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Tomé-Fernández M, Berbegal-Bernabeu M, Sánchez-Sansegundo M, Zaragoza-Martí A, Rubio-Aparicio M, Portilla-Tamarit I, Rumbo-Rodríguez L, Hurtado-Sánchez JA. Neurocognitive Suicide and Homicide Markers in Patients with Schizophrenia Spectrum Disorders: A Systematic Review. Behav Sci (Basel) 2023; 13:446. [PMID: 37366698 DOI: 10.3390/bs13060446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/19/2023] [Accepted: 05/21/2023] [Indexed: 06/28/2023] Open
Abstract
Suicide and homicide are considered important problems in public health. This study aims to identify the cognitive performance of suicidal and homicidal behaviors in people with schizophrenia spectrum disorders, as well as examining whether there are shared neuropsychological mechanisms. A systematic review of the recent literature was carried out from September 2012 to June 2022 using the Medline (via PubMed), Scopus, Embase, and Cochrane databases. Among the 870 studies initially identified, 23 were finally selected (15 related to suicidal behaviors and 8 to homicidal behaviors). The results evidenced a relationship between impairment of cognitive performance and homicidal behavior; meanwhile, for suicidal behaviors, no consistent results were found. High neuropsychological performance seems to act as a protective factor against violent behavior in people with schizophrenia spectrum disorders, but not against suicidal behavior; indeed, it can even act as a risk factor for suicidal behavior. To date, there is insufficient evidence that shared neurocognitive mechanisms exist. However, processing speed and visual memory seem to be affected in the presence of both behaviors.
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Affiliation(s)
- Mario Tomé-Fernández
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Marina Berbegal-Bernabeu
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Miriam Sánchez-Sansegundo
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Ana Zaragoza-Martí
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - María Rubio-Aparicio
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Irene Portilla-Tamarit
- Department of Health Psychology, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
| | - Lorena Rumbo-Rodríguez
- Department of Nursing, Faculty of Health Science, University of Alicante, 03690 Alicante, Spain
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Kappes JR, Huber DA, Kirchebner J, Sonnweber M, Günther MP, Lau S. Self-Harm Among Forensic Psychiatric Inpatients With Schizophrenia Spectrum Disorders: An Explorative Analysis. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:352-372. [PMID: 34861802 DOI: 10.1177/0306624x211062139] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The burden of self-injury among offenders undergoing inpatient treatment in forensic psychiatry is substantial. This exploratory study aims to add to the previously sparse literature on the correlates of self-injury in inpatient forensic patients with schizophrenia spectrum disorders (SSD). Employing a sample of 356 inpatients with SSD treated in a Swiss forensic psychiatry hospital, patient data on 512 potential predictor variables were retrospectively collected via file analysis. The dataset was examined using supervised machine learning to distinguish between patients who had engaged in self-injurious behavior during forensic hospitalization and those who had not. Based on a combination of ten variables, including psychiatric history, criminal history, psychopathology, and pharmacotherapy, the final machine learning model was able to discriminate between self-injury and no self-injury with a balanced accuracy of 68% and a predictive power of AUC = 71%. Results suggest that forensic psychiatric patients with SSD who self-injured were younger both at the time of onset and at the time of first entry into the federal criminal record. They exhibited more severe psychopathological symptoms at the time of admission, including higher levels of depression and anxiety and greater difficulty with abstract reasoning. Of all the predictors identified, symptoms of depression and anxiety may be the most promising treatment targets for the prevention of self-injury in inpatient forensic patients with SSD due to their modifiability and should be further substantiated in future studies.
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Affiliation(s)
| | | | | | | | | | - Steffen Lau
- Psychiatric University Hospital Zurich, Switzerland
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3
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Machetanz L, Lau S, Habermeyer E, Kirchebner J. Suicidal Offenders and Non-Offenders with Schizophrenia Spectrum Disorders: A Retrospective Evaluation of Distinguishing Factors Using Machine Learning. Brain Sci 2023; 13:brainsci13010097. [PMID: 36672077 PMCID: PMC9856902 DOI: 10.3390/brainsci13010097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 12/29/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
Patients with schizophrenia spectrum disorders (SSD) have an elevated risk of suicidality. The same has been found for people within the penitentiary system, suggesting a cumulative effect for offender patients suffering from SSD. While there appear to be overlapping characteristics, there is little research on factors distinguishing between offenders and non-offenders with SSD regarding suicidality. Our study therefore aimed at evaluating distinguishing such factors through the application of supervised machine learning (ML) algorithms on a dataset of 232 offenders and 167 non-offender patients with SSD and history of suicidality. With an AUC of 0.81, Naïve Bayes outperformed all other ML algorithms. The following factors emerged as most powerful in their interplay in distinguishing between offender and non-offender patients with a history of suicidality: Prior outpatient psychiatric treatment, regular intake of antipsychotic medication, global cognitive deficit, a prescription of antidepressants during the referenced hospitalisation and higher levels of anxiety and a lack of spontaneity and flow of conversation measured by an adapted positive and negative syndrome scale (PANSS). Interestingly, neither aggression nor overall psychopathology emerged as distinguishers between the two groups. The present findings contribute to a better understanding of suicidality in offender and non-offender patients with SSD and their differing characteristics.
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Drzał E, Banaszek A, Stanicki P, Wingralek Z. Self-mutilation in people with psychiatric diagnosis - literature review. CURRENT PROBLEMS OF PSYCHIATRY 2023. [DOI: 10.12923/2353-8627/2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
Introduction: Self-mutilation is of an auto-aggressive nature. They take many forms. Usually they do not occur as an isolated phenomenon. Self-injuring persons often have a diagnosed mental disorder, and a psychiatric diagnosis is one of the risk factors for the occurrence of self-harm.
Material and method: In this study, articles were analyzed that contained information on the occurrence of various mental disorders. These articles searched for information on the occurrence of self-mutilation, its type, origin and causes.
Discussion: Self-mutilation is common in patients with a psychiatric diagnosis. The frequency of such behaviors can range from 33% to 50% in people with autism, up to 22%, and even 49% in people diagnosed with psychotic disorders. Acts of selfharm may affect 50-78% of people diagnosed with border-line personality disorder. In adolescents with eating disorders, 41% of patients report self-harm. In the group of people diagnosed with bipolar disorder, it may be as high as 77.3%. People with depression are also a large self-injuring group. It is reported that it may be up to 71.2% of patients with unipolar disorder.
Conclusions: Self-mutilation is a phenomenon that is more and more topical and common not only in the adolescent population. This is a multi-factorial issue. One of the risk factors are mental disorders. Self-mutineers choose various methods, and this choice depends, among others, on from recognition. The size of the phenomenon and its evolution make it necessary to study it in order to increase the level of knowledge, update information and, consequently, the ability to help people at risk of NSSI.
Keywords: self-mutilation, autism spectrum disorder, schizophrenia, bipolar disorder, personality disorders
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Affiliation(s)
- Ewelina Drzał
- I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Agnieszka Banaszek
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Paweł Stanicki
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
| | - Zuzanna Wingralek
- Student Research Group at the I Department of Psychiatry, Psychotherapy, and Early Intervention, Medical University of Lublin, Poland
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Reasoning, problem solving, attention/vigilance, and working memory are candidate phenotypes of non-suicidal self-injury in Chinese Han nationality. Neurosci Lett 2021; 753:135878. [PMID: 33823235 DOI: 10.1016/j.neulet.2021.135878] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 03/06/2021] [Accepted: 03/31/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Non-suicidal self-injury (NSSI) is an act of deliberately hurting one's body without the purpose of death. Internal phenotypes have been used in numerous studies of mental disorders, suicide, and self-injury. This research aimed to evaluate the cognitive function of patients with NSSI and determine their potential endophenotype. METHODS This study used a comparative control design and included 61 patients with NSSI, 55 healthy siblings (HS), and 53 healthy controls. Visual learning, reasoning and problem, verbal learning, attention/vigilance, working memory, and speed of processing were used to evaluate the cognitive function of the subjects. RESULTS Patients with NSSI and their HS showed cognitive defects in reasoning and problem, attention/vigilance, and working memory. Substantial differences were observed in verbal learning among the three groups, but no significant difference was recorded in the scores in Brief Assessment of Cognition in Schizophrenia. CONCLUSIONS The results suggest that reasoning and problem, attention/vigilance, and working memory may be potential endophenotypes in early identification of Chinese Han people with NSSI behavior.
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6
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Cognition and self-injurious thoughts and behaviors: A systematic review of longitudinal studies. Clin Psychol Rev 2019; 69:97-111. [DOI: 10.1016/j.cpr.2018.07.002] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 07/08/2018] [Accepted: 07/12/2018] [Indexed: 12/11/2022]
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Brown S, O’Rourke S, Schwannauer M. Risk factors for inpatient violence and self-harm in forensic psychiatry: the role of head injury, schizophrenia and substance misuse. Brain Inj 2018; 33:313-321. [DOI: 10.1080/02699052.2018.1553064] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Sarah Brown
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
| | - Suzanne O’Rourke
- Clinical Psychology, University of Edinburgh, Edinburgh, UK
- Department of Psychology, The State Hospital, Carstairs, UK
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8
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Lien YJ, Chang HA, Kao YC, Tzeng NS, Yeh CB, Loh CH. Self-Stigma Mediates the Impact of Insight on Current Suicide Ideation in Suicide Attempters with Schizophrenia: Results of a Moderated Mediation Approach. Suicide Life Threat Behav 2018; 48:661-676. [PMID: 28869800 DOI: 10.1111/sltb.12384] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 05/28/2017] [Indexed: 12/12/2022]
Abstract
This study examined the relationships among insight, self-stigma, self-esteem, hope, quality of life, and suicidal behavior in individuals diagnosed as having schizophrenia. Hypotheses concerning mediating and moderating effects were examined. A total of 170 community-dwelling patients with schizophrenia participated in the study. The results revealed a negative association between insight and suicide ideation, which was partially mediated by self-stigma. Moreover, this indirect link was stronger among patients with suicide attempts than among those without attempts. We discuss the implications of these results for preventing or reducing the considerable risks of suicide in this population.
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Affiliation(s)
- Yin-Ju Lien
- Department of Health Promotion and Health Education, National Taiwan Normal University, Taipei, Taiwan
| | - Hsin-An Chang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Yu-Chen Kao
- Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital Songshan Branch, Taipei, Taiwan
| | - Nian-Sheng Tzeng
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Chin-Bin Yeh
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.,Department of Psychiatry, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Hui Loh
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
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9
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"We Went Out to Explore, But Gained Nothing But Illness": Immigration Expectations, Reality, Risk and Resilience in Chinese-Canadian Women with a History of Suicide-Related Behaviour. Cult Med Psychiatry 2018; 42:504-534. [PMID: 29383554 DOI: 10.1007/s11013-018-9566-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Suicide is a complex and tragic outcome driven by biological, psychological, social and cultural factors. Women of Chinese descent and women who have immigrated to other countries have higher rates of suicidal ideation and behaviour, and immigration-related stress may contribute. To understand the experiences of immigration and their relationship with distress and suicide-related behaviour in Chinese women who have immigrated to Canada. 10 semi-structured qualitative interviews with Chinese women who have immigrated to Toronto, Canada and have a history of suicide-related behaviour were completed and analyzed using a constructivist grounded theory methodology. Immigration-related and acculturation stress stemmed from unmet expectations and harsh realities. These repeated experiences resulted in hopelessness, helplessness, and alienation, which are risk factors for suicide and suicide-related behaviour. However, immigration-related support can also increase hope, self-efficacy and connectedness to foster recovery and resilience. This is the first qualitative study focusing on immigration experiences and its relationship to suicide-related behaviour in Chinese immigrant women. Knowledge of immigration and acculturation stressors can a) help identify and support women at risk for suicide and b) form a target for social intervention for all immigrant women, regardless of suicide risk.
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10
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Eddy CM. Social cognition and self-other distinctions in neuropsychiatry: Insights from schizophrenia and Tourette syndrome. Prog Neuropsychopharmacol Biol Psychiatry 2018; 82:69-85. [PMID: 29195921 DOI: 10.1016/j.pnpbp.2017.11.026] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 02/08/2023]
Abstract
Impairments in social cognition may reflect dysfunction of disorder specific or disorder general mechanisms. Although cross-disorder comparison may prove insightful, few studies have compared social cognition in different neuropsychiatric disorders. Parallel investigation of schizophrenia and Tourette syndrome (TS) is encouraged by similarities including the presence of problematic social behavior, echophenomena, emotional dysregulation and dopamine dysfunction. Focusing on tests of social cognition administered in both disorders, this review aims to summarize behavioral, neurophysiological and neuroimaging findings, before exploring how these may contribute to clinical symptoms. Studies investigating social cognition (imitation, emotion recognition, and understanding of beliefs or intentions) in patients with schizophrenia or TS were identified through Web of Science and PubMed searches. Although findings indicate that social cognitive deficits are more apparent in schizophrenia, adults with TS can exhibit similar task performance to patients with paranoia. In both disorders, behavioral and neuroimaging findings raise the possibility of increased internal simulation of others' actions and emotions, in combination with a relative under-application of mentalizing. More specifically, dysfunction in neurobiological substrates such as temporo-parietal junction and inferior frontal gyrus may underlie problems with self-other distinctions in both schizophrenia and TS. Difficulties in distinguishing between actions and mental states linked to the self and other may contribute to a range of psychiatric symptoms, including emotional dysregulation, paranoia, social anhedonia and socially disruptive urges. Comparing different patient populations could therefore reveal common neuro-cognitive risk factors for the development of problematic social behaviors, in addition to markers of resilience, coping strategies and potential neuro-compensation mechanisms.
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Affiliation(s)
- Clare M Eddy
- BSMHFT National Centre for Mental Health, Birmingham, and College of Medical and Dental Sciences, University of Birmingham, UK.
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11
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Massons C, Lopez-Morinigo JD, Pousa E, Ruiz A, Ochoa S, Usall J, Nieto L, Cobo J, David AS, Dutta R. Insight and suicidality in psychosis: A cross-sectional study. Psychiatry Res 2017; 252:147-153. [PMID: 28273629 DOI: 10.1016/j.psychres.2017.02.059] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2016] [Revised: 02/23/2017] [Accepted: 02/26/2017] [Indexed: 10/20/2022]
Abstract
AIMS We aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. METHODS 143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. RESULTS Those subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of "disturbed thinking and loss of control over the situation" and "having a vague feeling that something is wrong") were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. CONCLUSIONS Suicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.
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Affiliation(s)
- Carmen Massons
- Mental Health Deparment, Corporació Sanitària Parc Taulí- Universitat Autònoma de Barcelona, Campus d'Excel·lència Internacional, Bellaterra 08193, Spain.
| | - Javier-David Lopez-Morinigo
- King's College of London, Institute of Psychiatry, Psychology and Neurosciences, Department of Psychosis Studies, London, UK
| | - Esther Pousa
- Mental Health Deparment, Corporació Sanitària Parc Taulí- Universitat Autònoma de Barcelona, Campus d'Excel·lència Internacional, Bellaterra 08193, Spain
| | - Ada Ruiz
- Institut de Neuropsiquiatria i Addiccions, Parc de Salut Mar, Barcelona, Spain; IMIM ( Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Susana Ochoa
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Judith Usall
- Research and Development Unit, Parc Sanitari San Joan de Dèu - CIBERSAM, Sant Boi de Llobregat, Barcelona, Spain
| | - Lourdes Nieto
- Department of Research Instituto Nacional de Psiquiatría Ramón de la Fuente Muñiz, Calzada México-Xochimilco 101, San Lorenzo Huipulco, Tlalpan, México D.F. 14370, Mexico
| | - Jesus Cobo
- Mental Health Deparment, Corporació Sanitària Parc Taulí- Universitat Autònoma de Barcelona, Campus d'Excel·lència Internacional, Bellaterra 08193, Spain; Department of Psychiatry and Forensic Medicine, Universitat Autònoma de Barcelona, 08193 Bellaterra, Barcelona, Spain; Centro de Investigación Biomédica En Red de Salud Mental, CIBERSAM, Sabadell, Spain
| | - Anthony S David
- King's College of London, Institute of Psychiatry, Psychology and Neurosciences, Department of Psychosis Studies, London, UK
| | - Rina Dutta
- King's College London, Institute of Psychiatry, Psychology and Neurosciences, Department of Psychological Medicine, London, UK
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12
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de Cates AN, Rees K, Jollant F, Perry B, Bennett K, Joyce K, Leyden E, Harmer C, Hawton K, van Heeringen K, Broome MR. Are neurocognitive factors associated with repetition of self-harm? A systematic review. Neurosci Biobehav Rev 2016; 72:261-277. [PMID: 27923730 DOI: 10.1016/j.neubiorev.2016.10.032] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 09/13/2016] [Accepted: 10/27/2016] [Indexed: 01/27/2023]
Abstract
BACKGROUND Prediction of self-harm is limited clinically. Early identification of individuals likely to repeat self-harm could improve outcomes and reduce suicide risk. Various neurocognitive deficits have been found in people who self-harm, but the ability of these to predict repetition has yet to be established AIMS: Identify neurocognitive factors that may predict repetition of self-harm. METHODS Systematic narrative review of English language publications assessing neurocognitive functioning and self-harm repetition, searching multiple databases from inception to March 2015. Quality of studies was appraised. A narrative synthesis was performed. RESULTS 7026 unique records were identified, and 169 full-texts assessed. 15 unique studies provided data. No imaging studies could be included. Most studies assessed cognitive control or problem solving, but neither factor was consistently associated with repetition. However, specific tasks may show promise. Two studies in adolescents suggest that value-based decision-making impairments could be predictive of repetition. There were too few results for memory to draw specific conclusions. CONCLUSIONS Selected studies suggest promise for particular neurocognitive factors and specific cognitive tasks in terms of repetition of self-harm.
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Affiliation(s)
- Angharad N de Cates
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK.
| | - Karen Rees
- Division of Health Sciences, Warwick Medical School, University of Warwick, UK
| | - Fabrice Jollant
- McGill University, Department of Psychiatry & Douglas Mental Health University Institute, McGill Group for Suicide Studies, Montréal, Québec, Canada; Academic Hospital (CHU) of Nîmes, France
| | - Benjamin Perry
- Unit of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, UK; Coventry and Warwickshire Partnership NHS Trust, Coventry, UK
| | | | - Katie Joyce
- Warwick Medical School, University of Warwick, UK
| | - Eimear Leyden
- University Hospitals of Coventry and Warwickshire, Coventry, UK
| | | | - Keith Hawton
- Centre for Suicide Research, Department of Psychiatry, University of Oxford, UK
| | - Kees van Heeringen
- Unit for Suicide Research, Department of Psychiatry and Medical Psychology, Ghent University, Ghent, Belgium
| | - Matthew R Broome
- Department of Psychiatry, University of Oxford, UK; Oxford Health NHS Foundation Trust, Oxford, UK
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13
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Lee SJ, Kim B, Oh D, Kim MK, Kim KH, Bang SY, Choi TK, Lee SH. White matter alterations associated with suicide in patients with schizophrenia or schizophreniform disorder. Psychiatry Res Neuroimaging 2016; 248:23-29. [PMID: 26774424 DOI: 10.1016/j.pscychresns.2016.01.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 10/13/2015] [Accepted: 01/03/2016] [Indexed: 11/22/2022]
Abstract
The risk of suicide is disproportionately high among people diagnosed with schizophrenia or schizophreniform disorder. Brain imaging studies have shown a few relationships between neuroanatomy and suicide. This study examines the relationship between alterations in brain white matter (WM) and suicidal behavior in people with schizophrenia or schizophreniform disorder. The study participants were 56 patients with schizophrenia or schizophreniform disorder, with (n=15) and without (n=41) a history of suicide attempts. Fractional anisotropy (FA) values were compared between suicide attempters and non-attempters using Tract-Based Spatial Statistics (TBSS). Attempters showed significantly higher FA values than non-attempters in the left corona radiata, the superior longitudinal fasciculus, the posterior limb and retrolenticular part of the internal capsule, the external capsule, the insula, the posterior thalamic radiation, the cerebral peduncle, the sagittal stratum, and temporal lobe WM. Scores of the picture arrangement test showed a significant positive correlation with FA values of the right corona radiata, the right superior longitudinal fasciculus, the body of the corpus callosum, and the left corona radiata in attempters but not in non-attempters. These findings suggest that fronto-temporo-limbic circuits can be associated mainly with suicidal behavior in people with schizophrenia or schizophreniform disorder.
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Affiliation(s)
- Sung-Jae Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Borah Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Daeyoung Oh
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Min-Kyoung Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Keun-Hyang Kim
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Seong Yun Bang
- Department of Public Health, Graduate School of Health and Welfare, CHA University, Seongnam, Republic of Korea
| | - Tai Kiu Choi
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
| | - Sang-Hyuk Lee
- Department of Psychiatry, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.
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14
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Violent typologies among women inpatients with severe mental illness. Soc Psychiatry Psychiatr Epidemiol 2016; 51:1615-1622. [PMID: 27591986 PMCID: PMC5131083 DOI: 10.1007/s00127-016-1280-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 08/28/2016] [Indexed: 11/04/2022]
Abstract
PURPOSE Extant severe mental illness (SMI) and physical violence literature focus disproportionately on community-based men samples. To address this empirical imbalance, the current study explored violence towards others and oneself among women inpatients with SMI. As those with SMI are more likely to be victims than perpetrators of violence, victimisation was also an important factor assessed in this study. METHODS The study used a quantitative within-subject cross-sectional design. Data were extracted from 5675 inpatient women cases between 2009 and 2013. RESULTS Women with a manic disorder (without psychotic features) were 4.5 times, whilst those with psychotic disorders were 2 times, more likely to be physically violent to others compared to those with major mood disorders. Conversely, women with a major mood disorders were 4.8 times and 7.5 times more likely to engage in violence towards oneself (deliberate self-harm), compared to those with psychotic disorder and manic disorders, respectively. The past victimisation increased the likelihood of later physical violence. CONCLUSION The data illuminate differential risk factors among women inpatients with SMI that may help predict violence occurring towards others and oneself and allow gender comparisons with the established literature.
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15
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Lee KH, Pluck G, Lekka N, Horton A, Wilkinson ID, Woodruff PWR. Self-harm in schizophrenia is associated with dorsolateral prefrontal and posterior cingulate activity. Prog Neuropsychopharmacol Biol Psychiatry 2015; 61:18-23. [PMID: 25784601 DOI: 10.1016/j.pnpbp.2015.03.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 02/25/2015] [Accepted: 03/09/2015] [Indexed: 10/23/2022]
Abstract
Self-harm, such as self-cutting, self-poisoning or jumping from height, regardless of intentions, is common among people with schizophrenia. We wished to investigate brain activations relating to self-harm, in order to test whether these activations could differentiate between schizophrenia patients with self-harm and those without. We used event-related functional MRI with a go/no-go response inhibition paradigm. Fourteen schizophrenia patients with a history of self-harm were compared with 14 schizophrenia patients without a history of self-harm and 17 healthy control participants. In addition, we used standard clinical measures and neuropsychological tests to assess risk factors associated with self-harm. The right dorsolateral prefrontal cortex (DLPFC) and the left posterior cingulate cortex differentiated all three groups; brain activation in these regions being greatest in the control group, and the self-harm patient group being greater than in the non-self-harm patient group. In the self-harm patient group, right DLPFC activity was positively correlated with severity of suicidal thinking. In addition, both patient groups showed less activation in the right orbitofrontal cortex, left ventral anterior cingulate cortex and right thalamus. This is the first study to report right DLPFC activation in association with self-harm and suicidal thinking in patients with schizophrenia. This area could be a target for future neuromodulation studies to treat suicidal thinking and self-harm behaviors in patients with schizophrenia.
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Affiliation(s)
- Kwang-Hyuk Lee
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK; Department of Psychology, University of Sheffield, UK.
| | - Graham Pluck
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK
| | - Nicoletta Lekka
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK
| | - Andrew Horton
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK
| | - Iain D Wilkinson
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK; Academic Unit of Radiology, School of Medicine, University of Sheffield, UK
| | - Peter W R Woodruff
- Sheffield Cognition and Neuroimaging Laboratory (SCANLab), Academic Clinical Psychiatry, Department of Neuroscience, University of Sheffield, UK
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16
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Does Dual Diagnosis Affect Violence and Moderate/Superficial Self-harm in Heroin Addiction at Treatment Entry? J Addict Med 2014; 8:116-22. [DOI: 10.1097/adm.0000000000000019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Mork E, Walby FA, Harkavy-Friedman JM, Barrett EA, Steen NE, Lorentzen S, Andreassen OA, Melle I, Mehlum L. Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm--a cross-sectional study. BMC Psychiatry 2013; 13:255. [PMID: 24106884 PMCID: PMC3852098 DOI: 10.1186/1471-244x-13-255] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 10/03/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. METHODS Using a cross-sectional design, 251 patients (18-61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. RESULTS Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. CONCLUSIONS Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.
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Affiliation(s)
- Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway.
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway,Department of Psychiatry, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | | | - Elizabeth A Barrett
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Nils E Steen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Steinar Lorentzen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway
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Abstract
Background: Homelessness is associated with an increased incidence of mental illness and risk of self-harm, including suicide. Aims: To assess the prevalence of self-harm (including nonsuicidal self-injury and attempted suicide) among a UK sample of homeless adults and to compare demographic, clinical, and homeless-related variables to determine which are linked to self-harm in this population. Method: A sample of 80 homeless adults were interviewed regarding history of self-harm, mental health history, demographic, and homeless-related information. Results: Sixty-eight percent of the sample reported past acts of self-harm. Those with histories of self-harm started using significantly more substances since becoming homeless and were younger when they first became homeless. They were also significantly more likely to have a past psychiatric admission and thoughts of self-harm in the past year. Conclusion: Self-harm is common among homeless adults and linked to long-term and enduring social and mental health concerns.
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Affiliation(s)
- Graham Pluck
- Academic Clinical Psychiatry, University of Sheffield, UK
| | - Kwang-Hyuk Lee
- Academic Clinical Psychiatry, University of Sheffield, UK
| | - Randolph W. Parks
- Academic Clinical Psychiatry, University of Sheffield, UK
- Alton Mental Health Center, Illinois Department of Human Services, Alton, IL, USA
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