the influence of externalising symptoms. METHODS We utilised data, from a longitudinal school cohort from Northern Ireland (Belfast Youth Developmental Study), over three time points where the participants were 16, 17 and 21 years of age. A total of 3118 participants were included, 1713 females and 1405 males. Second-order latent growth models were applied to examine growth trajectories. Parallel process growth models were used to assess whether growth trajectories of the symptoms were associated. Externalising symptoms were subsequently added as a covariate. RESULTS Alcohol problems among males significantly increased over time but decreased in females. Depressive symptoms initially increased then decreased in both genders. Results indicated associations of the alcohol problems and depression, both initially and with time. Accounting for externalising symptoms only somewhat diminished this effect in males but not in females. An increase of initial levels of depression was associated with a decrease in alcohol problems over time. This association was only true among females. After controlling for externalising symptoms, the relationship was no longer observed. CONCLUSIONS The present study provides further evidence of a significant relationship of alcohol problems and depression in adolescents and further supports a small literature indicating that depression may have protective effects of alcohol problems. Finally, the study shows the importance of accounting for externalising symptoms.
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Yuodelis-Flores C, Ries RK. Addiction and Suicide: A Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:193-199. [PMID: 32021589 PMCID: PMC6526997 DOI: 10.1176/appi.focus.17203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from The American Journal on Addictions 24: 98-104, 2015).
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Tobore TO. On the Neurobiological Role of Oxidative Stress in Alcohol-Induced Impulsive, Aggressive and Suicidal Behavior. Subst Use Misuse 2019; 54:2290-2303. [PMID: 31369300 DOI: 10.1080/10826084.2019.1645179] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Objectives: Alcohol abuse is known to result in behavioral impairments (such as increased impulsivity, aggressive, and suicidal behavior), but the neurobiological basis for these behavioral impairments remains unknown. The objective of this review is to propose a neurobiological basis for alcohol-induced aggression, impulsivity, and suicidal behavior. Methods: Search was done by accessing PubMed/Medline, EBSCO, and PsycINFO databases. The search string used was "(Alcohol OR Alcoholism* OR Alcohol Abuse) AND (Behavior* OR Behavioral Impairment or Disorder) AND (Oxidative Stress OR Reactive Oxygen Species)." The electronic databases were searched for titles or abstracts containing these terms in all published articles between January 1, 1960, and May 31, 2019. The search was limited to studies published in English and other languages involving both animal and human subjects. Articles selected included randomized clinical trials (RCTs), observational studies, meta-analyses, and both systemic and narrative reviews, providing both quantitative and qualitative information with a measure of alcohol abuse or alcoholism as an outcome. Exclusion criteria were unpublished data of any form, including conference proceedings and dissertation. New key terms were identified (new term included: "Antioxidants, Neurotransmitters, Dopamine, Serotonin, GABA, Glutamate. Aggression, Impulsivity, Suicidal Behavior, hippocampus, prefrontal cortex, limbic system, psychiatric disorders, PTSD, Anxiety, Depression. These new terms were searched with Alcohol or Alcoholism or Alcohol Abuse and Oxidative Stress separately resulting in the identification of over 3000 articles. 196 were included in this article. Results: Multiple lines of evidence indicate that oxidative stress (OS) plays a critical underlying role in alcohol toxicity and behavioral impairments. Conclusions/Importance: People diagnosed with PTSD, anxiety disorder, depression, and those with a personality high in psychoticism as measured by the P Scale of the Eysenck Personality Questionnaire, with comorbid alcohol abuse or alcohol use disorder (AUD), may display increased impulsivity, aggression, and suicidal behavior because of the potentiating effect of alcohol-induced OS on their elevated brain oxidative status. Antioxidant therapy should be an integral part of acute alcohol intoxication and AUD treatment. Further research is necessary to fully understand the relationship between OS and alcohol-induced behavioral impairments.
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Influence of comorbid alcohol use disorders on the clinical patterns of major depressive disorder: A general population-based study. Drug Alcohol Depend 2018; 187:40-47. [PMID: 29626745 DOI: 10.1016/j.drugalcdep.2018.02.009] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 11/21/2022]
Abstract
BACKGROUND To compare the symptom patterns of major depressive disorder (MDD) among subjects with MDD and 1) no alcohol use disorder (AUD), 2) alcohol abuse and 3) alcohol dependence, respectively. METHODS In a general population survey of 38,694 French individuals, MDD and AUDs were assessed using the Mini International Neuropsychiatric Interview 5.0.0 (MINI). A total of 4339 subjects (11.2%) in the sample met the criteria for MDD. Among them, 413 (9.5%) AUD subjects were identified: 138 (3.2%) for alcohol abuse and 275 (6.3%) for alcohol dependence. The associations of each of the ten MDD criteria of the MINI and psychiatric clinical features were compared among the three groups. The relative profiles of 'MDD + AUD' vs. 'MDD alone' were determined using a multivariable stepwise regression model. RESULTS With the noAUD group as the reference, sadness (OR = 0.46; 95%CI, 0.29-0.74) and anhedonia (OR = 1.66; 95%CI, 1.06-2.73) were only associated with alcohol abuse. Sleep disorders (OR = 2.07; 95%CI, 1.51-2.88), feelings of guilt (OR = 1.41; 95%CI, 1.05-1.90), diminished concentration/indecisiveness (OR = 1.52; 95%CI, 1.12-2.07) and thoughts of death (OR = 1.95; 95%CI 1.49-2.55) were only associated with alcohol dependence. Weight or appetite variations were both associated with alcohol abuse (OR = 1.7; 95%CI, 1.15-2.53) and dependence (OR = 1.41; 95%CI, 1.06-1.88). Bipolar disorder and PTSD were only associated with alcohol dependence. Psychotic features, previous suicide attempts, and panic disorder were more frequent in the MDD-AUD group. CONCLUSION MDD-AUD subjects displayed a more severe profile with specific symptomatology and comorbidity profiles compared to MDD-only subjects.
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Agabio R, Trogu E, Pani PP. Antidepressants for the treatment of people with co-occurring depression and alcohol dependence. Cochrane Database Syst Rev 2018; 4:CD008581. [PMID: 29688573 PMCID: PMC6494437 DOI: 10.1002/14651858.cd008581.pub2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Alcohol dependence is a major public health problem characterized by recidivism, and medical and psychosocial complications. The co-occurrence of major depression in people entering treatment for alcohol dependence is common, and represents a risk factor for morbidity and mortality, which negatively influences treatment outcomes. OBJECTIVES To assess the benefits and risks of antidepressants for the treatment of people with co-occurring depression and alcohol dependence. SEARCH METHODS We searched the Cochrane Drugs and Alcohol Group Specialised Register (via CRSLive), Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Embase from inception to July 2017. We also searched for ongoing and unpublished studies via ClinicalTrials.gov (www.clinicaltrials.gov) and the World Health Organization (WHO) International Clinical Trials Registry Platform (ICTRP) (apps.who.int/trialsearch/).All searches included non-English language literature. We handsearched references of topic-related systematic reviews and the included studies. SELECTION CRITERIA Randomized controlled trials and controlled clinical trials comparing antidepressants alone or in association with other drugs or psychosocial interventions (or both) versus placebo, no treatment, and other pharmacological or psychosocial interventions. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as expected by Cochrane. MAIN RESULTS We included 33 studies in the review (2242 participants). Antidepressants were compared to placebo (22 studies), psychotherapy (two studies), other medications (four studies), or other antidepressants (five studies). The mean duration of the trials was 9.9 weeks (range 3 to 26 weeks). Eighteen studies took place in the USA, 12 in Europe, two in Turkey, and one in Australia. The antidepressant included in most of the trials was sertraline; other medications were amitriptyline, citalopram, desipramine, doxepin, escitalopram, fluoxetine, fluvoxamine, imipramine, mianserin, mirtazepine, nefazodone, paroxetine, tianeptine, venlafaxine, and viloxazine. Eighteen studies were conducted in an outpatient setting, nine in an inpatient setting, and six in both settings. Psychosocial treatment was provided in 18 studies. There was high heterogeneity in the selection of outcomes and the rating systems used for diagnosis and outcome assessment.Comparing antidepressants to placebo, low-quality evidence suggested that antidepressants reduced the severity of depression evaluated with interviewer-rated scales at the end of trial (14 studies, 1074 participants, standardized mean difference (SMD) -0.27, 95% confidence interval (CI) -0.49 to -0.04). However, the difference became non-significant after the exclusion of studies with a high risk of bias (SMD -0.17, 95% CI -0.39 to 0.04). In addition, very low-quality evidence supported the efficacy of antidepressants in increasing the response to the treatment (10 studies, 805 participants, risk ratio (RR) 1.40, 95% Cl 1.08 to 1.82). This result became non-significant after the exclusion of studies at high risk of bias (RR 1.27, 95% CI 0.96 to 1.68). There was no difference for other relevant outcomes such as the difference between baseline and final score, evaluated using interviewer-rated scales (5 studies, 447 participants, SMD 0.15, 95% CI -0.12 to 0.42).Moderate-quality evidence found that antidepressants increased the number of participants abstinent from alcohol during the trial (7 studies, 424 participants, RR 1.71, 95% Cl 1.22 to 2.39) and reduced the number of drinks per drinking days (7 studies, 451 participants, mean difference (MD) -1.13 drinks per drinking days, 95% Cl -1.79 to -0.46). After the exclusion of studies with high risk of bias, the number of abstinent remained higher (RR 1.69, 95% CI 1.18 to 2.43) and the number of drinks per drinking days lower (MD -1.21 number of drinks per drinking days, 95% CI -1.91 to -0.51) among participants who received antidepressants compared to those who received placebo. However, other outcomes such as the rate of abstinent days did not differ between antidepressants and placebo (9 studies, 821 participants, MD 1.34, 95% Cl -1.66 to 4.34; low-quality evidence).Low-quality evidence suggested no differences between antidepressants and placebo in the number of dropouts (17 studies, 1159 participants, RR 0.98, 95% Cl 0.79 to 1.22) and adverse events as withdrawal for medical reasons (10 studies, 947 participants, RR 1.15, 95% Cl 0.65 to 2.04).There were few studies comparing one antidepressant versus another antidepressant or antidepressants versus other interventions, and these had a small sample size and were heterogeneous in terms of the types of interventions that were compared, yielding results that were not informative. AUTHORS' CONCLUSIONS We found low-quality evidence supporting the clinical use of antidepressants in the treatment of people with co-occurring depression and alcohol dependence. Antidepressants had positive effects on certain relevant outcomes related to depression and alcohol use but not on other relevant outcomes. Moreover, most of these positive effects were no longer significant when studies with high risk of bias were excluded. Results were limited by the large number of studies showing high or unclear risk of bias and the low number of studies comparing one antidepressant to another or antidepressants to other medication. In people with co-occurring depression and alcohol dependence, the risk of developing adverse effects appeared to be minimal, especially for the newer classes of antidepressants (such as selective serotonin reuptake inhibitors). According to these results, in people with co-occurring depression and alcohol dependence, antidepressants may be useful for the treatment of depression, alcohol dependence, or both, although the clinical relevance may be modest.
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Affiliation(s)
- Roberta Agabio
- University of CagliariDepartment of Biomedical Sciences, Section of Neuroscience and Clinical PharmacologyCagliariItaly
| | - Emanuela Trogu
- Cagliari Public Health TrustDepartment of PsychiatryASL CagliariCagliariSardiniaItaly09128
| | - Pier Paolo Pani
- Sardinia Protection Health TrustSassari Social‐Health AreaSassariSardiniaItaly
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Sher L, Grunebaum MF, Burke AK, Chaudhury S, Mann JJ, Oquendo MA. Depressed Multiple-SuicideAttempters – A High-Risk Phenotype. CRISIS 2017; 38:367-375. [DOI: 10.1027/0227-5910/a000475] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Abstract. Background: There is compelling evidence that suicide attempts are among the strongest predictors of suicide and future suicide attempts. Aim: This study aimed to examine psychopathology in multiple-suicide attempters. Method: We compared the demographic and clinical features of three groups: depressed patients without a history of suicide attempts (non-attempters), depressed patients with a history of one to three suicide attempts (attempters), and depressed patients with a history of four or more suicide attempts (multiple attempters). Results: We found that attempters and multiple attempters had higher levels of depression, hopelessness, aggression, hostility, and impulsivity and were more likely to have borderline personality disorder and family history of major depression or alcohol use disorder compared with non-attempters, but did not differ between each other on these measures. Multiple attempters had greater suicidal ideation at study entry and were more likely to have family history of suicide attempt compared with attempters. Importantly, multiple attempters had greater suicide intent at the time of the most medically serious suicide attempt and more serious medical consequences during their most medically serious suicide attempt compared with attempters. Limitations: The cross-sectional design of the study. Conclusion: Our data suggest that multiple-suicide attempters require careful evaluation as their behavior can have serious medical consequences.
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Affiliation(s)
- Leo Sher
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- James J. Peters Veterans' Administration Medical Center and Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael F. Grunebaum
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Ainsley K. Burke
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Sadia Chaudhury
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - J. John Mann
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
| | - Maria A. Oquendo
- New York State Psychiatric Institute and Columbia University College of Physicians and Surgeons, New York, NY, USA
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA
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Sher L, Fisher AM, Kelliher CH, Penner JD, Goodman M, Koenigsberg HW, New AS, Siever LJ, Hazlett EA. Clinical features and psychiatric comorbidities of borderline personality disorder patients with versus without a history of suicide attempt. Psychiatry Res 2016; 246:261-266. [PMID: 27728869 DOI: 10.1016/j.psychres.2016.10.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 07/31/2016] [Accepted: 10/02/2016] [Indexed: 11/18/2022]
Abstract
Patients with borderline personality disorder (BPD) are at high risk for suicidal behavior. However, many BPD patients do not engage in suicidal behavior. In this study, we compared clinical features of BPD patients with or without a history of suicide attempts and healthy volunteers. Compared with healthy volunteers, both BPD groups had higher Affective Lability Scale (ALS), ALS - Depression-Anxiety Subscale, Barratt Impulsivity Scale (BIS), and Lifetime History of Aggression (LHA) scores and were more likely to have a history of temper tantrums. BPD suicide attempters had higher ALS, ALS - Depression-Anxiety Subscale and LHA scores and were more likely to have a history of non-suicidal self-injury or temper tantrums compared to BPD non-attempters. Also, BPD suicide attempters were more likely to have a history of comorbid major depressive disorder and less likely to have comorbid narcissistic personality disorder (NPD) in comparison to BPD non-attempters. About 50% of study participants in each BPD group had a history of comorbid substance use disorder (SUD). Our study indicates that BPD patients with a history of suicide attempt are more aggressive, affectively dysregulated and less narcissistic than BPD suicide non-attempters.
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Affiliation(s)
- Leo Sher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States.
| | - Amanda M Fisher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Caitlin H Kelliher
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Justin D Penner
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Marianne Goodman
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Harold W Koenigsberg
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States
| | - Antonia S New
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Larry J Siever
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Inpatient and Outpatient Psychiatry, James J. Peters VA Medical Center, Bronx, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
| | - Erin A Hazlett
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, United States; Mental Illness Research, Education, and Clinical Center (MIRECC; VISN 2 South), James J. Peters VA Medical Center, Bronx, NY, United States
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Sher L. Commentary: Exogenous Testosterone Rapidly Increases Aggressive Behavior in Dominant and Impulsive Men. Front Public Health 2016; 4:229. [PMID: 27785451 PMCID: PMC5059441 DOI: 10.3389/fpubh.2016.00229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022] Open
Affiliation(s)
- Leo Sher
- James J. Peters Veterans’ Administration Medical Center, Bronx, NY, USA
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
- *Correspondence: Leo Sher,
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Yoo HJ, Hong JP, Cho MJ, Fava M, Mischoulon D, Heo JY, Kim K, Jeon HJ. Lifetime suicidal ideation and attempt in adults with full major depressive disorder versus sustained depressed mood. J Affect Disord 2016; 203:275-280. [PMID: 27314814 DOI: 10.1016/j.jad.2016.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2016] [Revised: 05/29/2016] [Accepted: 06/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Major depressive disorder (MDD) is a well-known risk factor for suicidality, but depressed mood has been used non-specifically to describe the emotional state. We sought to compare influence of MDD versus sustained depressed mood on suicidality. METHODS A total of 12,532 adults, randomly selected through the one-person-per-household method, completed a face-to-face interview using the Korean version of Composite International Diagnostic Interview (K-CIDI) and a questionnaire for lifetime suicidal ideation (LSI) and lifetime suicidal attempt (LSA). RESULTS Of 12,361 adults, 565 were assessed as 'sustained depressed mood group' having depressed mood for more than two weeks without MDD (4.6%), and 810 adults were assessed as having full MDD (6.55%) which consisted of 'MDD with depressed mood group' (6.0%) and 'MDD without depressed mood group' (0.5%). The MDD with depressed mood group showed higher odds ratios for LSI and LSA than the sustained depressed mood group. Contrarily, no significant differences were found in LSI and LSA between the MDD group with and without depressed mood. MDD showed significant associations with LSI (AOR=2.83, 95%CI 2.12-3.78) and LSA (AOR=2.17, 95%CI 1.34-3.52), whereas sustained depressed mood showed significant associations with neither LSI nor LSA after adjusting for MDD and other psychiatric comorbidities. Interaction effect of sustained depressed mood with MDD was significant for LSI but not for LSA. CONCLUSIONS Sustained depressed mood was not related to LSI and LSA after adjusting for psychiatric comorbidities, whereas MDD was significantly associated with both LSI and LSA regardless of the presence of sustained depressed mood.
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Affiliation(s)
- Hye Jin Yoo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Jin Pyo Hong
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Maeng Je Cho
- Department of Psychiatry & Behavioral Science, Seoul National University College of Medicine, Seoul, South Korea
| | - Maurizio Fava
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - David Mischoulon
- Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jung-Yoon Heo
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Kiwon Kim
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Hong Jin Jeon
- Department of Psychiatry, Depression Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, USA; Department of Health Sciences & Technology, Department of Medical Device Management & Research, and Department of Clinical Research Design & Evaluation, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul, Republic of Korea.
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Nam YY, Kim CH, Roh D. Comorbid panic disorder as an independent risk factor for suicide attempts in depressed outpatients. Compr Psychiatry 2016; 67:13-8. [PMID: 27095329 DOI: 10.1016/j.comppsych.2016.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 01/15/2016] [Accepted: 02/13/2016] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Although comorbid panic disorder is associated with more severe symptoms and poorer therapeutic response in depressive patients, the relationship between panic disorder and risk of suicide attempt has not been confirmed. This study aimed to examine the relationship between comorbid panic disorder and clinical characteristics associated with suicidal risk as well as the likelihood of suicide attempt. METHOD A total of 223 outpatients with current major depressive disorder participated in the study. Both subjects with panic disorder (33%) and those without panic disorder (67%) were compared based on history of suicide attempts, current psychopathologies, and traits of impulsivity and anger. RESULTS Subjects with panic disorder had higher levels of impulsivity, depression, and hopelessness and were more likely to report a history of suicide attempts. Subjects with panic disorder were younger at the time of first suicide attempt than those without panic disorder. Logistic regression analyses indicated that comorbid panic disorder was significantly associated with a history of suicide attempts after adjusting for other clinical correlates (odds ratio = 2.8; p < 0.01). CONCLUSIONS These findings suggest that comorbid panic disorder in patients with major depressive disorder may be associated with a more severe burden of illness and may independently increase the likelihood of suicide attempt.
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Affiliation(s)
- Yoon-Young Nam
- Division of Planning and Public Relations, National Center for Mental Health, Seoul, Republic of Korea
| | - Chan-Hyung Kim
- Department of Psychiatry, Yonsei University College of Medicine, Seoul, Republic of Korea; Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Daeyoung Roh
- Department of Psychiatry, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon-si, Gangwon-do, Republic of Korea.
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Han C, Ahn D, Hahm W, Nam J, Park Y, Lim S, Kim DJ. Serum Levels of Growth Factors in Alcohol-dependent Patients according to Comorbid Depressive Symptoms. CLINICAL PSYCHOPHARMACOLOGY AND NEUROSCIENCE 2016; 14:43-8. [PMID: 26792039 PMCID: PMC4730941 DOI: 10.9758/cpn.2016.14.1.43] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/08/2015] [Accepted: 06/09/2015] [Indexed: 11/18/2022]
Abstract
OBJECTIVE This study aims to reveal the relationship of depression with growth factors such as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), and insulin-like growth factor-1 (IGF-1) in inpatients diagnosed with alcohol dependence, and to identify candidate growth factors as biological markers to indicate the comorbid of alcohol dependence and depression. METHODS This study examined demographic factors in 45 alcohol-dependent patients. The ADS (Korean version of the Alcohol Dependence Scale) and BDI (Korean version of Beck's Depression Inventory) were used. BDNF, NGF, and IGF-1 were measured through ELISA. RESULTS The average drinking quantity and the ADS score were significantly more severe in alcohol-dependent patients with depression than in those without depression. Linearly comparing BDNF, NGF, and IGF-1 with BDI values, IGF-1 was the growth factor significantly correlated with BDI scores. BDI scores were significantly correlated with ADS scores. IGF-1 was significantly higher in alcohol-dependent patients with depression. Alcohol-dependent patients with depression had greater alcohol use and more severe ADS scores. BDNF and NGF showed no significant difference between alcohol-dependent patients with and without depression, but IGF-1 was significantly higher in those with than in those without depression. CONCLUSION IGF-1 was found to be associated with depression in alcohol-dependent patients, suggesting that IGF-1 in alcohol- dependent patients could be an important biomarker to indicate whether alcohol-dependence is accompanied by depression.
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Affiliation(s)
- Changwoo Han
- Department of Psychiatry, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea
| | - Donghyun Ahn
- Department of Neuropsychiatry, Hanyang University College of Medicine and Institute of Mental Health, Seoul, Korea
| | - Woong Hahm
- Department of Neuropsychiatry, Keyo Hospital, Uiwang, Korea
| | - Junghyun Nam
- Department of Neuropsychiatry, Hanyang University College of Medicine and Institute of Mental Health, Seoul, Korea
| | - Yongchon Park
- Department of Neuropsychiatry, Hanyang University College of Medicine and Institute of Mental Health, Seoul, Korea
| | - Seulgi Lim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Dai-Jin Kim
- Department of Psychiatry, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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González-Castro TB, Hernández-Díaz Y, Tovilla-Zárate CA, González-Gutiérrez KP, Fresán A, Juárez-Rojop IE, López-Narváez L, Villar Soto M, Genis A. Differences by gender in completed suicides in a Mexican population: A psychological autopsy study. J Forensic Leg Med 2015; 38:70-4. [PMID: 26717248 DOI: 10.1016/j.jflm.2015.11.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 11/26/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Using the method of psychological autopsy, we identified differences by gender in socio-demographic aspects, signs and symptoms, and suicide characteristics in a population of the state of Tabasco. Mexico. METHODS Between the years 2007-2014, 182 psychological autopsies were documented by the Secretary of Health of the State of Tabasco, Mexico. A structured questionnaire was used to obtain information on socio-demographic aspects and suicide characteristics. RESULTS The sample was mainly formed by males (78%). 84% of the sample used hanging as suicide method. However, in comparison with the male group, females were older on the average (p = 0.002); they were mostly housewives (37.5%) and had more years of schooling (p = 0.004). Other significant differences predominantly present in the male group were: the use of alcohol at the time of suicide (52.1%), job retirement, and increases in apathy (50.7%) and aggressiveness (36.6%) (p < 0.05). CONCLUSION Our results suggest that there are differences by gender between subjects with completed suicide. Factors such as alcohol consumption, job retirement, aggressiveness and isolation/social apathy certainly render men more vulnerable to suicide in the Mexican population.
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Affiliation(s)
| | - Yazmín Hernández-Díaz
- Universidad Juárez Autónoma de Tabasco, División Académica de Jalpa de Méndez, Cunduacán, Tabasco, Mexico.
| | - Carlos Alfonso Tovilla-Zárate
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Krystell P González-Gutiérrez
- Universidad Juárez Autónoma de Tabasco, División Académica Multidisciplinaria de Comalcalco, Comalcalco, Tabasco, Mexico.
| | - Ana Fresán
- Subdirección de Investigaciones Clínicas, Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, México, D. F., Mexico.
| | - Isela E Juárez-Rojop
- Universidad Juárez Autónoma de Tabasco, División Académica de Ciencias de la Salud, Villahermosa, Tabasco, Mexico.
| | | | - Mario Villar Soto
- Hospital de Alta Especialidad "Gustavo A. Rovirosa P, Villahermosa, Tabasco, Mexico.
| | - Alma Genis
- Instituto Nacional de Medicina Genómica (INMEGEN), Servicios de Atención Psiquiátrica (SAP), Secretaría de Salud, México, D. F, Mexico.
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Pasi S, Singh PK, Pandey RK, Dikshit PC, Jiloha RC, Rao VR. Evaluation of psychiatric and genetic risk factors among primary relatives of suicide completers in Delhi NCR region, India. Psychiatry Res 2015. [PMID: 26205629 DOI: 10.1016/j.psychres.2015.07.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Suicide as a public health problem is studied worldwide and association of psychiatric and genetic risk factors for suicidal behavior are the point of discussion in studies across different ethnic groups. The present study is aimed at evaluating psychiatric and genetic traits among primary relatives of suicide completer families in an urban Indian population. Bi-variate analysis shows significant increase in major depression (PHQ and Hamilton), stress, panic disorder, somatoform disorder and suicide attemptamong primary compared to other relatives. Sib pair correlations also reveal significant results for major depression (Hamilton), stress, suicide attempt, intensity of suicide ideation and other anxiety syndrome. 5-HTTLPR, 5-HTT (Stin2) and COMT risk alleles are higher among primary relatives, though statistically insignificant. Backward conditional logistic regression analysis show only independent variable, Depression (Hamilton) made a unique statistically significant contribution to the model in primary relatives.
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Affiliation(s)
- Shivani Pasi
- Department of Anthropology, University of Delhi, Delhi, India
| | | | | | - P C Dikshit
- Department of Forensic Medicine, Moulana Azad Medical College, Delhi, India; Department of Forensic Medicine and Toxicology, Jamia Hamdard Institute of Medical Sciences & Research, New Delhi, India
| | - R C Jiloha
- Department of Psychiatry, G.B. Pant Hospital, Delhi, India
| | - V R Rao
- Department of Anthropology, University of Delhi, Delhi, India.
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Agyapong VIO, Mrklas K, Suen VYM, Rose MS, Jahn M, Gladue I, Kozak J, Leslie M, Dursun S, Ohinmaa A, Greenshaw A. Supportive text messages to reduce mood symptoms and problem drinking in patients with primary depression or alcohol use disorder: protocol for an implementation research study. JMIR Res Protoc 2015; 4:e55. [PMID: 25979786 PMCID: PMC4814207 DOI: 10.2196/resprot.4371] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/18/2015] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Depression and Alcohol Use Disorders (AUDs) are two leading causes of disability worldwide and are associated with significant treatment challenges requiring new, innovative, cost-effective and technologically-based therapies including the use of supportive text messages. OBJECTIVE To determine the feasibility and effectiveness of supportive text messages in long-term follow-up to reduce mood symptoms and problem drinking in patients with Depression or AUD respectively and to explore the usefulness of self-reports of health services utilization as an outcomes measure. METHODS This will be a longitudinal, prospective, parallel-design, two-arm, placebo-controlled single-rater-blinded randomized clinical trial with a recruitment period of 6 months and an observation period of 12 months for each participant, with two strata based on primary diagnosis of Major Depressive Disorder or AUD. The sample size will be 120, with about 60 patients randomized from each primary diagnostic grouping. Patients in all intervention groups will receive twice-daily supportive SMS text messages for 3 months and then daily supportive text messages for the next three months. Patients will also receive a phone call every two weeks from the research assistant assigning treatment allocation to confirm that they are still receiving the text messages and to thank them for taking part in the study. Patients in the control group will receive no text messages but will also receive a phone call from the same research assistant every two weeks to thank them for taking part in the study. RESULTS The study starts in April 2015 and ends in September 2016. It is envisaged that both qualitative and quantitative primary and secondary outcomes, including patient perceptions of the intervention, will shed light on the feasibility of using automated supportive text message interventions in long term for patients with Depression and AUD. This will inform a full-scale clinical trial. CONCLUSIONS The paradigm for behavior change using text messages as a patient-direct intervention is consistent with a cognitive behavior therapy approach and addictions counselling principles. Given the automaticity of the messages, we anticipate that if the intervention proves successful, it will represent a low cost strategy that will be readily available and can bring relief to patients in hard-to-reach areas with limited access to psychological therapies. TRIAL REGISTRATION ClinicalTrials.gov: NCT02327858; https://clinicaltrials.gov/ct2/show/NCT02327858 (Archived by WebCite at https://clinicaltrials.gov/ct2/show/NCT02327858).
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Pennel L, Quesada JL, Begue L, Dematteis M. Is suicide under the influence of alcohol a deliberate self-harm syndrome? An autopsy study of lethality. J Affect Disord 2015; 177:80-5. [PMID: 25745839 DOI: 10.1016/j.jad.2015.02.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Revised: 01/30/2015] [Accepted: 02/06/2015] [Indexed: 11/15/2022]
Abstract
BACKGROUND Alcohol is a risk factor for suicide and is often involved in violent actions. The aim of the study was to assess the involvement of alcohol in suicides and its relationship with the lethality of suicide methods. METHODS In a retrospective study on autopsy reports, we compared suicide and non-suicide victims, suicides with positive and negative blood alcohol concentration (BAC), and studied the lethality of suicide methods using a multivariate analysis. RESULTS Suicide victims (n=88) were not different to non-suicide victims (n=270) for positive BAC and narcotics, but were more often positive for prescription medications (59.1 vs. 35.6%, p=0.003) and medications in blood (72.7 vs. 54.8%, p=0.004). Whereas non-suicidal victims died mainly of traumas (60%, p<0.001), two populations of suicides emerged with regard to BAC, self-poisoning predominating with positive BAC (38.9%, p=0.039) and asphyxiation with negative BAC (41.4%, p=0.025). Positive BAC appeared as the unique and strong independent predictive factor, increasing the risk of self-poisoning suicide by 4.36 [1.29-14.76], and decreasing the risk of suicidal asphyxiation by 84% (OR=0.16 [0.03-0.83]). Positive blood narcotics tended to behave in the similar way to alcohol. LIMITATIONS Recruitment bias (victims declared by the Forensic authorities) and incomplete autopsy reports are the two main limitations. CONCLUSIONS Characteristics of suicide victims with positive BAC are suggestive of Deliberate Self-Harm Syndrome (low lethality methods, substance misuse). These being at high risk of repeated suicide attempts, previous self-harm involving alcohol may represent a warning sign and access to medication should be limited to prevent recidivism.
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Affiliation(s)
- Lucie Pennel
- Université Grenoble Alpes, Faculty of Medicine, Grenoble F-38042, France; INSERM U836, Team 10, Grenoble F-38042, France; University Hospital, Department of Addiction Medicine, Grenoble F-38043, France
| | - Jean-Louis Quesada
- University Hospital, Clinical Research and Innovation Direction, Grenoble F-38043, France
| | - Laurent Begue
- Inter-university Laboratory of Psychology, EA4145, University of Grenoble 2, France
| | - Maurice Dematteis
- Université Grenoble Alpes, Faculty of Medicine, Grenoble F-38042, France; University Hospital, Department of Addiction Medicine, Grenoble F-38043, France; INSERM U1042, Grenoble F-38042, France.
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O'Donnell O, House A, Waterman M. The co-occurrence of aggression and self-harm: systematic literature review. J Affect Disord 2015; 175:325-50. [PMID: 25665494 DOI: 10.1016/j.jad.2014.12.051] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 12/19/2014] [Accepted: 12/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Epidemiological research supports an association between aggression and self-harm through data on the frequency with which individuals exhibit both behaviours. Unbiased evidence, however, is needed to draw conclusions about the nature and extent of co-occurrence. METHOD Systematic review of published studies was undertaken to evaluate whether or not the frequency with which aggression and self-harm co-occur is beyond that which would be expected by chance. Outcome measures included: (a) between-group differences on a standardised aggression/self-harm measure - the groups defined by scores on a measure of the other behaviour; (b) correlations between the two behaviours; (c) co-occurrence rates in populations defined by the presence of either behaviour; (d) co-occurrence rates in populations not defined by either behaviour. Odds ratios were calculated for studies presenting complete frequency data. RESULTS 123 studies, some yielding more than one type of result, met the inclusion criteria. Most case-control studies found elevated levels of aggression in self-harming populations (or self-harm in aggressive populations) compared to controls. The majority of correlational, co-occurrence rate, and odds ratio data found aggression and self-harm to be associated. LIMITATIONS Results were subject to descriptive synthesis only and thus, unable to report an overall effect size. CONCLUSIONS Evidence suggests that aggression and self-harm frequently co-occur. Such evidence necessitates more theoretical discussion and associated research on the source and nature of co-occurrence. Nonetheless, individuals who present with one behaviour may be considered an 'at-risk' group in terms of exhibiting the other. Such evidence holds implications for practice (e.g. risk assessment).
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Affiliation(s)
| | | | - Mitch Waterman
- Institute of Psychological Sciences, Faculty of Medicine and Health, University of Leeds, UK
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Yuodelis-Flores C, Ries RK. Addiction and suicide: A review. Am J Addict 2015; 24:98-104. [PMID: 25644860 DOI: 10.1111/ajad.12185] [Citation(s) in RCA: 169] [Impact Index Per Article: 18.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/30/2014] [Accepted: 11/16/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Addiction specialists frequently find themselves faced with suicidal behavior in their addictions patients. Although many addiction treatment programs will not accept clients with recent suicidal behavior, up to 40% of patients seeking treatment for substance dependence report a history of suicide attempt(s).(1-3) Risk factors for suicide have been studied in the general population and among people with mental illness, less is known about risk factors in those with substance use disorders and co-occurring disorders. METHODS Studies, psychological autopsies and recent reviews on risk factors for suicide and suicide attempts in patients with alcohol and drug use disorders and the relationship with co-occurring mental illness were examined. RESULTS AND CONCLUSIONS Suicidal behavior is a significant problem for people with co-occurring disorders seeking addiction treatment. Several predisposing and precipitating risk factors such as marital and interpersonal relationship disruption, occupational and financial stressors, recent heavy substance use and intoxication as well as a history of previous suicide attempts and sexual abuse combine in an additive fashion with personality traits and mental illnesses to intensify risk for suicidal behavior in addiction patients. Major depression, bipolar disorder, borderline personality disorder and post-traumatic stress disorder are especially associated with suicidal behavior in people with addictive disorders. DISCUSSION AND SCIENTIFIC SIGNIFICANCE Treatment implications of these findings are discussed. Addiction treatment providers should routinely gather information about client's suicidal histories, thoughts, and plans in order to assess risk and develop treatment plans for suicidality at various points in treatment.
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Affiliation(s)
| | - Richard K Ries
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
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Cook TB, Brenner LA, Cloninger CR, Langenberg P, Igbide A, Giegling I, Hartmann AM, Konte B, Friedl M, Brundin L, Groer MW, Can A, Rujescu D, Postolache TT. "Latent" infection with Toxoplasma gondii: association with trait aggression and impulsivity in healthy adults. J Psychiatr Res 2015; 60:87-94. [PMID: 25306262 DOI: 10.1016/j.jpsychires.2014.09.019] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 09/03/2014] [Accepted: 09/19/2014] [Indexed: 11/28/2022]
Abstract
BACKGROUND Latent chronic infection with Toxoplasma gondii (T. gondii), a common neurotropic pathogen, has been previously linked with suicidal self-directed violence (SSDV). We sought to determine if latent infection with T. gondii is associated with trait aggression and impulsivity, intermediate phenotypes for suicidal behavior, in psychiatrically healthy adults. METHODS Traits of aggression and impulsivity were analyzed in relationship to IgG antibody seropositivity for T. gondii and two other latent neurotropic infections, herpes simplex virus 1 (HSV1) and cytomegalovirus (CMV). One thousand community-residing adults residing in the Munich metropolitan area with no Axis I or II conditions by SCID for DSM-IV (510 men, 490 women, mean age 53.6 ± 15.8, range 20-74). Plasma samples were tested for IgG antibodies to T. gondii, HSV-1 and CMV by ELISA. Self-reported ratings of trait aggression scores (Questionnaire for Measuring Factors of Aggression [FAF]) and trait impulsivity (Sensation-Seeking Scale-V [SSS-V]) were analyzed using linear multivariate methods. RESULTS T. gondii IgG seropositivity was significantly associated with higher trait reactive aggression scores among women (p < .01), but not among men. T. gondii-positivity was also associated with higher impulsive sensation-seeking (SSS-V Disinhibition) among younger men (p < .01) aged 20-59 years old (median age = 60). All associations with HSV-1 and CMV were not significant. CONCLUSIONS Aggression and impulsivity, personality traits considered as endophenotypes for SSDV, are associated with latent T. gondii infection in a gender and age-specific manner, and could be further investigated as prognostic and treatment targets in T. gondii-positive individuals at risk for SSDV.
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Affiliation(s)
- Thomas B Cook
- Department of Public Health, Mercyhurst Institute for Public Health, Mercyhurst University, Erie, PA, USA
| | - Lisa A Brenner
- Veterans Integrated Service Network (VISN) 19, Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Physical Medicine and Rehabilitation, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA; Department of Neurology, University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | - C Robert Cloninger
- Department of Psychiatry, Sansone Centre for Well-Being, Washington University, St. Louis, MO, USA
| | - Patricia Langenberg
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Ajirioghene Igbide
- DC Department of Behavioral Health, Saint Elizabeths Hospital, Psychiatry Residency Program, Washington, DC, USA
| | - Ina Giegling
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Annette M Hartmann
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Bettina Konte
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Marion Friedl
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Lena Brundin
- Division of Psychiatry and Behavioral Medicine, College of Human Medicine, Michigan State University, Van Andel Research Institute, Grand Rapids, MI, USA
| | | | - Adem Can
- Department of Psychiatry, University of Maryland-Baltimore School of Medicine, Baltimore, MD, USA
| | - Dan Rujescu
- Department of Psychiatry, Martin-Luther-University Halle-Wittenberg, Halle, Germany
| | - Teodor T Postolache
- Veterans Integrated Service Network (VISN) 19, Mental Illness Research Education and Clinical Center (MIRECC), Denver, CO, USA; Department of Psychiatry, University of Maryland-Baltimore School of Medicine, Baltimore, MD, USA; Veterans Integrated Service Network (VISN) 5, Mental Illness Research Education and Clinical Center (MIRECC), Baltimore, MD, USA.
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Psychiatric and psycho-social characteristics of suicide completers: a comprehensive evaluation of psychiatric case records and postmortem findings. Ir J Psychol Med 2014; 32:167-176. [DOI: 10.1017/ipm.2014.47] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
ObjectivesTo explore the demographic, psychosocial and clinical characteristics of individuals known to the mental health services, who died by probable suicide in the West of Ireland.MethodsPostmortem reports between January 2006 and May 2012 detailed 153 individuals who died by probable suicide, 58 of whom attended the mental health services. Relevant socio-demographic and clinical data was extracted from individuals’ lifetime case notes.ResultsRecurrent depressive disorder (44%) was the most common diagnosis and hanging the most common method of death (58%). Of individuals who died by hanging, 79% previously attempted suicide by the same method. For individuals with a documented history of depression, only 32% had antidepressants detected in their toxicology reports. Similarly, only one individual (20%) with schizophrenia had antipsychotics detected in their toxicology report.ConclusionsIndividuals who died by probable suicide, most commonly died by hanging and drowning; with previous attempts of hanging particularly prevalent in the group who subsequently died by hanging. At the time of death, less than one-third of individuals according to toxicology reports were taking the medication that was last prescribed to them by the mental health services suggesting a high rate of treatment non-concordance in individuals who died by probable suicide.
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Association of testosterone levels and future suicide attempts in females with bipolar disorder. J Affect Disord 2014; 166:98-102. [PMID: 25012416 PMCID: PMC4329970 DOI: 10.1016/j.jad.2014.04.068] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2014] [Accepted: 04/25/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND Considerable evidence suggests that testosterone may play a role in the pathophysiology of mood disorders in females. This is the first prospective study to examine whether blood testosterone levels predict suicide attempts in females with bipolar disorder. METHODS Females with a DSM-IV diagnosis of a bipolar disorder in a depressive or mixed episode with at least one past suicide attempt were enrolled. Demographic and clinical parameters were assessed and recorded. Plasma testosterone was assayed using a double antibody radioimmunoassay procedure. Patients were followed up prospectively for up to 2.5 years. RESULTS At baseline, testosterone levels positively correlated with the number of previous major depressive episodes and suicide attempts. Cox proportional hazards regression analysis found that higher baseline testosterone levels predicted suicide attempts during the follow-up period. LIMITATIONS A limitation of the study is that the sample size is modest. Another limitation is that we did not have a bipolar nonattempter or healthy volunteer control group for comparison. CONCLUSION Testosterone levels may predict suicidal behavior in women with bipolar disorder.
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Understanding PTSD comorbidity and suicidal behavior: associations among histories of alcohol dependence, major depressive disorder, and suicidal ideation and attempts. J Anxiety Disord 2014; 28:318-25. [PMID: 24681282 DOI: 10.1016/j.janxdis.2014.02.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 02/18/2014] [Accepted: 02/24/2014] [Indexed: 01/09/2023]
Abstract
Individuals with posttraumatic stress disorder (PTSD) are at an elevated risk for experiencing suicidal thoughts and actions. However, a relative dearth of research has examined factors that may impact this relation, such as common co-occurring disorders. Utilizing the National Comorbidity Survey-Replication data, the current study examined comparisons between comorbid PTSD and major depressive disorder (MDD) and comorbid PTSD and alcohol dependence (AD) in relation to suicidal ideation and suicide attempts. It was hypothesized that comorbid MDD would be associated with an elevated likelihood of suicidal ideation, while comorbid AD would be associated with an elevated likelihood of suicide attempt history. Results indicated that only PTSD-AD was significantly associated with an elevated likelihood of endorsing histories of both suicidal ideation and suicide attempts. These findings suggest that AD may be a critical risk factor for acquiring the capability for suicide attempts.
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Handley TE, Kay-Lambkin FJ, Baker AL, Lewin TJ, Kelly BJ, Inder KJ, Attia JR, Kavanagh DJ. Incidental treatment effects of CBT on suicidal ideation and hopelessness. J Affect Disord 2013; 151:275-83. [PMID: 23820094 DOI: 10.1016/j.jad.2013.06.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Revised: 06/01/2013] [Accepted: 06/01/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND Depression and alcohol misuse are among the most prevalent diagnoses in suicide fatalities. The risk posed by these disorders is exacerbated when they co-occur. Limited research has evaluated the effectiveness of common depression and alcohol treatments for the reduction of suicide vulnerability in individuals experiencing comorbidity. METHODS Participants with depressive symptoms and hazardous alcohol use were selected from two randomised controlled trials. They had received either a brief (1 session) intervention, or depression-focused cognitive behaviour therapy (CBT), alcohol-focused CBT, therapist-delivered integrated CBT, computer-delivered integrated CBT or person-centred therapy (PCT) over a 10-week period. Suicidal ideation, hopelessness, depression severity and alcohol consumption were assessed at baseline and 12-month follow-up. RESULTS Three hundred three participants were assessed at baseline and 12 months. Both suicidal ideation and hopelessness were associated with higher severity of depressive symptoms, but not with alcohol consumption. Suicidal ideation did not improve significantly at follow-up, with no differences between treatment conditions. Improvements in hopelessness differed between treatment conditions; hopelessness improved more in the CBT conditions compared to PCT and in single-focused CBT compared to integrated CBT. LIMITATIONS Low retention rates may have impacted on the reliability of our findings. Combining data from two studies may have resulted in heterogeneity of samples between conditions. CONCLUSIONS CBT appears to be associated with reductions in hopelessness in people with co-occurring depression and alcohol misuse, even when it is not the focus of treatment. Less consistent results were observed for suicidal ideation. Establishing specific procedures or therapeutic content for clinicians to monitor these outcomes may result in better management of individuals with higher vulnerability for suicide.
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Affiliation(s)
- Tonelle E Handley
- Centre for Translational Neuroscience and Mental Health, University of Newcastle, Newcastle, NSW 2308, Australia.
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Harford TC, Yi HY, Grant BF. Other- and self-directed forms of violence and their relationships to DSM-IV substance use and other psychiatric disorders in a national survey of adults. Compr Psychiatry 2013; 54:731-9. [PMID: 23587529 PMCID: PMC3779474 DOI: 10.1016/j.comppsych.2013.02.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 01/22/2013] [Accepted: 02/04/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE To examine associations between DSM-IV psychiatric disorders and other- and self-directed violence in the general population. METHODS Data were obtained from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) Waves 1 & 2 (n=34,653). Four violence categories were derived from a latent class analysis (LCA) of 5 other-directed and 4 self-directed violent behavior indicators. Multinomial logistic regression examined class associations for gender, race-ethnicity, age and DSM-IV substance use, mood, anxiety, and personality disorders. RESULTS Approximately 16% of adults reported some form of violent behavior distributed as follows: other-directed only, 4.6%; self-directed only, 9.3%; combined self- and other-directed, 2.0%; and no violence, 84.1%. The majority of the DSM-IV disorders included in this study were significantly and independently related to each form of violence. Generally, other-directed violence was more strongly associated with any substance use disorders (81%) and any personality disorders (42%), while self-directed violence was more strongly associated with mood (41%) and anxiety disorders (57%). Compared with these two forms of violence, the smaller group with combined self- and other-directed violence was more strongly associated with any substance use disorders (88%), mood disorders (63%), and personality disorders (76%). CONCLUSION Findings from this study are consistent with recent conceptualizations of disorders as reflecting externalizing disorders and internalizing disorders. The identification of the small category with combined forms of violence further extends numerous clinical studies which established associations between self- and other-directed violent behaviors. The extent to which the combined violence category represents a meaningful and reliable category of violence requires further detailed studies.
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Affiliation(s)
- Thomas C. Harford
- Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, Virginia
| | - Hsiao-ye Yi
- Alcohol Epidemiologic Data System, CSR, Incorporated, Arlington, Virginia
| | - Bridget F. Grant
- National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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Is methoxydine a new rapid acting antidepressant for the treatment of depression in alcoholics? Med Hypotheses 2013; 81:10-4. [DOI: 10.1016/j.mehy.2013.03.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Accepted: 03/21/2013] [Indexed: 12/31/2022]
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Sher L. Low testosterone levels may be associated with suicidal behavior in older men while high testosterone levels may be related to suicidal behavior in adolescents and young adults: a hypothesis. Int J Adolesc Med Health 2013; 25:263-268. [PMID: 23893672 DOI: 10.1515/ijamh-2013-0060] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Accepted: 10/02/2012] [Indexed: 06/02/2023]
Abstract
Several lines of evidence suggest that there is an association between testosterone and suicidal behavior. A link between testosterone and the neurobiology of suicidal behavior may be related to: a) a direct effect of testosterone on suicidality via certain brain mechanisms; and/or b) a testosterone influence on aggression and, consequently, suicidality; and/or c) a testosterone effect on mood and, consequently, suicidality; and/or d) a testosterone effect on cognition and, consequently, suicidality. At least one study has demonstrated a relation between high levels of testosterone and suicide in young people. A significant number of studies suggest that high testosterone levels are associated with aggression in adolescents and adults. Multiple lines of evidence indicate that aggression is associated with suicidal behavior. The effect of high testosterone levels on suicidality in adolescents and young adults may be mediated by testosterone-related elevated aggression. It is also possible that, in young people, high testosterone levels are directly linked to suicidality via certain brain mechanisms. In older men, decreased testosterone levels are associated with depressive symptoms and reduced cognitive function, whereas higher blood levels of testosterone are associated with better mood and cognitive functioning. Depression and reduced cognition are associated with suicidal behavior and may mediate the effect of decreased testosterone levels on suicidality. Therefore, it is reasonable to propose that suicidal behavior in adolescents and young adults is associated with high testosterone levels, whereas suicidality in older men is associated with decreased testosterone secretion.
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Agyapong VIO, Ahern S, McLoughlin DM, Farren CK. Supportive text messaging for depression and comorbid alcohol use disorder: single-blind randomised trial. J Affect Disord 2012; 141:168-76. [PMID: 22464008 DOI: 10.1016/j.jad.2012.02.040] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 02/28/2012] [Accepted: 02/29/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Mobile phone text message technology has the potential to improve outcomes for patients with depression and co-morbid Alcohol Use Disorder (AUD). AIMS To perform a randomised rater-blinded trial to explore the effects of supportive text messages on mood and abstinence outcomes for patients with depression and co-morbid AUD. METHODS Participants (n=54) with a DSM IV diagnosis of unipolar depression and AUD who completed an in-patient dual diagnosis treatment programme were randomised to receive twice daily supportive text messages (n=26) or a fortnightly thank you text message (n=28) for three months. Primary outcome measures were Beck's Depression Inventory (BDI-II) scores and Cumulative Abstinence Duration (CAD) in days at three months. TRIAL REGISTRATION NCT0137868. RESULTS There was a statistically significant difference in three month BDI-II scores between the intervention and control groups; 8.5 (SD=8.0) vs. 16.7 (SD=10.3) respectively after adjusting for the baseline scores, F (1, 49)=9.54, p=0.003, η(p)(2)=0.17. The mean difference in change BDI-II scores was -7.9 (95% CI -13.06 to -2.76, Cohen'sd=0.85). There was a trend for a greater CAD in the text message group than the control group: 88.3 (SD=6.2) vs. 79.3 (SD=24.1), t=1.78, df=48, p=0.08. LIMITATIONS Limitations of the study include the small sample size, the potential for loss of rater blinding and the lack of long term follow-up to determine the longer term effects of the intervention. CONCLUSION Supportive text messages have the potential to improve outcomes for patients with comorbid depression and alcohol dependency syndrome.
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Affiliation(s)
- Vincent I O Agyapong
- Department of Psychiatry, Trinity College Dublin, St Patrick's University Hospital, Dublin 8, Ireland.
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Abstract
OBJECTIVE The best known neurobehavioral effects of testosterone are on sexual function and aggression. However, testosterone and other androgens may be involved in the pathophysiology of mood disorders and suicidal behavior. This is the first study to examine whether there is a relation between testosterone levels and clinical parameters in bipolar suicide attempters. METHODS Patients with a DSM-IV diagnosis of a bipolar disorder (16 males and 51 females), in a depressive or mixed episode with at least one past suicide attempt were enrolled. Demographic and clinical parameters, including lifetime suicidal behavior, were assessed and recorded. Plasma testosterone was assayed using a double antibody radioimmunoassay procedure. RESULTS The number of major depressive episodes, the maximum lethality of suicide attempts, and the testosterone levels were higher in men compared to women. Current suicidal ideation scores were higher in women compared to men. Controlling for sex, we found that testosterone levels positively correlated with the number of manic episodes and the number of suicide attempts. CONCLUSION Our findings are consistent with previous observations of the association between testosterone levels and parameters of mood and behavior. This study suggests that testosterone levels may be related to the course of bipolar disorder and suicidal behavior. Further studies of the role of testosterone in the neurobiology of mood disorders and suicidal behavior are merited.
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Chachamovich E, Ding Y, Turecki G. Levels of aggressiveness are higher among alcohol-related suicides: results from a psychological autopsy study. Alcohol 2012; 46:529-36. [PMID: 22579734 DOI: 10.1016/j.alcohol.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023]
Abstract
Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.
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Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, Quebec, Canada H4H 1R3.
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Coêlho BM, Andrade LH, Guarniero FB, Wang YP. The influence of the comorbidity between depression and alcohol use disorder on suicidal behaviors in the São Paulo Epidemiologic Catchment Area Study, Brazil. ACTA ACUST UNITED AC 2011; 32:396-408. [PMID: 21308261 DOI: 10.1590/s1516-44462010005000027] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Accepted: 04/27/2010] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate in a community sample the association of suicide-related cognitions and behaviors ("thoughts of death", "desire for death", "suicidal thoughts", and "suicidal attempts") with the comorbidity of depressive disorders (major depressive episode or dysthymia) and alcohol or substance use disorders. METHOD The sample was 1464 subjects interviewed in their homes using the Composite International Diagnostic Interview to generate DSM-III-R diagnosis. Descriptive statistics depicted the prevalence of suicide-related cognitions and behaviors by socio-demographic variables and diagnoses considered (major depressive episode, dysthymia, alcohol or substance use disorders). We performed a multivariate logistic regression analysis to estimate the effect of comorbid major depressive episode/dysthymia and alcohol or substance use disorders on each of the suicide-related cognitions and behaviors. RESULTS The presence of major depressive episode and dysthymia was significantly associated with suicide-related cognitions and behaviors. In the regression models, suicide-related cognitions and behaviors were predicted by major depressive episode (OR=range 2.3-9.2) and dysthymia (OR=range 5.1-32.6), even in the presence of alcohol use disorders (OR=range 2.3-4.0) or alcohol or substance use disorders (OR=range 2.7-2.8). The interaction effect was observed between major depressive episode and alcohol use disorders, as well as between dysthymia and gender. Substance use disorders were excluded from most of the models. CONCLUSION Presence of major depressive episode and dysthymia influences suicide-related cognitions and behaviors, independently of the presence of alcohol or substance use disorders. However, alcohol use disorders and gender interact with depressive disorders, displaying a differential effect on suicide-related cognitions and behaviors.
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Affiliation(s)
- Bruno Mendonça Coêlho
- Section of Psychiatric Epidemiology, Institute and Department of Psychiatry, School of Medicine, Universidade de São Paulo, and Núcleo de Epidemiologia Psiquiátrica, Instituto de Psiquiatria do Hospital das Clínicas, São Paulo, SP, Brazil.
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Nenadic-Sviglin K, Nedic G, Nikolac M, Kozaric-Kovacic D, Stipcevic T, Muck Seler D, Pivac N. Suicide attempt, smoking, comorbid depression, and platelet serotonin in alcohol dependence. Alcohol 2011; 45:209-16. [PMID: 21167673 DOI: 10.1016/j.alcohol.2010.11.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2009] [Revised: 09/10/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022]
Abstract
The risk of suicide in patients with alcoholism increases if alcoholism is related to comorbid depression. Both alcoholism and suicidal behavior are associated with reduced serotonin (5-hydroxytryptamine [5-HT]) function. Because suicide is enormous public health problem worldwide, to prevent suicide attempts, it is important to find peripheral marker of suicidal behavior. The aim of this study was to assess whether platelet 5-HT concentration is altered in alcoholic patients with or without suicide attempt. Platelet 5-HT concentration was evaluated in 397 male and 108 female ethnically homogenous medication-free patients with alcoholism, subdivided according to smoking status, comorbid depression, and a history of suicide attempt and in 450 male and 139 female healthy control (nonsuicidal) subjects. Suicide attempt was assessed by two measures: according to the score 4 on the item 3 from the Hamilton Rating Scale for Depression and according to the Structured Clinical Interview regarding suicidal attempt during lifetime. Both male and female patients with alcoholism who were nonsmokers had significantly lower platelet 5-HT concentration than the corresponding healthy subjects. Multifactor analyses of variance revealed the significant effects of alcoholism and smoking, but the lack of significant effects of suicide attempt, sex, or comorbid depression, and no interactions between variables, on platelet 5-HT concentration. Platelet 5-HT concentration did not differ significantly between suicidal patients compared with nonsuicidal patients with alcoholism. Because the results from the present study showed similar platelet 5-HT values between patients with or without a history of suicide attempt, our data did not support the hypothesis that platelet 5-HT concentration might be used as a peripheral marker of the pronounced suicidal behavior in alcoholism.
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Affiliation(s)
- Korona Nenadic-Sviglin
- Center for Alcoholism and other Addictions, Psychiatric Hospital Vrapce, Zagreb, Croatia
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Conner KR, Gunzler D, Tang W, Tu XM, Maisto SA. Test of a clinical model of drinking and suicidal risk. Alcohol Clin Exp Res 2010; 35:60-8. [PMID: 20958331 DOI: 10.1111/j.1530-0277.2010.01322.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND There are few data on the role of drinking patterns in suicidal thoughts or behavior among alcohol-dependent individuals (ADIs) and meager data on variables that may influence the role of drinking in suicidal thoughts and behavior. This study tested a heuristic model that predicts that drinking promotes suicidal thoughts and behavior, the association is mediated (accounted for) by depressive symptoms, and that anger moderates (increases) the risk associated with intense drinking. METHODS Data from Project MATCH, a multisite alcohol use disorders treatment trial, were analyzed using structural equation modeling. There were 1,726 participants including 24% women and a mean age of 40.2 ± 11.0 years. Subjects were assessed at baseline and at 3-, 9-, and 15-month follow-up. Two categorical measures (presence/absence) of suicidal ideation (SI) were used that were analyzed in separate models. Predictors of interest were continuous assessments of average drinking intensity (i.e., drinks per drinking day or DDD), drinking frequency (i.e., percent days abstinent or PDA), depression, and anger. RESULTS Both DDD and PDA were associated with SI at a statistically significant level, with PDA showing an inverse association. Depression scores served as a partial mediator or a full mediator of the drinking-SI relationship depending on the measure of SI used in the analysis. The models testing anger scores as a moderator fit the data poorly and did not support that anger serves as a moderator of the drinking-SI association. CONCLUSIONS Greater drinking intensity and drinking frequency predict SI among ADIs and depression serves as a mediator of these associations, but anger does not appear to serve as a moderator. Further research is required to clarify whether depression serves as a partial or full mediator and to see whether the results herein extend to suicidal behavior (i.e., suicide attempt, suicide).
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Pani PP, Trogu E, Amato L, Davoli M. Antidepressants for the treatment of depression in alcohol dependent individuals. Hippokratia 2010. [DOI: 10.1002/14651858.cd008581] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Pier Paolo Pani
- Health District 8 (ASL 8) Cagliari; Social-Health Division; Cittadella della Salute, padiglione C via Romagna 16 Cagliari Sardinia Italy 09127
| | - Emanuela Trogu
- Health District 8 (ASL 8) Cagliari; Social-Health Division; Cittadella della Salute, padiglione C via Romagna 16 Cagliari Sardinia Italy 09127
| | - Laura Amato
- ASL RM/E; Department of Epidemiology; Via di Santa Costanza, 53 Rome Italy 00198
| | - Marina Davoli
- ASL RM/E; Department of Epidemiology; Via di Santa Costanza, 53 Rome Italy 00198
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Pompili M, Serafini G, Innamorati M, Dominici G, Ferracuti S, Kotzalidis GD, Serra G, Girardi P, Janiri L, Tatarelli R, Sher L, Lester D. Suicidal behavior and alcohol abuse. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2010; 7:1392-431. [PMID: 20617037 PMCID: PMC2872355 DOI: 10.3390/ijerph7041392] [Citation(s) in RCA: 225] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2010] [Revised: 03/15/2010] [Accepted: 03/19/2010] [Indexed: 12/22/2022]
Abstract
Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns.
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Affiliation(s)
- Maurizio Pompili
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
- McLean Hospital, Harvard Medical School, Belmont, MA 02478, USA
- Author to whom correspondence should be addressed; E-Mail:
or
; Tel. +39-06 33775675; Fax +39-0633775342
| | - Gianluca Serafini
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Marco Innamorati
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giovanni Dominici
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Stefano Ferracuti
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giorgio D. Kotzalidis
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Giulia Serra
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Paolo Girardi
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Luigi Janiri
- Department of Psychiatry, Catholic University Medical School, Largo F. Vito 1, Rome 00168, Italy; E-Mail:
| | - Roberto Tatarelli
- Department of Neuroscience, Mental Health and Sensory Functions, Suicide Prevention Center, Sant’Andrea Hospital, Sapienza University of Rome, Rome 00189, Italy; E-Mails:
(G.S.);
(M.I.);
(G.D.);
(S.F.);
(G.D.K.);
(G.S.);
(P.G.);
(R.T.)
| | - Leo Sher
- Department of Psychiatry, Columbia University, New York, NY 10032, USA; E-Mail:
| | - David Lester
- The Richard Stockton College of New Jersey, Pomona, NJ 08240-0195, USA; E-Mail:
| |
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