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Brager-Larsen A, Zeiner P, Mehlum L. DSM-5 Non-Suicidal Self-Injury Disorder in a Clinical Sample of Adolescents with Recurrent Self-Harm Behavior. Arch Suicide Res 2024; 28:523-536. [PMID: 37506259 DOI: 10.1080/13811118.2023.2192767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/30/2023]
Abstract
INTRODUCTION Non-suicidal self-injury disorder (NSSID) is a new diagnosis proposed in DSM-5 with a need of further study, especially in adolescent clinical populations where non-suicidal self-injury (NSSI) is particularly prevalent. We aimed to study characteristics of NSSID and estimate an optimal cutoff frequency level of NSSI behavior. METHODS Data were collected from 103 outpatient adolescents (ages 12-18) with recurrent self-harm behavior. RESULTS Adolescents with NSSID reported significantly more frequent NSSI behavior and suicide attempts than adolescents without NSSID. Frequency of NSSI, global functioning, depressive symptoms, number of self-harm methods and anxiety symptoms best discriminated between adolescents with and without NSSID. An optimal cutoff level for a diagnosis of NSSID was found to be ≥15 days with NSSI during the last year, which led to a reduction in the rate of adolescents diagnosed with NSSID from 54% to 46%. CONCLUSION This study shows that NSSID is a highly impairing disorder characterized by high risk of multiple NSSI and suicide attempts, decreased functioning and other associated psychiatric disorders. Clinical awareness of these risks are important to ensure early detection and treatment. Future prospective longitudinal studies are needed to further validate the characteristics of the NSSID diagnosis and its clinical utility.
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2
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Brager-Larsen A, Zeiner P, Mehlum L. Sub-threshold or full-syndrome borderline personality disorder in adolescents with recurrent self-harm - distinctly or dimensionally different? Borderline Personal Disord Emot Dysregul 2023; 10:26. [PMID: 37705040 PMCID: PMC10500832 DOI: 10.1186/s40479-023-00234-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/27/2023] [Indexed: 09/15/2023] Open
Abstract
BACKGROUND Borderline personality disorder (BPD) is a severe mental disorder frequently seen in individuals with recurrent self-harm behaviour. To what extent there are distinguishing characteristics between self-harming adolescents who meet the criteria for a full diagnosis of BPD, a sub-threshold number of BPD criteria and those who don't have BPD, with respect to clinical characteristics, is still uncertain and could have important clinical implications. METHODS Data from 103 adolescents with recurrent self-harm behaviour recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports. Bivariate analyses comparing participants with or without a diagnosis of BPD were performed. Group differences based on the number of BPD criteria fulfilled (few-if-any BPD: 0-2 criteria, sub-threshold BPD: 3-4 criteria, full-syndrome BPD: 5 or more criteria) were tested and regression analyses performed. RESULTS Adolescents with a diagnosis of BPD (28.2%) had significantly higher numbers of co-morbid DSM-5 disorders, suicide attempts and self-harm methods. They also reported significantly higher levels of suicidal ideation, depression, anxiety and impulsivity, compared with adolescents without BPD. Adolescents with sub-threshold BPD (20.4%) place themselves in the intermediate position between participants with full-syndrome BPD and participants with few-if-any BPD, in terms of these symptoms. Higher levels of emotional regulation difficulties and a lower level of global functioning were significantly associated with fulfilling a higher number of BPD criteria. CONCLUSION Adolescents with recurrent self-harm who meet diagnostic criteria for a full-syndrome BPD or sub-threshold BPD seem to have difficulties within the same spectrum. They seem dimensionally, but not categorically, different with respect to the severity of their difficulties. These adolescents need interventions aimed at their dysfunctional self-harm behaviour, emotional regulation difficulties and BPD symptoms at an earlier, rather than at a later stage of symptom development.
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Affiliation(s)
- Anne Brager-Larsen
- Child and Adolescent Mental Health Research Unit, Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372, Oslo, Norway.
| | - Pål Zeiner
- Child and Adolescent Mental Health Research Unit, Division of Mental Health and Addiction, Department of Research and Innovation, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372, Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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3
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Winters DE, Mikulich SK, Hopfer C, Sakai JT. Adolescents in Treatment for Substance Use Disorders: Callous-Unemotional Traits Moderate Associations Between Transdiagnostic Symptoms and Adolescent Suicidality. Child Psychiatry Hum Dev 2023; 54:397-405. [PMID: 34559328 PMCID: PMC8942863 DOI: 10.1007/s10578-021-01256-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/15/2021] [Indexed: 10/20/2022]
Abstract
Suicide, a common cause of death in adolescents, is linked to internalizing and externalizing symptoms. These associations are pronounced amongst adolescents who use substances. But these relationships are complex. For example, sex differences are present in association with internalizing/externalizing symptoms as well as differences in suicidality. A rarely explored factor that may account for this complexity as a moderator is callous-unemotional traits. The present study examines associations of internalizing and externalizing in relation to suicidality in the context of callous-unemotional traits amongst adolescents in substance use treatment. Additionally, sex differences were explored. A sample of 317 adolescents (13-18; 16.05 ± 1.22) in treatment for substance use completed measures for internalizing, externalizing, and suicidal symptoms. The main result suggested the presence of callous-unemotional (CU) traits attenuated the positive association between internalizing and a latent suicidality factor. This novel result contextualizes the association between transdiagnostic symptoms and suicidality. Assessing CU traits in the presence of internalizing symptoms may be an important component of understanding suicide risk amongst adolescents in treatment for substance use.
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Affiliation(s)
- Drew E Winters
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA.
| | - Susan K Mikulich
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Christian Hopfer
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
| | - Joseph T Sakai
- Department of Psychiatry, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO, USA
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Klumpp H, Bauer BW, Glazer J, Macdonald-Gagnon G, Feurer C, Duffecy J, Medrano GR, Craske MG, Phan KL, Shankman SA. Neural responsiveness to reward and suicidal ideation in social anxiety and major depression before and after psychotherapy. Biol Psychol 2023; 178:108520. [PMID: 36801433 PMCID: PMC10106432 DOI: 10.1016/j.biopsycho.2023.108520] [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: 10/19/2022] [Revised: 01/23/2023] [Accepted: 02/15/2023] [Indexed: 02/19/2023]
Abstract
Suicidality is prevalent in Social Anxiety Disorder (SAD) and Major Depressive Disorder (MDD). Limited data indicate the reward positivity (RewP), a neurophysiological index of reward responsivity, and subjective capacity for pleasure may serve as brain and behavioral assays for suicide risk though this has yet to be examined in SAD or MDD in the context of psychotherapy. Therefore, the current study tested whether suicidal ideation (SI) relates to RewP and subjective capacity for anticipatory and consummatory pleasure at baseline and whether Cognitive Behavioral Therapy (CBT) impacts these measures. Participants with SAD (n = 55) or MDD (n = 54) completed a monetary reward task (gains vs. losses) during electroencephalogram (EEG) before being randomized to CBT or supportive therapy (ST), a comparator common factors arm. EEG and SI data were collected at baseline, mid-treatment, and post-treatment; capacity for pleasure was collected at baseline and post-treatment. Baseline results showed participants with SAD or MDD were comparable in SI, RewP, and capacity for pleasure. When controlling for symptom severity, SI negatively corresponded with RewP following gains and SI positively corresponded with RewP following losses at baseline. Yet, SI did not relate to subjective capacity for pleasure. Evidence of a distinct SI-RewP association suggests RewP may serve as a transdiagnositic brain-based marker of SI. Treatment outcome revealed that among participants with SI at baseline, SI significantly decreased regardless of treatment arm; also, consummatory, but not anticipatory, pleasure increased across participants regardless of treatment arm. RewP was stable following treatment, which has been reported in other clinical trial studies.
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Affiliation(s)
- Heide Klumpp
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA.
| | - Brian W Bauer
- Department of Psychology, University of Georgia, Athens, GA, USA
| | - James Glazer
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
| | | | - Cope Feurer
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Jennifer Duffecy
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Gustavo R Medrano
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Michelle G Craske
- Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, CA, USA
| | - K Luan Phan
- Department of Psychiatry and Behavioral Health, The Ohio State University, Columbus, OH, USA
| | - Stewart A Shankman
- Department of Psychiatry and Behavioral Sciences, Northwestern University, Chicago, IL, USA
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5
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London-Nadeau K, Chadi N, Taylor AB, Chan A, Pullen Sansfaçon A, Chiniara L, Lefebvre C, Saewyc EM. Social Support and Mental Health Among Transgender and Nonbinary Youth in Quebec. LGBT Health 2023; 10:306-314. [PMID: 36787477 DOI: 10.1089/lgbt.2022.0156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
Abstract
Purpose: Transgender and nonbinary (TNB) youth face elevated levels of discrimination, stigma, mental health disorders, and suicidality when compared with their cisgender counterparts. Family and school support may mitigate some of the effects of the stressors facing TNB youth. This study aimed to better understand the impact of each of these sources of support on TNB youths' mental health and wellbeing. Methods: We used data collected between 2018 and 2019 as part of the Canadian Trans Youth Health Survey, a bilingual online survey to measure social support, physical health, and mental health in a sample of 220 TNB youth aged 14-25 living in Québec, Canada. We examined the relationships among different sources of support, and mental health and wellbeing outcomes using logistic regression. Analyses were conducted on the full sample and according to linguistic groups (French and English). Results: Participants reported high levels of mental health symptoms, self-harm, and suicidality, and mental health symptoms were higher in the English-speaking group (p = 0.005). In models controlling for age, family connectedness was associated with good/excellent self-reported mental health (odds ratio [OR] = 2.62, p = 0.001) and lower odds of having considered suicide (OR = 0.49, p = 0.003) or attempted suicide (OR = 0.43, p = 0.002), whereas school connectedness was associated with higher odds of good/very good/excellent general (OR = 2.42, p = 0.013) and good/excellent mental (OR = 2.45, p = 0.045) health. Conclusion: Family and school support present consistent associations with TNB youths' health and may constitute key areas for intervention for those supporting them.
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Affiliation(s)
- Kira London-Nadeau
- Department of Psychology, Université de Montréal, Montréal, Québec, Canada.,CHU Sainte-Justine Research Center, Montréal, Québec, Canada
| | - Nicholas Chadi
- CHU Sainte-Justine Research Center, Montréal, Québec, Canada.,Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada.,Division of Adolescent Medicine, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Ashley B Taylor
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Ace Chan
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annie Pullen Sansfaçon
- Canada Research Chair on Transgender Children and their Families, School of Social Work, Université de Montréal, Montréal, Québec, Canada.,School of Social Work, Stellenbosch University, Stellenbosch, South Africa
| | - Lyne Chiniara
- Division of Endocrinology, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Claire Lefebvre
- Division of General Pediatrics, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Québec, Canada
| | - Elizabeth M Saewyc
- Stigma and Resilience Among Vulnerable Youth Centre, School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Bell KA, Gratch I, Ebo T, Cha CB. Examining Discrepant Reports of Adolescents' Self-Injurious Thoughts and Behaviors: A Focus on Racial and Ethnic Minority Families. Arch Suicide Res 2022; 26:1505-1519. [PMID: 34019780 DOI: 10.1080/13811118.2021.1925607] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Adolescents and their parents do not always see eye to eye. This principle applies to multi-informant reports of adolescents' self-injurious thoughts and behaviors. Although prior work has revealed the presence of parent-adolescent discrepant reports, we have little insight into exactly who is most likely to display such discrepancies. To address this knowledge gap, the present investigation examines demographic correlates of parent-adolescent reports of adolescents' self-injurious thoughts and behaviors, with a focus on race and ethnicity. METHOD The sample included 45 dyads of adolescents (M = 15.79 years, SD = 1.42) and their parents reporting on adolescents' history of suicide ideation, suicide plan, suicide gesture, suicide attempt, and nonsuicidal self-injury (NSSI). RESULTS Greater discrepancies in reports of adolescents' suicide ideation and NSSI were observed among racial minority parent-adolescent dyads (Black, Asian, Multiracial, Other) relative to White dyads. Racial minority parents tended to report less suicide ideation and NSSI observed in their adolescents compared to adolescents' self-report. Moreover, Hispanic parents tended to report less NSSI relative to adolescents' self-report. Parent-adolescent discrepancies did not consistently correspond with other characteristics such as age and sexual orientation. CONCLUSION Racial minority parent-adolescent dyads, relative to White parent-adolescent dyads, are less likely to see eye to eye on adolescents' suicidal and nonsuicidal self-harming tendencies.
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Moss AC, Roberts AJ, Yi-Frazier JP, Read KL, Taplin CE, Weaver KW, Pihoker C, Hirsch IB, Malik FS. Identifying Suicide Risk in Adolescents and Young Adults With Type 1 Diabetes: Are Depression Screeners Sufficient? Diabetes Care 2022; 45:1288-1291. [PMID: 35147698 PMCID: PMC9375441 DOI: 10.2337/dc21-1553] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 01/20/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Examine the utility of suicide-risk items embedded within depression screeners for identifying the presence of suicide risk in adolescents and young adults (AYA) with type 1 diabetes. RESEARCH DESIGN AND METHODS Sensitivity, specificity, and predictive value of self-report of suicide risk on the Patient Health Questionniaire-9 (PHQ-9) were compared with the pediatric psychologist-administered Columbia-Suicide Severity Rating Scale (C-SSRS) as the reference standard for AYA with type 1 diabetes seen in a multidisciplinary AYA Diabetes Program clinic. RESULTS Of 133 participants, 9.8% and 11.3% reported suicide risk on the PHQ-9 and C-SSRS, respectively. Sensitivity of the PHQ-9 risk item was 53.3% (95% CI 27.4%-77.7%), specificity was 95.7% (95% CI 89.9%-98.4%), positive predictive value was 61.5% (95% CI 32.3%-84.9%), and negative predictive value was 94.2% (95% CI 87.9-97.4%). CONCLUSIONS Depression screeners appear to under-identify AYA with type 1 diabetes who may otherwise be at risk for suicide.
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Affiliation(s)
- Ashley C Moss
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Alissa J Roberts
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
| | | | - Kendra L Read
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Craig E Taplin
- Department of Pediatrics, University of Washington, Seattle, WA.,Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Kathryn W Weaver
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA
| | - Catherine Pihoker
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
| | - Irl B Hirsch
- Department of Medicine, Division of Metabolism, Endocrinology, and Nutrition, University of Washington, Seattle, WA
| | - Faisal S Malik
- Department of Pediatrics, University of Washington, Seattle, WA.,Seattle Children's Research Institute, Seattle, WA
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Ferreira ACZ, Capistrano FC, Kaled M, Maftum MA, Kalinke LP, Palm RDCM, Miasso AI. Tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento. REME: REVISTA MINEIRA DE ENFERMAGEM 2022. [DOI: 10.35699/2316-9389.2022.38798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Objetivo: identificar os fatores associados à tentativa de suicídio por pessoas com transtornos relacionados ao uso de substâncias em tratamento nos Centros de Atenção Psicossocial de Álcool e outras Drogas. Método: estudo observacional e transversal realizado com 137 pessoas com transtornos relacionados ao uso de substâncias em tratamento em Centros de Atenção Psicossocial de Álcool e outras Drogas de uma capital da região Sul do Brasil. Os dados foram coletados entre abril e novembro de 2018 por entrevista estruturada e submetidos à análise quantitativa descritiva, univariada e múltipla. Resultados: 51,8% dos participantes apresentaram ao menos uma tentativa de suicídio alguma vez na vida. Pensamentos suicidas ativos com intenção e com planejamento permaneceram associadas de modo independente ao histórico de tentativa de suicídio (RP: 2,87; IC: 1,04-7,91; p: 0,041). Na análise univariada houve associação entre tentativa de suicídio e dias de problema físico, intensidade dos pensamentos suicidas, comportamento preparatório, sentimentos depressivos, histórico familiar de transtorno mental, internamento em hospital psiquiátrico, importância de tratamento em saúde mental e prescrição de medicamentos. Conclusão: mais gravidade de pensamentos suicidas foi identificada como fator associado ao histórico de tentativa de suicídio. Enfatiza-se a importância da escuta ativa na prática profissional em saúde, do vínculo terapêutico e do acolhimento nos serviços de atenção à saúde.
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Virk F, Waine J, Berry C. A rapid review of emergency department interventions for children and young people presenting with suicidal ideation. BJPsych Open 2022; 8:e56. [PMID: 35241211 PMCID: PMC8935937 DOI: 10.1192/bjo.2022.21] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Suicidal ideation is an increasingly common presentation to the paediatric emergency department. The presence of suicidal ideation is linked to acute psychiatric hospital admission and increased risk of suicide. The paediatric emergency department plays a critical role in reducing risk of suicide, strengthening protective factors and encouraging patient engagement with ongoing care. AIMS This rapid review aims to synthesise evidence on interventions that can be implemented in the paediatric emergency department for children and adolescents presenting with suicidal ideation. METHOD Six electronic databases were searched for studies published since January 2010: PubMed, Web of Science, Medline, PsycINFO, CINAHL and Cochrane. Outcomes of interest included suicidal ideation, engagement with out-patient services, incidence of depressive symptoms, hopelessness, family empowerment, hospital admission and feasibility of interventions. The Cochrane risk-of-bias tool was used to evaluate the quality of studies. RESULTS Six studies of paediatric emergency department-initiated family-based (n = 4) and motivational interviewing interventions (n = 2) were narratively reviewed. The studies were mainly small and of varying quality. The evidence synthesis suggests that both types of intervention, when initiated by the paediatric emergency department, reduce suicidal ideation and improve patient engagement with out-patient services. Family-based interventions also showed a reduction in suicidality and improvement in family empowerment, hopelessness and depressive symptoms. CONCLUSIONS Paediatric emergency department-initiated interventions are crucial to reduce suicidal ideation and risk of suicide, and to enhance ongoing engagement with out-patient services. Further research is needed; however, family-based and motivational interviewing interventions could be feasibly and effectively implemented in the paediatric emergency department setting.
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Affiliation(s)
- Farazi Virk
- Brighton and Sussex Medical School, University of Sussex, UK
| | - Julie Waine
- Mental Health Liaison Team, Queen Alexandra Hospital, UK
| | - Clio Berry
- Brighton and Sussex Medical School, University of Sussex, UK
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Brager-Larsen A, Zeiner P, Klungsøyr O, Mehlum L. Is age of self-harm onset associated with increased frequency of non-suicidal self-injury and suicide attempts in adolescent outpatients? BMC Psychiatry 2022; 22:58. [PMID: 35081930 PMCID: PMC8790924 DOI: 10.1186/s12888-022-03712-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 01/12/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-harm in adolescents is an increasing public health concern and an important risk factor for suicide. We aimed to examine how age of self-harm onset in adolescents was associated with frequency of subsequent suicidal and non-suicidal self-harm (NSSI) episodes, and how age of onset and duration of self-harm may influence the frequency of self-harm. METHODS Data from 103 adolescents with recurrent self-harm recruited from child and adolescent psychiatric outpatient clinics were collected through clinical interviews and self-reports, and analysed with negative binomial and hurdle models. RESULTS A lower age of self-harm onset and a longer duration of self-harm were both significantly associated with increased frequency of subsequent episodes of NSSI and risk of a first suicide attempt. There was an increase in repeated suicide attempts when the age of onset of self-harm decreased and the duration increased, and dramatically more for long duration of NSSI before first suicide attempt. CONCLUSION Initiating self-harm behaviour at the youngest age had the highest risk of increased frequency of NSSI and suicide attempts. Longer duration of self-harm behaviour increased this risk. This underlines the importance of early identification of self-harm behaviour in adolescents, and the use of effective interventions.
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Affiliation(s)
- Anne Brager-Larsen
- Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372, Oslo, Norway.
| | - Pål Zeiner
- grid.55325.340000 0004 0389 8485Child and Adolescent Mental Health Research Unit, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Sognsvannsveien 12, Bygg 12, N-0372 Oslo, Norway
| | - Ole Klungsøyr
- grid.55325.340000 0004 0389 8485Section for treatment research, Department of Research and Innovation, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Lars Mehlum
- grid.5510.10000 0004 1936 8921National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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11
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Furnes D, Gjestad R, Rypdal K, Mehlum L, Hart S, Oedegaard KJ, Mellesdal L. Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics. Suicide Life Threat Behav 2021; 51:528-539. [PMID: 33368501 DOI: 10.1111/sltb.12726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/07/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We studied the point prevalence of suicidal and violent ideation, as well as their co-occurrence and associated characteristics in inpatients with mental health disorders. METHODS Data on suicidal and violent ideation, and sociodemographic and clinical information, were gathered from 1,737 patients when admitted to the acute psychiatric ward. RESULTS The point prevalence was 51.9% for suicidal ideation and 19.8% for violent ideation. The point prevalence of co-occurring suicidal and violent ideation was 12.3%, which was significantly greater than expected by chance. Logistic regression analyses indicated that both suicidal and violent ideation were associated with young age and the absence of diagnoses of psychotic disorders; in addition, suicidal ideation was associated with female gender, violent ideation, and diagnoses of mood- neurotic and personality disorders, whereas violent ideation was associated with male gender, suicidal ideation, and diagnoses of mood and neurotic disorders. CONCLUSIONS Overall, the findings highlight the need for further research on suicidal and violent ideation in people with mental health problems including, but not limited to, their association with adverse behavioral outcomes, as well as the need to routinely assess both suicidal and violent ideation in clinical practice.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Knut Rypdal
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Stephen Hart
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Haukeland, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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12
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Trajectories of Victimization and Bullying at University: Prevention for a Healthy and Sustainable Educational Environment. SUSTAINABILITY 2021. [DOI: 10.3390/su13063426] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The bullying phenomenon is both an uncomfortable reality and a serious social problem for educational community institutions. Its presence is incompatible with a healthy and sustainable education environment. The educational, psychological, and social consequences of bullying transcend the personal sphere and reach the family and work environment in adulthood. Traditionally, bullying has been studied in the compulsory educational stages. However, at present, this problem is also being addressed in higher education. The present research, which is of a transversal nature, aims to explore bullying in the Spanish university setting, along with its typology, scope, and predictive factors, from both socio-demographic and family perspectives. In this sense, we set ourselves the following objectives: (GO1) to see if university students are exposed to bullying, as well as to identify the profiles of the subjects of bullying from three dimensions (physical, relational, and verbal victimization) and (GO2) to determine whether there are trajectories of bullying in university students from the compulsory education stage to the present. Based on a descriptive quantitative methodology, this study was conducted in 10 Spanish universities. The research’s major results show that the persistence of bullying in university classrooms is of a relational and verbal nature, but is not physical. Victimization occurs mainly in women who carry out studies linked to social and legal sciences or art and the humanities. Additionally, it is observed that a spiral of relational violence is produced, perpetuating this type of aggression over time. Among other predictive factors in university students is that they have suffered relational violence during their compulsory education. These data should alert educational and health institutions about the persistence of bullying in university students to prevent it and to facilitate its early detection and treatment to eradicate this problem from higher education classrooms.
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Brawman-Mintzer O, Tang XC, Bizien M, Harvey PD, Horner MD, Arciniegas DB, Raskind M, Johnson-Greene L, Martineau RJ, Hamner M, Rodriguez-Suarez M, Jorge RE, McGarity S, Wortzel HS, Wei Y, Sindowski T, Mintzer J, Kindy AZ, Donovan K, Reda D. Rivastigmine Transdermal Patch Treatment for Moderate to Severe Cognitive Impairment in Veterans with Traumatic Brain Injury (RiVET Study): A Randomized Clinical Trial. J Neurotrauma 2021; 38:1943-1952. [PMID: 33514274 DOI: 10.1089/neu.2020.7146] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Cognitive impairment is common in veterans with histories of traumatic brain injury (TBI). Cholinergic deficits have been hypothesized as contributors to this impairment. We report the effects of cholinesterase inhibitor rivastigmine transdermal patch treatment in veterans with TBI and post-traumatic memory impairment. Our objective was to evaluate the efficacy and safety of a 9.5 mg/24 h (10 cm2) rivastigmine patch in veterans of military conflicts with persistent moderate to severe memory impairment at least 12 weeks after TBI. This randomized, outpatient, double-blind, placebo-controlled 12-week trial with an exploratory double-blind phase of an additional 14 weeks was conducted at 5 VA Medical Centers, among veterans with closed, non-penetrating TBI who met or exceeded modified American Congress of Rehabilitation Medicine criteria for mild TBI with verbal memory deficits, as assessed by the Hopkins Verbal Learning Test, Revised (HVLT-R). Patients were randomized 1:1 to rivastigmine or matching placebo patches after a 1-week single-blind, placebo run-in phase. At randomization, patients received 4.6 mg/24 h rivastigmine patches or matching placebo increased to a 9.5 mg/24 h patch after 4 weeks. The primary efficacy outcome measure was the proportion of participants who had at least a five-word improvement on the HVLT-R Total Recall Index (Trials 1-3). A total of 3671 participants were pre-screened, of whom 257 (7.0%) were screened; 96 (37%) randomized, and 94 included in study analyses. Responder rates were 40.8% (20 of 49) and 51.1% (23 of 45) in the rivastigmine and placebo groups, respectively (p = 0.41). A mixed-effect model including treatment, time, and treatment-by-time interaction indicated no significant difference in treatment effect over time between the groups (p = 0.24). Overall, there were no significant differences in changes for all secondary outcomes between the rivastigmine and placebo groups. The most commonly observed adverse events were application site reactions. This trial provides the largest sample to date of veterans with TBI and post-traumatic memory deficits enrolled in a pharmacological trial. Trial Registration: clinicaltrials.gov Identifier: NCT01670526.
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Affiliation(s)
- Olga Brawman-Mintzer
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.,Medical University of South Carolina, Charleston, South Carolina, USA
| | - X Charlene Tang
- Edward Hines Junior VA Hospital Cooperative Studies Program, Hines, Illinois, USA
| | - Marcel Bizien
- Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, Albuquerque, New Mexico, USA
| | | | - Michael D Horner
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.,Medical University of South Carolina, Charleston, South Carolina, USA
| | | | - Murray Raskind
- VA Puget Sound Healthcare System, Seattle, Washington, USA
| | | | | | - Mark Hamner
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA.,Medical University of South Carolina, Charleston, South Carolina, USA
| | | | | | | | - Hal S Wortzel
- Rocky Mountain MIRECC for Suicide Prevention, Denver, Colorado, USA
| | - Yongliang Wei
- Edward Hines Junior VA Hospital Cooperative Studies Program, Hines, Illinois, USA
| | - Tom Sindowski
- Edward Hines Junior VA Hospital Cooperative Studies Program, Hines, Illinois, USA
| | - Jacobo Mintzer
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Arianne Z Kindy
- Roper St. Francis Healthcare, Charleston, South Carolina, USA
| | - Keaveny Donovan
- Ralph H. Johnson VA Medical Center, Charleston, South Carolina, USA
| | - Domenic Reda
- Edward Hines Junior VA Hospital Cooperative Studies Program, Hines, Illinois, USA
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14
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Mathew A, Saradamma R, Krishnapillai V, Muthubeevi SB. Exploring the Family factors associated with Suicide Attempts among Adolescents and Young Adults: A Qualitative Study. Indian J Psychol Med 2021; 43:113-118. [PMID: 34376885 PMCID: PMC8313455 DOI: 10.1177/0253717620957113] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Suicides are among the leading cause of death among adolescents and young adults worldwide, including India. Suicide attempts are about 20 times more common than completed suicides. Teenagers and youth who attempt suicide belong to a heterogeneous group. Various biological and psychosocial factors, including family factors, contribute to such behavior. Quality of family functioning and relationships may act as an important contextual factor in deciding suicidal behavior. Hence, this study was done to explore the family factors contributing to suicide attempts. METHODS Qualitative exploratory study design and purposive sampling were used. Data were collected from 22 adolescents and young adults using an in-depth interview method. All audio recordings were transcribed in Malayalam, and then translated to English. Codes were developed using the qualitative data analysis software. Thematic analysis was done. Themes and relationships were identified and synthesized to a framework that represents the summary of the data. RESULTS Most of the participants perceived the home environment as hostile. Problems within the family included parental conflicts and separation, conflict with a sibling or other members of the family, and marital disharmony. Most of them perceived low family support. Socioeconomic factors such as financial issues, superstitious beliefs, disturbing neighborhoods, interpersonal issues, and the stigma of having a mental illness, in a family member, were also noted. CONCLUSION Hostile family environment, faulty interactions between family members, and lack of perceived family support may contribute to suicidal behavior among adolescents and young adults. Hence, it is imperative to consider these factors while treating them or planning any suicide prevention program for them.
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Affiliation(s)
- Anju Mathew
- Dept of Psychiatry, Government Medical College, Thiruvananthapuram, Kerala, India
| | - Remadevi Saradamma
- Dept. of Community Medicine, Government Medical College, Thiruvananthapuram, Kerala, India
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15
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Frey M, Obermeier V, von Kries R, Schulte-Körne G. Age and sex specific incidence for depression from early childhood to adolescence: A 13-year longitudinal analysis of German health insurance data. J Psychiatr Res 2020; 129:17-23. [PMID: 32554228 DOI: 10.1016/j.jpsychires.2020.06.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 05/08/2020] [Accepted: 06/01/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Epidemiological studies indicate a disproportionate increase of depression incidence among adolescent girls, compared with boys. Since results regarding the age of onset of this sex difference are heterogeneous, this study aimed to investigate this difference on a large and representative sample. A second investigation sought to clarify whether there is a relevant sex difference in prepubertal onset of depression regarding the further course. METHODS Health insurance data of 6-18-year-old Barmer insured patients, representing a 7.9% sample of the German population born in 1999 (N = 61.199), were analyzed. The incidence of depression episodes (ICD-10 F32.x) was evaluated. Subsequently, the absolute and relative risk of a depression diagnosis (F32.x/F33.x) in early/late adolescence was analyzed based on the diagnosis of depression in primary school age in unstratified and stratified univariate analyses performed in SAS. RESULTS From 13 years of age, we found a significantly higher incidence of depressive disorders in girls than in boys. More than a fifth of the children with a depression diagnoses in primary school age had a depression relapse in early or late adolescence (early: 23.2%; 95% CI 19.6-26.9/late: 22.9%; 95% CI 19.3-26.5). Boys with depression in primary school age have a significantly higher relative risk for a depression relapse in late adolescence than girls (boys RR 4.2, 95% CI 3.3-5.2, girls RR: 2.1, 95% CI 1.7-2.7). LIMITATIONS The analysis is based on administrative data. Low sensitivity for depression in primary care setting and low service utilization leads to an underestimation of the incidence. CONCLUSIONS During puberty the risk for a first depressive episode increases more steeply in girls than in boys. Childhood depression has a high risk of relapse for both sexes, but is much more pronounced for boys.
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Affiliation(s)
- Michael Frey
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 5a, D-80336, Munich, Germany.
| | - Viola Obermeier
- Institute for Social Paediatrics and Adolescent Medicine, Ludwig Maximilians University, Haydnstraße 5, D-80336, Munich, Germany.
| | - Rüdiger von Kries
- Institute for Social Paediatrics and Adolescent Medicine, Ludwig Maximilians University, Haydnstraße 5, D-80336, Munich, Germany.
| | - Gerd Schulte-Körne
- Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University Hospital, LMU Munich, Nussbaumstrasse 5a, D-80336, Munich, Germany.
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Goodman M, Brown GK, Galfalvy HC, Spears AP, Sullivan SR, Kapil-Pair KN, Jager-Hyman S, Dixon L, Thase ME, Stanley B. Group ("Project Life Force") versus individual suicide safety planning: A randomized clinical trial. Contemp Clin Trials Commun 2020; 17:100520. [PMID: 32043013 PMCID: PMC7000793 DOI: 10.1016/j.conctc.2020.100520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 12/20/2019] [Accepted: 01/04/2020] [Indexed: 11/28/2022] Open
Abstract
One in five suicide deaths is a Veteran and in spite of enhanced suicide prevention services in the Veterans Health Administration (VHA), twenty Veterans die by suicide each day. One component of the VHA's coordinated effort to treat high-risk suicidal Veterans, and diminish suicide risk, is the use of the safety plan. The current study aims to examine a novel intervention integrating skills training and social support with safety planning for Veterans at high-risk for suicide, "Project Life Force" (PLF). A randomized clinical trial (RCT) will be conducted examining if Veterans who are at high-risk for suicide will benefit from the novel group intervention, PLF, compared to Veterans who receive treatment as usual (TAU). We plan to randomize 265 Veterans over the course of the study. The primary outcome variable is the incidence of suicidal behavior, during follow-up, established using a rigorous, multi-method assessment. Secondary outcomes include depression, hopelessness, suicide coping and treatment utilization. Exploratory analyses include safety plan quality and belongingness for those in both arms as well as group cohesion for those in the PLF intervention. Strengths and limitations of this protocol are discussed.
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Affiliation(s)
- Marianne Goodman
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Gregory K. Brown
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Hanga C. Galfalvy
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
| | | | | | - Kalpana Nidhi Kapil-Pair
- James J Peters Veterans Affairs Medical Center, Bronx, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY USA
| | - Shari Jager-Hyman
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
| | - Lisa Dixon
- Department of Psychiatry, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY USA
- New York State Psychiatric Institute, New York, NY, USA
| | - Michael E. Thase
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA USA
- Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, PA USA
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Sisek-Šprem M, Gradiški IP, Žaja N, Herceg M. The longitudinal course of schizophrenia: testosterone and progression of the negative symptoms. Nord J Psychiatry 2020; 74:147-154. [PMID: 31651218 DOI: 10.1080/08039488.2019.1681509] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background: The longitudinal course of schizophrenia shows a high level of heterogeneity with testosterone as a possible factor in the variety of clinical outcomes.Aim: Evaluation of the course of schizophrenia in male patients over an eight-year period and of the possible testosterone effects on changes in clinical features.Subjects and methods: The initial study population consisted of 120 male schizophrenic patients (aged 18-40) hospitalized in the University Psychiatric Hospital Vrapce in 2009. Patients were classified into nonaggressive (control, n = 60) and aggressive (n = 60) groups. In 2017, we reassessed 85 patients (67,5%) from the initial sample. Symptoms of schizophrenia were determined using the Positive and Negative Syndrome Scale (PANSS) and compared with the total serum testosterone level taken at the inclusion in the study. The distribution of values for individual variables was determined using the Smirnov-Kolmogorov test; for all further analyses, the appropriate non-parametric test was used.Results: The control group showed a statistically significant negative correlation between testosterone and negative PANSS. The initial PANSS scores, compared to those at the follow-up, showed a statistically significant reduction in positive and general symptoms in all groups, with the greatest reduction in the control group.Conclusion: We found a reduction in positive and general symptoms of schizophrenia among all patients and no changes in negative symptoms. Inverse correlation between testosterone and negative symptoms was found only in the control group, but there was no testosterone influence on the progression of any PANSS subscales.
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Affiliation(s)
| | | | - Nikola Žaja
- University Psychiatric Hospital Vrapče, Zagreb, Croatia
| | - Miroslav Herceg
- University Psychiatric Hospital Vrapče, Zagreb, Croatia.,School of Medicine, University of Zagreb, Zagreb, Croatia
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Tang JJ, Yu Y, Wilcox HC, Kang C, Wang K, Wang C, Wu Y, Chen R. Global risks of suicidal behaviours and being bullied and their association in adolescents: School-based health survey in 83 countries. EClinicalMedicine 2020; 19:100253. [PMID: 32140671 PMCID: PMC7046520 DOI: 10.1016/j.eclinm.2019.100253] [Citation(s) in RCA: 46] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Global risks of suicidal behaviours (SB) and being bullied as well as their association among adolescents have been poorly understood. We aimed to determine the risks of suicidal ideation (SI), suicide planning (SP), suicide attempt (SA) and being bullied in adolescents and their related associations across gender, countries and different WHO regions. METHODS We examined data from the Global School-based Health Survey (GSHS), which recorded health behaviours among adolescents aged 12 to 15 years from 83 countries. We computed prevalence rates of SB and being bullied and their 95% confidence intervals (CIs). Multilevel models were employed to examine the association of being bullied with risks of SI, SP and SA. RESULTS The overall prevalence of SI was 16·5%, SP 16·5%, SA 16·4%, and being bullied 35·3%. The highest risks of SB and being bullied were in Africa (SI 19·9%, SP 23·2%, SA 20·8%, being bullied 48·0%). Compared to boys, girls had an increased risk for SI (18·2%) and SP (17·3%) but similar risk for SA (16·7%) and being bullied (33·3%). Being bullied was associated with SA (adjusted odds ratio ‒ aOR 2·14, 95%CI 2·06-2·23), more strongly than SI (1·83, 1·78-1·89) and SP (1·70, 1·65-1·76). The strongest association with SA was in the Western Pacific (2·68, 2·45-2·92) and with SI (2·04, 1·74-2·39) and SP (1·81, 1·68-1·95) were in Southeast Asia. There were no gender differences in aOR for SI and SP, but the aOR for SA among boys (2·28, 2·14-2·42) was significantly greater than among girls (2·04, 1·93-2·15), ratio of two odds ratios was 1.12 (P = 0.008). INTERPRETATION SB and being bullied were common among adolescents worldwide. The findings of gender differences in SB, being bullied and their association could inform the design of prevention programmes to reduce the risks of SI, SP and SA in adolescents worldwide.
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Affiliation(s)
- James Jie Tang
- Department of Preventive Medicine, School of Public Health, Guangzhou Medical University, Xinzao, Panyu District, 511436, Guangzhou, PR China
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Millennium City Building, Wulfruna Street, Wolverhampton, WV1 1LY, UK
| | - Yizhen Yu
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13th Hangkong Road, Qiaokou District, Wuhan, Hubei, 430030, PR China
| | - Holly C. Wilcox
- Department of Mental Health, Bloomberg School of Public Health, Johns Hopkins University, USA
| | - Chun Kang
- School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13th Hangkong Road, Qiaokou District, Wuhan, Hubei, 430030, PR China
| | - Kun Wang
- Institute of Medical Information, Chinese Academy of Medical Science, Beijing, PR China
| | - Cunku Wang
- Center for Health Statistics and Information, National Health Commission, Beijing, PR China
| | - Yu Wu
- Shenzhen Centre for Disease Control and Prevention, Shenzhen, PR China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Millennium City Building, Wulfruna Street, Wolverhampton, WV1 1LY, UK
- Department of Medicine, School of Medicine, Johns Hopkins University, USA
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Phillips D, Lidón-Moyano C, Cerdá M, Gruenewald P, Goldman-Mellor S. Association between unintentional injuries and self-harm among adolescent emergency department patients. Gen Hosp Psychiatry 2020; 64:87-92. [PMID: 32304935 PMCID: PMC7211429 DOI: 10.1016/j.genhosppsych.2020.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 03/19/2020] [Accepted: 03/23/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Unintentional injury, a leading cause of morbidity among adolescents, may also be a risk factor for deliberate self-harm. To inform clinical and public health prevention efforts in adolescent populations, we examined whether distinct subtypes of unintentional injury were differentially associated with deliberate self-harm. METHODS Statewide, all-payer, individually linkable administrative data on adolescent patients presenting to any California emergency department (ED) in 2010 (n = 490,071) were used to investigate longitudinal associations between subtypes of unintentional injury and deliberate self-harm. Adolescents aged 10-19 years presenting with unintentional drug poisoning, other poisoning, fall, suffocation, or cutting/piercing injuries formed the exposure groups; adolescents presenting with unintentional strike injuries formed the primary referent group. Study patients were followed back in time (2006-2009) to compare the groups' odds of a prior ED visit for deliberate self-harm, as well as forwards in time (2010-2015) to compare their risks of subsequent self-harm. RESULTS Unintentional drug-poisoning injury was strongly associated with increased likelihood of ED visits for deliberate self-harm, assessed both retrospectively (adjusted OR = 4.52; 95% confidence interval [CI] = 3.08, 6.64) and prospectively (adjusted RR = 3.74; 95% CI = 3.03, 4.60). Positive associations with odds of prior self-harm and/or risk of subsequent self-harm were also observed for patients with unintentional non-drug poisoning, suffocation, and cutting/piercing injuries. CONCLUSIONS Certain subtypes of unintentional injury, particularly drug poisoning, are strongly associated with risk for deliberate self-harm among adolescents, a finding with implications for targeting clinical assessment and intervention in emergency department settings. More research is needed to understand the mechanisms underlying these associations.
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Affiliation(s)
- Dwena Phillips
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
| | | | - Magdalena Cerdá
- Department of Population Health, New York University, New York, NY 10016, USA.
| | - Paul Gruenewald
- Prevention Research Center, Pacific Institute for Research and Evaluation, Oakland, CA 94612, USA.
| | - Sidra Goldman-Mellor
- Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California, Merced, Merced, CA 95343, USA.
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Ciuffini R, Stratta P, Rossi R, Perilli E, Marrelli A. Hopelessness in persons with epilepsy: Relationship with demographic, clinical, and social variables. Epilepsy Behav 2019; 100:106383. [PMID: 31574427 DOI: 10.1016/j.yebeh.2019.06.027] [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: 04/07/2019] [Revised: 06/05/2019] [Accepted: 06/13/2019] [Indexed: 10/25/2022]
Abstract
Persons with epilepsy show a higher risk of suicidal ideation and behavior than the general population. Hopelessness, as a feature of demoralization, is considered an emerging risk factor for suicidal ideation. Psychopathological comorbidity, mainly depression, has to be taken into account to predict suicidal attempts but the relationship between suicidality and epilepsy has been also reported independently from depressive disorders. The aim of the study was to investigate hopelessness in a sample of persons suffering from epilepsy without comorbidity with psychiatric disorders and its association with demographic, social, and clinical variables, putatively predictive of suicidal behaviors. Beck Hopelessness Scale (BHS) has been used as measure of suicidal ideation in 72 consecutive outpatients afferent to a third level epilepsy center. Exclusion criterion was psychiatric comorbidity evaluated by clinical approach and quantified by Clinical Global Impression (CGI) Scale. Clinical (focus localization, age at onset, number of drugs), demographic, social variables, and intellectual level were considered. Age, age at onset, gender, intellectual level, socioeconomic status, duration of illness and therapy, number of drugs, seizure frequency, and localization of the epileptic focus and side involved were found associated with BHS score increase. In a sample of persons with epilepsy, without psychiatric comorbidity, our data show an association between factors related to the biological pathophysiology and the clinical course of the disease with the sociodemographic status, as a risk factor for suicidal ideation.
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Affiliation(s)
- Roberta Ciuffini
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy; Clinical Neurophysiology Unit, San Salvatore Hospital, L'Aquila, Italy.
| | | | - Rodolfo Rossi
- PhD program Psychiatry, Tor Vergata University, Roma, Italy
| | - Enrico Perilli
- Department of Life, Health and Environmental Sciences, University of L'Aquila, Italy
| | - Alfonso Marrelli
- Clinical Neurophysiology Unit, San Salvatore Hospital, L'Aquila, Italy
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21
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Binder P, Heintz AL, Servant C, Roux MT, Robin S, Gicquel L, Ingrand P. Screening for adolescent suicidality in primary care: the bullying-insomnia-tobacco-stress test. A population-based pilot study. Early Interv Psychiatry 2018; 12:637-644. [PMID: 27153149 DOI: 10.1111/eip.12352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 03/30/2016] [Accepted: 04/08/2016] [Indexed: 12/19/2022]
Abstract
AIM Adolescents at risk for suicide often see their general practitioner solely for somatic or administrative reasons. A simple screening test given during a conversation would be of substantial help to send a signal and tackle the problem. We propose to update a screening test previously validated in France - the TSTS-Cafard - because of significant changes in the lives of adolescents with the growth of the cyber world since 2000. METHODS The design and setting was a cross-sectional study involving 912 15-year-old adolescents in 90 French schools. They completed a questionnaire that included the TSTS-Cafard and risk factors extracted from the Health Behaviour in School-Aged Children survey. To improve the test, we selected questions drawn from the recent literature. Answers were analysed according to 'suicidality' = at least one suicide attempt in life or suicidal ideation often over the past 12 months. RESULTS Suicidality rates were 9.6% for boys and 23.1% for girls. Although the TSTS-Cafard test was generally effective, one question was no longer discriminating. A new test, entitled 'BITS', included only four questions on bullying, insomnia, tobacco and stress, with three levels of response and scores ranging from 0 to 8. Improvement was achieved without loss of performance. Using a cut-off score of 3, we achieved 78% accuracy (area under the curve), 75% sensitivity and 70% specificity. CONCLUSION The BITS test could allow the question of suicide risk to be addressed during a routine check-up in primary care but the results need to be validated with 13 to 18-year olds.
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Affiliation(s)
- Philippe Binder
- Faculty of Medicine, Department of General Practice, Poitiers, France
| | - Anne-Laure Heintz
- Faculty of Medicine, Department of General Practice, Poitiers, France
| | - Coralie Servant
- Faculty of Medicine, Department of General Practice, Poitiers, France
| | | | - Stéphane Robin
- Research Analyst Regional Health Observatory (ORS) Poitou-Charentes, Saint-Benoit, France
| | - Ludovic Gicquel
- INSERM Q3 U894, Psychiatry and Neurosciences Center, Child and Adolescent Psychiatry Department, University of Poitiers, Poitiers, France
| | - Pierre Ingrand
- INSERM CIC-1402, Faculty of Medicine, Department of Epidemiology & Biostatistics, Poitiers, Poitiers, France
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An open-label, flexible dose adaptive study evaluating the efficacy of vortioxetine in subjects with panic disorder. Ann Gen Psychiatry 2018; 17:19. [PMID: 29760763 PMCID: PMC5946398 DOI: 10.1186/s12991-018-0190-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 05/04/2018] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Despite the current treatments available for panic disorder (PD), as many as one-third of patients have persistent and treatment-resistant panic attacks. Vortioxetine is an approved medicine for major depressive disorder and has been shown to have anxiolytic properties. The purpose of this study was to evaluate its efficacy and safety in an adult population with a diagnosis of PD. METHODS The study design was open label with flexible dose strategies (5, 10, or 20 mg) with a treatment period of 10 weeks. 27 male and female subjects aged between 18 and 60 years, who met DSM-IV criteria for PD with or without agoraphobia, or who had a Panic Disorder Severity Scale (PDSS) score > 8 at baseline were enrolled. Statistical significance was established by the Student's T test. RESULTS A statistically significant decrease in the occurrence of panic attacks was measured with the PDSS with vortioxetine. In addition, a moderate improvement in the quality of life and no significant side effects were observed using the Quality-of-Life Scale and Monitoring of Side Effects Scale, respectively. CONCLUSIONS These results provide some support for the use of vortioxetine in the management of panic disorder.Trial registration ClinicalTrials.gov ID#: NCT02395510. Registered March 23, 2015, https://clinicaltrials.gov/ct2/show/NCT02395510.
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Perepletchikova F, Nathanson D, Axelrod SR, Merrill C, Walker A, Grossman M, Rebeta J, Scahill L, Kaufman J, Flye B, Mauer E, Walkup J. Randomized Clinical Trial of Dialectical Behavior Therapy for Preadolescent Children With Disruptive Mood Dysregulation Disorder: Feasibility and Outcomes. J Am Acad Child Adolesc Psychiatry 2017; 56:832-840. [PMID: 28942805 DOI: 10.1016/j.jaac.2017.07.789] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Revised: 07/24/2017] [Accepted: 08/03/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Persistent irritability and behavior outbursts in disruptive mood dysregulation disorder (DMDD) are associated with severe impairment in childhood and with negative adolescent and adult outcomes. There are no empirically established treatments for DMDD. This study examined the feasibility and preliminary efficacy of dialectical behavior therapy adapted for preadolescent children (DBT-C) with DMDD. METHOD Children 7 to 12 years old with DMDD (N = 43) were randomly assigned 1:1 to DBT-C or treatment as usual (TAU). The 6 domains of feasibility included recruitment, randomization, retention, attendance, participants' satisfaction, and therapist adherence. Blinded raters assessed participants at baseline, after 8, 16, 24, and 32 weeks, and at 3-month follow-up. The primary efficacy outcome was the positive response rate on the Clinical Global Impression-Improvement scale. Improvements in behavior outbursts and angry/irritable mood were assessed by the Clinical Global Impression-Severity scale. RESULTS Mean number of participants randomized per month was 2.53 ± 2.72. Participants in DBT-C (n = 21) attended 89% of sessions compared with 48.6% in TAU (n = 22). Eight TAU participants (36.4%) dropped out compared with none in DBT-C. Parents and children in DBT-C expressed significantly higher treatment satisfaction than those in TAU. The rate of positive response was 90.4% in DBT-C compared with 45.5% in TAU, despite 3 times as many participants in TAU receiving psychiatric medications. Remission rates were 52.4% for DBT-C and 27.3% for TAU. Improvements were maintained at 3-month follow-up. Therapists showed adherence to DBT-C. CONCLUSION DBT-C demonstrated feasibility in all prespecified domains. Outcomes also indicated preliminary efficacy of DBT-C. Clinical trial registration information-Adapting DBT for Children With DMDD: Pilot RCT; http://clinicaltrials.gov/; NCT01862549.
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Affiliation(s)
| | - Donald Nathanson
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | | | - Amy Walker
- Cognitive Behavioral Consultants, White Plains, NY
| | | | | | | | - Joan Kaufman
- Center for Child and Family Traumatic Stress, Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, MD
| | - Barbara Flye
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
| | | | - John Walkup
- Weill Cornell Medicine and NewYork-Presbyterian Hospital, White Plains, NY
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Gryglewicz K, Bozzay M, Arthur-Jordon B, Romero GD, Witmeier M, Chapple R, Karver MS. A Silenced Population. CRISIS 2017; 38:433-442. [DOI: 10.1027/0227-5910/a000470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Abstract. Background: Given challenges that exceed the normal developmental requirements of adolescence, deaf and hard-of-hearing (DHH) youth are believed to be at elevated risk for engaging in suicide-related behavior (SRB). Unfortunately, little is known about the mechanisms that put these youth potentially at risk. Aims: To determine whether peer relationship difficulties are related to increased risk of SRB in DHH youth. Method: Student records (n = 74) were retrieved from an accredited educational center for deaf and blind students in the United States. Results: Peer relationship difficulties were found to be significantly associated with engagement in SRB but not when accounting for depressive symptomatology. Limitations: The restricted sample limits generalizability. Conclusions regarding risk causation cannot be made due to the cross-sectional nature of the study. Conclusion: These results suggest the need for future research that examines the mechanisms of the relationship between peer relationship difficulties, depression, and suicide risk in DHH youth and potential preventive interventions to ameliorate the risks for these at-risk youth.
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Affiliation(s)
- Kim Gryglewicz
- School of Social Work, College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Melanie Bozzay
- Department of Psychology, University of South Florida, Tampa, FL, USA
| | | | | | - Melissa Witmeier
- Florida Council for Community Mental Health, Tallahassee, FL, USA
| | - Reshawna Chapple
- School of Social Work, College of Health and Public Affairs, University of Central Florida, Orlando, FL, USA
| | - Marc S. Karver
- Department of Psychology, University of South Florida, Tampa, FL, USA
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25
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Bergeron L, Smolla N, Berthiaume C, Renaud J, Breton JJ, St.-Georges M, Morin P, Zavaglia E, Labelle R. Reliability, Validity, and Clinical Utility of the Dominic Interactive for Adolescents-Revised A DSM-5-Based Self-Report Screen for Mental Disorders, Borderline Personality Traits, and Suicidality. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:211-222. [PMID: 27638424 PMCID: PMC5317018 DOI: 10.1177/0706743716670129] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES The Dominic Interactive for Adolescents-Revised (DIA-R) is a multimedia self-report screen for 9 mental disorders, borderline personality traits, and suicidality defined by the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM-5). This study aimed to examine the reliability and the validity of this instrument. METHODS French- and English-speaking adolescents aged 12 to 15 years ( N = 447) were recruited from schools and clinical settings in Montreal and were evaluated twice. The internal consistency was estimated by Cronbach alpha coefficients and the test-retest reliability by intraclass correlation coefficients. Cutoff points on the DIA-R scales were determined by using clinically relevant measures for defining external validation criteria: the Schedule for Affective Disorders and Schizophrenia for School-Aged Children, the Beck Hopelessness Scale, and the Abbreviated-Diagnostic Interview for Borderlines. Receiver operating characteristic (ROC) analyses provided accuracy estimates (area under the ROC curve, sensitivity, specificity, likelihood ratio) to evaluate the ability of the DIA-R scales to predict external criteria. RESULTS For most of the DIA-R scales, reliability coefficients were excellent or moderate. High or moderate accuracy estimates from ROC analyses demonstrated the ability of the DIA-R thresholds to predict psychopathological conditions. These thresholds were generally capable to discriminate between clinical and school subsamples. However, the validity of the obsessions/compulsions scale was too low. CONCLUSIONS Findings clearly support the reliability and the validity of the DIA-R. This instrument may be useful to assess a wide range of adolescents' mental health problems in the continuum of services. This conclusion applies to all scales, except the obsessions/compulsions one.
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Affiliation(s)
- Lise Bergeron
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychology, Université de Montréal, Montréal, Québec
- Lise Bergeron, PhD, Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, 7070 Perras Boulevard, Montréal, QC H1E 1A4, Canada.
| | - Nicole Smolla
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychiatry, Université de Montréal, Montréal, Québec
| | - Claude Berthiaume
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Johanne Renaud
- CIUSSS de l’Ouest-de-l’Île-de-Montréal, Douglas Mental Health University Institute, Montréal, Québec
- Department of Psychiatry, McGill University, Montréal, Québec
| | - Jean-Jacques Breton
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Department of Psychiatry, Université de Montréal, Montréal, Québec
| | - Marie St.-Georges
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Pauline Morin
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
| | - Elissa Zavaglia
- Department of Psychology, Université de Montréal, Montréal, Québec
| | - Réal Labelle
- Research Centre, CIUSSS du Nord-de-l’Île-de-Montréal, Rivière-des-Prairies Hospital, Montréal, Québec
- Research Centre, CIUSSS de l’Est-de-l’Île-de-Montréal, Montréal, Québec
- Department of Psychology, Université du Québec à Montréal, Montréal, Québec
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Zisook S, Tal I, Weingart K, Hicks P, Davis LL, Chen P, Yoon J, Johnson GR, Vertrees JE, Rao S, Pilkinton PD, Wilcox JA, Sapra M, Iranmanesh A, Huang GD, Mohamed S. Characteristics of U.S. Veteran Patients with Major Depressive Disorder who require "next-step" treatments: A VAST-D report. J Affect Disord 2016; 206:232-240. [PMID: 27479536 DOI: 10.1016/j.jad.2016.07.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 07/09/2016] [Accepted: 07/16/2016] [Indexed: 02/09/2023]
Abstract
OBJECTIVE Finding effective and lasting treatments for patients with Major Depressive Disorder (MDD) that fail to respond optimally to initial standard treatment is a critical public health imperative. Understanding the nature and characteristics of patients prior to initiating "next-step" treatment is an important component of identifying which specific treatments are best suited for individual patients. We describe clinical features and demographic characteristics of a sample of Veterans who enrolled in a "next-step" clinical trial after failing to achieve an optimal outcome from at least one well-delivered antidepressant trial. METHODS 1522 Veteran outpatients with nonpsychotic MDD completed assessments prior to being randomized to study treatment. Data is summarized and presented in terms of demographic, social, historical and clinical features and compared to a similar, non-Veteran sample. RESULTS Participants were largely male and white, with about half unmarried and half unemployed. They were moderately severely depressed, with about one-third reporting recent suicidal ideation. More than half had chronic and/or recurrent depression. General medical and psychiatric comorbidities were highly prevalent, particularly PTSD. Many had histories of childhood adversity and bereavement. Participants were impaired in multiple domains of their lives and had negative self-worth. LIMITATIONS These results may not be generalizable to females, and some characteristics may be specific to Veterans of US military service. There was insufficient data on age of clinical onset and depression subtypes, and three novel measures were not psychometrically validated. CONCLUSIONS Characterizing VAST-D participants provides important information to help clinicians understand features that may optimize "next-step" MDD treatments.
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Affiliation(s)
- Sidney Zisook
- VA San Diego Healthcare System and University of California, San Diego, USA.
| | - Ilanit Tal
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Kimberly Weingart
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Paul Hicks
- Central Texas Veterans Healthcare System and Department of Psychiatry and Behavioral Sciences Texas A&M Health Science Center College of Medicine, Temple, TX, USA
| | - Lori L Davis
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; University of Alabama School of Medicine, USA
| | - Peijun Chen
- Louis Stokes VA Medical Center and Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Jean Yoon
- Health Economics Resource Center (HERC), VA Palo Alto, Menlo Park, CA, USA
| | - Gary R Johnson
- VA Cooperative Studies Program Coordinating Center, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Julia E Vertrees
- VA Cooperative Studies Program Clinical Research Pharmacy Coordinating Center, New Mexico VA Healthcare System, Albuquerque, NM, USA
| | - Sanjai Rao
- VA San Diego Healthcare System and University of California, San Diego, USA
| | - Patricia D Pilkinton
- Tuscaloosa VA Medical Center, Tuscaloosa, AL, USA; Capstone College of Community Health Sciences, Tuscaloosa, AL, USA
| | - James A Wilcox
- Tucson VA Medical Center and Department of Psychiatry, University of Arizona, Tucson, AZ, USA
| | - Mamta Sapra
- Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Ali Iranmanesh
- Salem VA Medical Center, Salem, VA, USA; Virginia Tech Carilion School of Medicine, Roanoke, VA, USA
| | - Grant D Huang
- Cooperative Studies Program Central Office, VA Office of Research & Development, Washington DC, USA
| | - Somaia Mohamed
- VA VISN1 New England Mental Illness Research, Education and Clinical Center (MIRECC), Veterans Health Administration, West Haven, CT, USA; Yale University School of Medicine, USA
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Zalsman G, Shoval G, Mansbach-Kleinfeld I, Farbstein I, Kanaaneh R, Lubin G, Apter A. Maternal versus adolescent reports of suicidal behaviors: a nationwide survey in Israel. Eur Child Adolesc Psychiatry 2016; 25:1349-1359. [PMID: 27161340 DOI: 10.1007/s00787-016-0862-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 04/27/2016] [Indexed: 12/20/2022]
Abstract
Community and nationwide surveys on adolescent suicidal behaviors using clinical interviews are not abundant. Rates of self-reported suicide attempts in community samples vary greatly between 1 and 20 %. In general, adolescent and parental agreement in child psychiatry practice is low, and their agreement with regard to suicidal behavior is unknown. The current study assesses the rates of suicidal ideation and behaviors as well as the rate of agreement between adolescents and their mothers in a representative nationwide sample. The survey included a representative and randomized community sample of 14- to 17-year-old adolescents (n = 957), and their mothers who were interviewed using the Development and Well-Being Assessment Inventory (DAWBA). The prevalence of suicidal ideation and self-initiated behaviors was 4.9 and 1.9 %, respectively. The concordance between mothers' and adolescents' reporting on ideation was low (7.3 %). There was no concordance between mothers' and adolescents' reports of suicidal acts. Adolescents reported self-initiated behaviors nearly three times more frequently than their mothers. Paternal unemployment, care by welfare agencies and having a psychiatric disorder, specifically depression or post-traumatic stress disorder, was associated with a higher risk for both suicidal ideation and attempts. In this nationwide community study, by evaluating information gathered by clinical interviews, it was found that the lifetime rates of suicidal ideation were moderate. The rates of suicide attempts were lower than have been previously reported. The concordance between the reports of adolescents and their mothers was low for ideation and nonexistent for attempts. Thus, clinicians should interview adolescents separately from their mothers regarding their suicidality.
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Affiliation(s)
- Gil Zalsman
- Child and Adolescent Psychiatry Division, Geha Mental Health Center, P.O. Box 102, Petach Tiqwa, 49100, Israel. .,Child Psychiatry Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Division of Molecular Imaging and Neuropathology, Department of Psychiatry, Columbia University, New York, NY, USA.
| | - Gal Shoval
- Child and Adolescent Psychiatry Division, Geha Mental Health Center, P.O. Box 102, Petach Tiqwa, 49100, Israel.,Child Psychiatry Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ivonne Mansbach-Kleinfeld
- Mental Health Services, Ministry of Health, Jerusalem, Interdisciplinary Center (IDC-Herzliya), Herzliya, Israel.,The Feinberg Child Study Center, Schneider Children's Medical Center of Israel, Petach Tikva, Israel
| | - Ilana Farbstein
- Child and Adolescent Psychiatry, Ziv Hospital, Safed, Israel.,Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel
| | - Rasim Kanaaneh
- Child and Adolescent Psychiatry, Ziv Hospital, Safed, Israel
| | - Gad Lubin
- Mental Health Services, Ministry of Health, Jerusalem, Interdisciplinary Center (IDC-Herzliya), Herzliya, Israel
| | - Alan Apter
- Child Psychiatry Department, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Schneider Children's Medical Center of Israel, Petach Tiqwa, Israel
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Barrett JR, Shetty H, Broadbent M, Cross S, Hotopf M, Stewart R, Lee W. 'He left me a message on Facebook': comparing the risk profiles of self-harming patients who leave paper suicide notes with those who leave messages on new media. BJPsych Open 2016; 2:217-220. [PMID: 27703779 PMCID: PMC4995166 DOI: 10.1192/bjpo.bp.116.002832] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/19/2016] [Accepted: 05/11/2016] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In cases of non-fatal self-harm, suicide notes are a major risk factor for repeated self-harm and suicide. Suicide notes can now be left on new media services, emails or text messages, as well as on paper. AIMS In a group of people who had harmed themselves, we aimed to compare new media note-leavers with paper note-leavers and characterise these groups demographically and by risk factors. METHOD Clinical notes of patients who presented with non-fatal self-harm to two London emergency departments were anonymously searched for mentions of new media use. These were categorised and risk factors were compared for those who had left a new media note, a paper note, or no note to establish differences in risk of note-leaving. RESULTS New media note-leaving was associated with younger age and substance use; both risk factors for repeated self-harm. However, suicidal intent remained highest in paper note-leavers. CONCLUSIONS Paper note-leavers remain at greatest risk, however new media note leaving is still correlated with risk factors related to repeated self-harm and suicide. Clinicians should enquire about new media use during emergency department assessments of self-harm. DECLARATION OF INTEREST None. COPYRIGHT AND USAGE © The Royal College of Psychiatrists 2016. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) licence.
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Affiliation(s)
- Jessica R Barrett
- , MSc, Peninsula Schools of Medicine & Dentistry (PUPSMD), Plymouth University, Plymouth, UK
| | - Hitesh Shetty
- , MSc, South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK
| | - Matthew Broadbent
- , MA, South London and the Maudsley NHS Foundation Trust, Biomedical Research Centre Nucleus, London, UK
| | - Sean Cross
- , PhD, MRCPsych, Department of Psychological Medicine, St Thomas' Hospital, London, UK
| | - Matthew Hotopf
- , PhD, MRCPsych, Department of Psychological Medicine, King's College London (Institute of Psychiatry, Psychology & Neuroscience), London, UK
| | - Robert Stewart
- , MD, MRCPsych, King's College London (Institute of Psychiatry, Psychology & Neuroscience), London, UK
| | - William Lee
- , PhD, MRCPsych, Peninsula Schools of Medicine & Dentistry (PUPSMD), Plymouth University, Plymouth, UK
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29
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Girgis RR, Van Snellenberg JX, Glass A, Kegeles LS, Thompson JL, Wall M, Cho RY, Carter CS, Slifstein M, Abi-Dargham A, Lieberman JA. A proof-of-concept, randomized controlled trial of DAR-0100A, a dopamine-1 receptor agonist, for cognitive enhancement in schizophrenia. J Psychopharmacol 2016; 30:428-35. [PMID: 26966119 DOI: 10.1177/0269881116636120] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Evidence from preclinical and human studies indicates the presence of reduced dopamine-1 receptor (D1R) signaling in the cortex, where D1Rs predominate, in patients with schizophrenia (SCZ), which may contribute to their cognitive deficits. Furthermore, studies in nonhuman primates (NHP) have suggested that intermittent administration of low doses of D1R agonists produce long-lasting reversals in cognitive deficits. The purpose of this trial was to test whether a similar design, involving subacute intermittent administration of low doses of a full, selective agonist at D1Rs, DAR-0100A, would improve cognitive deficits in SCZ. METHODS We randomized 49 clinically stable individuals with SCZ to three weeks of intermittent treatment with 0.5 mg or 15 mg of DAR-0100A, or placebo (normal saline). Functional magnetic resonance imaging (fMRI) BOLD was used to evaluate the effects of drug administration on brain activity during a working memory (WM) task. Effects on cognition were also assessed using the MATRICS and the N-back task as primary endpoints. The CogState battery was used as a secondary endpoint. RESULTS There were no observed treatment effects on either the BOLD fMRI signal during WM tasks or the WM domains of the MATRICS. Moderate improvement was detected on the CogState battery and on the attention domain of the MATRICS. CONCLUSION These results suggest that low doses of D1 agonists that do not result in measureable occupancy of the D1R do not reliably improve cognition in SCZ, unlike the observations in NHP. As this drug is limited by its pharmacokinetic profile, better D1R agonists that can achieve adequate levels of D1R occupancy are needed to test the efficacy of this mechanism for cognitive enhancement in SCZ.
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Affiliation(s)
- Ragy R Girgis
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Jared X Van Snellenberg
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Andrew Glass
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Lawrence S Kegeles
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Judy L Thompson
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA Rutgers University, New Brunswick, NJ, USA
| | - Melanie Wall
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Raymond Y Cho
- Department of Psychiatry and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Cameron S Carter
- Department of Psychiatry and Behavioral Sciences, University of California-Davis, Sacramento, CA, USA
| | - Mark Slifstein
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
| | - Anissa Abi-Dargham
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA Department of Radiology, Columbia University, New York, NY, USA
| | - Jeffrey A Lieberman
- Department of Psychiatry, Columbia University, New York, NY, USA New York State Psychiatric Institute, New York, NY, USA
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Findling RL, Robb A, McNamara NK, Pavuluri MN, Kafantaris V, Scheffer R, Frazier JA, Rynn M, DelBello M, Kowatch RA, Rowles BM, Lingler J, Martz K, Anand R, Clemons TE, Taylor-Zapata P. Lithium in the Acute Treatment of Bipolar I Disorder: A Double-Blind, Placebo-Controlled Study. Pediatrics 2015; 136:885-94. [PMID: 26459650 PMCID: PMC4621794 DOI: 10.1542/peds.2015-0743] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/20/2015] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Lithium is a benchmark treatment for bipolar disorder in adults. Definitive studies of lithium in pediatric bipolar I disorder (BP-I) are lacking. METHODS This multicenter, randomized, double-blind, placebo-controlled study of pediatric participants (ages 7-17 years) with BP-I/manic or mixed episodes compared lithium (n = 53) versus placebo (n = 28) for up to 8 weeks. The a priori primary efficacy measure was change from baseline to the end of study (week 8/ET) in the Young Mania Rating Scale (YMRS) score, based on last-observation-carried-forward analysis. RESULTS The change in YMRS score was significantly larger in lithium-treated participants (5.51 [95% confidence interval: 0.51 to 10.50]) after adjustment for baseline YMRS score, age group, weight group, gender, and study site (P = .03). Overall Clinical Global Impression-Improvement scores favored lithium (n = 25; 47% very much/much improved) compared with placebo (n = 6; 21% very much/much improved) at week 8/ET (P = .03). A statistically significant increase in thyrotropin concentration was seen with lithium (3.0 ± 3.1 mIU/L) compared with placebo (-0.1 ± 0.9 mIU/L; P < .001). There was no statistically significant between-group difference with respect to weight gain. CONCLUSIONS Lithium was superior to placebo in reducing manic symptoms in pediatric patients treated for BP-I in this clinical trial. Lithium was generally well tolerated in this patient population and was not associated with weight gain, distinguishing it from other agents commonly used to treat youth with bipolar disorder.
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Affiliation(s)
- Robert L. Findling
- The Johns Hopkins University/Kennedy Krieger Institute, Baltimore, Maryland
| | - Adelaide Robb
- Children's National Medical Center, George Washington University, Washington District of Columbia
| | - Nora K. McNamara
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Mani N. Pavuluri
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Vivian Kafantaris
- The Zucker Hillside Hospital and Feinstein Institute for Medical Research of the North Shore–Long Island Jewish Health System, Manhasset, New York
| | | | - Jean A. Frazier
- Department of Psychiatry, University of Massachusetts Medical School/UMASS Memorial Medical Center, Worcester, Massachusetts
| | - Moira Rynn
- New York State Psychiatric Institute/Columbia University, New York, New York
| | | | - Robert A. Kowatch
- Wexner Medical Center/Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | | | - Jacqui Lingler
- Department of Psychiatry, Case Western Reserve University, Cleveland, Ohio
| | - Karen Martz
- The EMMES Corporation, Rockville, Maryland; and
| | | | | | - Perdita Taylor-Zapata
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, Maryland
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The VA augmentation and switching treatments for improving depression outcomes (VAST-D) study: Rationale and design considerations. Psychiatry Res 2015; 229:760-70. [PMID: 26279130 DOI: 10.1016/j.psychres.2015.08.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2015] [Revised: 07/22/2015] [Accepted: 08/04/2015] [Indexed: 11/22/2022]
Abstract
Because two-thirds of patients with Major Depressive Disorder do not achieve remission with their first antidepressant, we designed a trial of three "next-step" strategies: switching to another antidepressant (bupropion-SR) or augmenting the current antidepressant with either another antidepressant (bupropion-SR) or with an atypical antipsychotic (aripiprazole). The study will compare 12-week remission rates and, among those who have at least a partial response, relapse rates for up to 6 months of additional treatment. We review seven key efficacy/effectiveness design decisions in this mixed "efficacy-effectiveness" trial.
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Abstract
Background: Research shows that there is a high prevalence of suicide among nurses. Despite this, it has been 15 years since the last literature review on the subject was published. Aim: The aim of this article is to review the knowledge currently available on the risk of suicide among nurses and on contributory risk factors. Method: A search was conducted in electronic databases using keywords related to prevalence and risk factors of suicide among nurses. The abstracts were analyzed by reviewers according to selection criteria. Selected articles were submitted to a full-text review and their key elements were summarized. Results: Only nine articles were eligible for inclusion in this review. The results of this literature review highlight both the troubling high prevalence of suicide among nurses as well as the persistent lack of studies that examine this issue. Conclusion: Considering that the effects of several factors related to nurses' work and work settings are associated with high stress, distress, or psychiatric problems, we highlight the relevance of investigating work-related factors associated with nurses' risk of suicide. Several avenues for future studies are discussed as well as possible research methods.
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Affiliation(s)
- Marie Alderson
- Faculty of Nursing, Université de Montréal, Succ. Centre-Ville, Montréal, QC, Canada
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Sisek-Šprem M, Križaj A, Jukić V, Milošević M, Petrović Z, Herceg M. Testosterone levels and clinical features of schizophrenia with emphasis on negative symptoms and aggression. Nord J Psychiatry 2015; 69:102-9. [PMID: 25151994 DOI: 10.3109/08039488.2014.947320] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND Aggressive behavior and negative symptoms are two features of schizophrenia that may have a hormonal basis. AIM The aim of this study was to compare testosterone level with clinical features of schizophrenia, focusing on negative symptoms and aggressive behavior. METHODS The study population consisted of 120 male schizophrenic patients (ages 18-40) classified into non-aggressive (n = 60) and aggressive (n = 60) groups. Depending on the type of aggression that was manifested prior to admission, the aggressive group was divided into violent (n = 32) and suicidal (n = 28) subgroups. Psychopathological severity, violence and suicidality were assessed using the Positive and Negative Syndrome Scale (PANSS), Overt Aggression Scale and Columbia Suicide Severity Rating Scale, respectively. Total serum testosterone level was determined on the same morning that symptoms were assessed. RESULTS In the non-aggressive group, testosterone level was negatively correlated with the score on the negative subscale of PANSS (P = 0.04) and depression (P = 0.013), and positively correlated with excitement (P = 0.027), hostility (P = 0.02) and impulsive behavior (P = 0.008). In the aggressive group, testosterone level had non-significant correlation with these parameters, and with violent or suicidal behavior. CONCLUSIONS The results confirmed that non-aggressive male schizophrenic patients with lower levels of testosterone had a greater severity of negative symptoms. In aggressive patients, there was no correlation between testosterone and clinical features of the disorder or the degree or type of aggression. These findings indicate that therapeutic strategies targeting testosterone could be useful in the treatment of negative symptoms of schizophrenia.
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Affiliation(s)
- Mirna Sisek-Šprem
- Mirna Sisek-Šprem, M.D, Ph.D., Integral Ward, University Psychiatric Hospital Vrapče , Zagreb , Croatia
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Knafo A, Guilé JM, Breton JJ, Labelle R, Belloncle V, Bodeau N, Boudailliez B, de la Rivière SG, Kharij B, Mille C, Mirkovic B, Pripis C, Renaud J, Vervel C, Cohen D, Gérardin P. Coping strategies associated with suicidal behaviour in adolescent inpatients with borderline personality disorder. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2015; 60:S46-54. [PMID: 25886671 PMCID: PMC4345850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/01/2014] [Accepted: 12/01/2014] [Indexed: 03/07/2023]
Abstract
OBJECTIVES To compare the coping strategies of adolescents with borderline personality disorder (BPD) to the coping strategies of adolescents without BPD, and to explore the association of coping with suicidal ideation and attempts among adolescents with BPD. METHOD Adolescent inpatients (n = 167) aged 13 to 17 years were admitted after suicide attempts and evaluated within 10 days, using the abbreviated version of the Diagnostic Interview for Borderlines-Revised, the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version supported by a team consensus best estimate method for the primary diagnosis, the Adolescent Coping Scale, and the Columbia-Suicide Severity Rating Scale. RESULTS Firstly, compared with adolescents without BPD, adolescents with BPD relied more on nonproductive coping strategies, mostly avoidant strategies, and less on productive coping strategies. Secondly, coping appeared as a factor associated with suicidal ideation in adolescents with BPD. While while controlling for age, sex, and depression, multivariate analyses showed a significant positive association between the coping strategy to focusing on solving the problem and suicidal ideation. CONCLUSION The use of avoidant strategies by adolescents with BPD could be viewed as attempts to increase emotional regulation. Problem-solving strategies in the immediate aftermath of a suicide attempt may prevent adolescents with BPD from overcoming a crisis and may increase suicidal ideation.
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Affiliation(s)
- Alexandra Knafo
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Jean-Marc Guilé
- Professor and Department Head, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France; Associate Professor, Département de Psychiatrie, Université de Montréal, Montréal, Québec; Assistant Professor, Division of Child Psychiatry, Department of Psychiatry, McGill University, Montréal, Québec; Researcher, Centre de recherche de l’Institut universitaire en santé mentale de Montréal, site de l’Hôpital Rivière-des-Prairies, Montréal, Québec
| | - Jean-Jacques Breton
- Associate Professor, Département de Psychiatrie, Université de Montréal, Montréal, Québec; Researcher, Centre de recherche de l’Institut universitaire en santé mentale de Montréal, l’Hôpital Rivière-des-Prairies, Montréal, Québec
| | - Réal Labelle
- Psychologist and Researcher, Clinique des troubles de l’humeur and Centre de recherche de l’Institut universitaire en santé mentale de Montréal, Hôpital Rivière-des-Prairies, Montréal, Québec; Full Professor, Département de psychologie, Université du Québec à Montréal, Montréal, Québec; Associate Professor, Département de psychiatrie, Université de Montréal, Montréal, Québec
| | - Vincent Belloncle
- Psychiatrist, Département de pédiatrie médicale, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre hospitalier universitaire de Rouen et Centre hospitalier du Rouvray, Université de Rouen, Rouen, France
| | - Nicolas Bodeau
- Statistics Engineer and Data Manager, Service de Psychiatrie de l’Enfant et de l’Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique–Hopitaux de Paris et Université Pierre et Marie Curie, Paris, France
| | - Bernard Boudailliez
- Professor and Department Head, Service de pédiatrie et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Sébastien Garny de la Rivière
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Brahim Kharij
- Psychiatry Resident, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Christian Mille
- Professor, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Bojan Mirkovic
- Psychiatrist, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre hospitalier universitaire de Rouen, Rouen, France; PhD Student, Inserm U1079, Université de Rouen, Rouen, France
| | - Cornelia Pripis
- Senior Psychiatrist, Service de Psychopathologie de l’Enfant et de l’Adolescent et Unité de Médecine de l’Adolescent, Centre Hospitalier Universitaire d’Amiens, Université Picardie Jules Verne, Amiens, France
| | - Johanne Renaud
- Child and Adolescent Psychiatrist, Standard Life Centre for Breakthroughs in Teen Depression and Suicide Prevention, Douglas Mental Health University Institute, Montréal, Québec; Medical Chief, McGill Group for Suicide Studies, McGill University, Montréal, Québec
| | - Christine Vervel
- Head, Service de Pédiatrie, Centre Hospitalier de Compiègne, Compiègne, France
| | - David Cohen
- Professor and Department Head, Service de Psychiatrie de l’Enfant et de l’Adolescent, Groupe Hospitalier Pitié-Salpêtrière, Assistance Publique–Hopitaux de Paris et Université Pierre et Marie Curie, Paris, France; Researcher, CNRS UMR 7222 Institut des Systèmes Intelligents et Robotiques, Université Pierre et Marie Curie, Paris, France
| | - Priscille Gérardin
- Professor and Department Head, Département de pédiatrie médicale, Fédération hospitalo–universitaire de psychiatrie de l’enfant et de l’adolescent, Centre Hospitalier universitaire de Rouen et Centre hospitalier du Rouvray, France, Rouen et Rouvray, France; Researcher, Laboratoire Psy-NCA-EA-4700, Université de Rouen, Rouen, France
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The Reliability and Validity of the Korean Version of Columbia-Suicide Severity Rating Scale in Alcohol Dependent Patients. ACTA ACUST UNITED AC 2015. [DOI: 10.4306/jknpa.2015.54.2.222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Amichai-Hamburger Y, Klomek AB, Friedman D, Zuckerman O, Shani-Sherman T. The future of online therapy. COMPUTERS IN HUMAN BEHAVIOR 2014. [DOI: 10.1016/j.chb.2014.09.016] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Boege I, Corpus N, Schepker R, Fegert JM. Pilot study: feasibility of using the Suicidal Ideation Questionnaire (SIQ) during acute suicidal crisis. Child Adolesc Psychiatry Ment Health 2014; 8:28. [PMID: 25392714 PMCID: PMC4228183 DOI: 10.1186/1753-2000-8-28] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 10/17/2014] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Assessing youths in acute suicidal crisis is a common jet pivotal task in child and adolescent psychiatry, usually relying primarily on the clinicians skills of assessment. The objective of this pilot-study was to evaluate feasibility and usefulness of questionnaires during assessment of youths in acute suicidal crisis. METHOD 31 adolescents, presenting for suicide assessment, and their caregivers, were asked upon emergency presentation to fill in the Suicidal-Ideation-Questionnaire (SIQ) and the Youth Life Status Questionnaire (Y-LSQ) before receiving an assessment by a clinician. The SIQ has 30 items, 8 of which are defined as critical items able to predict suicidality with the highest probability. The Y-LSQ (30 items) measures the overall level of psychological distress. It has one suicidal item, which was used in this study for validation of the SIQ result. Clinical judgment and test results were collected and analyzed by an independent researcher. RESULTS It was feasible to ask adolescents in acute suicidal crisis to fill in a questionnaire. Clinical assessment of suicidality did not correlate significantly with the overall SIQ-score (p = 0.089), however there was a significant correlation between the SIQ 8 critical item result and clinical judgement of suicidality (p = 0.050). CONCLUSION The 8 critical SIQ items can be used to support clinical judgment of suicidality in acute crisis.
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Affiliation(s)
- Isabel Boege
- />ZfP Südwürttemberg, Abteilung für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Weingartshoferstrasse 2, 88214 Ravensburg, Germany
- />Universität Ulm, Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Ulm, Germany
| | - Nicole Corpus
- />ZfP Südwürttemberg, Abteilung für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Weingartshoferstrasse 2, 88214 Ravensburg, Germany
| | - Renate Schepker
- />ZfP Südwürttemberg, Abteilung für Psychiatrie und Psychotherapie des Kindes- und Jugendalters, Weingartshoferstrasse 2, 88214 Ravensburg, Germany
| | - Joerg M Fegert
- />Universität Ulm, Klinik für Kinder und Jugendpsychiatrie und Psychotherapie, Ulm, Germany
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Results from clinical trials of a selective ionotropic glutamate receptor 5 (iGluR5) antagonist, LY5454694 tosylate, in 2 chronic pain conditions. Pain 2014; 155:1140-1149. [DOI: 10.1016/j.pain.2014.02.023] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2013] [Revised: 02/20/2014] [Accepted: 02/27/2014] [Indexed: 10/25/2022]
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Pomaglumetad Methionil (LY2140023 Monohydrate) and Aripiprazole in Patients with Schizophrenia: A Phase 3, Multicenter, Double-Blind Comparison. SCHIZOPHRENIA RESEARCH AND TREATMENT 2014; 2014:758212. [PMID: 24772351 PMCID: PMC3977437 DOI: 10.1155/2014/758212] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2013] [Revised: 01/31/2014] [Accepted: 02/04/2014] [Indexed: 12/21/2022]
Abstract
We tested the hypothesis that long-term treatment with pomaglumetad methionil would demonstrate significantly less weight gain than aripiprazole in patients with schizophrenia. In this 24-week, multicenter, randomized, double-blind, Phase 3 study, 678 schizophrenia patients were randomized to either pomaglumetad methionil (n = 516) or aripiprazole (n = 162). Treatment groups were also compared on efficacy and various safety measures, including serious adverse events (SAEs), discontinuation due to adverse events (AEs), treatment-emergent adverse events (TEAEs), extrapyramidal symptoms (EPS), and suicide-related thoughts and behaviors. The pomaglumetad methionil group showed significantly greater weight loss at Week 24 (Visit 12) compared with the aripiprazole group (-2.8 ± 0.4 versus 0.4 ± 0.6; P < 0.001). However, change in Positive and Negative Syndrome Scale (PANSS) total scores for aripiprazole was significantly greater than for pomaglumetad methionil (-15.58 ± 1.58 versus -12.03 ± 0.99; P = 0.045). The incidences of SAEs (8.2% versus 3.1%; P = 0.032) and discontinuation due to AEs (16.2% versus 8.7%; P = 0.020) were significantly higher for pomaglumetad methionil compared with aripiprazole. No statistically significant differences in the incidence of TEAEs, EPS, or suicidal ideation or behavior were noted between treatment groups. In conclusion, long-term treatment with pomaglumetad methionil resulted in significantly less weight gain than aripiprazole. This trial is registered with ClinicalTrials.gov NCT01328093.
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Consoli A, Peyre H, Speranza M, Hassler C, Falissard B, Touchette E, Cohen D, Moro MR, Révah-Lévy A. Suicidal behaviors in depressed adolescents: role of perceived relationships in the family. Child Adolesc Psychiatry Ment Health 2013; 7:8. [PMID: 23497551 PMCID: PMC3655930 DOI: 10.1186/1753-2000-7-8] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2012] [Accepted: 02/25/2013] [Indexed: 11/10/2022] Open
Abstract
CONTEXT Suicide is the second leading cause of death in adolescents and young adults in Europe. Reducing suicides is therefore a key public health target. Previous studies have shown associations between suicidal behaviors, depression and family factors. OBJECTIVE To assess the role of family factors in depression and suicidality in a large community-based sample of adolescents and to explore specific contributions (e.g. mother vs. father; conflict vs. no conflict; separation vs. no separation) taking into account other risk factors. METHODS A cross-sectional sample of adolescents aged 17 years was recruited in 2008. 36,757 French adolescents (18,593 girls and 18,164 boys) completed a questionnaire including socio-demographic characteristics, drug use, family variables, suicidal ideations and attempts. Current depression was assessed with the Adolescent Depression Rating Scale (ADRS). Adolescents were divided into 4 groups according to suicide risk severity (grade 1 = depressed without suicidal ideation and without suicide attempts, grade 2 = depressed with suicidal ideations and grade 3 = depressed with suicide attempts; grade 0 = control group). Multivariate regressions were applied to assess the Odds Ratio of potential risk factors comparing grade 1, 2 or 3 risk with grade 0. RESULTS 7.5% of adolescents (10.4% among girls vs. 4.5% among boys) had ADRS scores compatible with depression; 16.2% reported suicidal ideations in the past 12 months and 8.2% reported lifetime suicide attempts. Repeating a year in school was significantly associated to severity grade of suicide risk (1 and 3), as well as all substance use, tobacco use (severity grades 2 and 3) and marijuana use (severity grade 3), for girls and boys. After adjustment, negative relationships with either or both parents, and parents living together but with a negative relationship were significantly associated with suicide risk and/or depression in both genders (all risk grades), and Odds Ratios increased according to risk severity grade. CONCLUSION Family discord and negative relationship with parents were associated with an increased suicide risk in depressed adolescents. So it appears essential to take intrafamilial relationships into account in depressed adolescents to prevent suicidal behaviours.
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Affiliation(s)
- Angèle Consoli
- Centre de Soins Psychothérapeutiques de Transition pour Adolescents, Hôpital d'Argenteuil, Argenteuil, Argenteuil, France.
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Investigation of a Ca
2+
Channel α2δ Ligand for the Treatment of Interstitial Cystitis: Results of a Randomized, Double-Blind, Placebo Controlled Phase II Trial. J Urol 2012; 188:817-23. [DOI: 10.1016/j.juro.2012.05.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Indexed: 11/19/2022]
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Wilson CM, Christensen BK. Ethical issues relevant to the assessment of suicide risk in nonclinical research settings. CRISIS 2012; 33:54-9. [PMID: 21945844 DOI: 10.1027/0227-5910/a000110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Our laboratory recently confronted this issue while conducting research with undergraduate students at the University of Waterloo (UW). Although our main objective was to examine cognitive and genetic features of individuals with schizotypal personality disorder (SPD), the study protocol also entailed the completion of various self-report measures to identify participants deemed at increased risk for suicide. AIMS AND METHODS This paper seeks to review and discuss the relevant ethical guidelines and legislation that bear upon a psychologist's obligation to further assess and intervene when research participants reveal that they are at increased risk for suicide. RESULTS AND CONCLUSIONS In the current paper we argue that psychologists are ethically impelled to assess and appropriately intervene in cases of suicide risk, even when such risk is revealed within a research context. We also discuss how any such obligation may potentially be modulated by the research participant's expectations of the role of a psychologist, within such a context. Although the focus of the current paper is on the ethical obligations of psychologists, specifically those practicing within Canada, the relevance of this paper extends to all regulated health professionals conducting research in nonclinical settings.
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Weisler RH, Pandina GJ, Daly EJ, Cooper K, Gassmann-Mayer C. Randomized clinical study of a histamine H3 receptor antagonist for the treatment of adults with attention-deficit hyperactivity disorder. CNS Drugs 2012; 26:421-34. [PMID: 22519922 DOI: 10.2165/11631990-000000000-00000] [Citation(s) in RCA: 68] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
BACKGROUND Psychostimulants, including methylphenidate and amphetamine preparations, are commonly prescribed for the treatment of attention-deficit hyperactivity disorder (ADHD) in children and adults. Histamine H3 receptors reside on non-histamine neurons and regulate other neurotransmitters (e.g. acetylcholine, noradrenaline [norepinephrine]) suggesting that H3 antagonists have the potential to improve attention and impulsivity. Research indicates that H3 receptor antagonists due to their novel mechanism of action may have a unique treatment effect offering an important alternative for the treatment of ADHD. Bavisant (JNJ-31001074) is a highly selective, orally active antagonist of the human H3 receptor with a novel mechanism of action, involving wakefulness and cognition, with potential as a treatment for ADHD. OBJECTIVE The objective of this study was to evaluate the efficacy, safety and tolerability of three dosages of bavisant compared with placebo in adults with ADHD. STUDY DESIGN This randomized, double-blind, placebo- and active-controlled, parallel-group, multicentre study evaluated three dosages of bavisant (1 mg/day, 3 mg/day or 10 mg/day) and two active controls in adults with ADHD. The study consisted of a screening phase of up to 14 days, a 42-day double-blind treatment phase and a 7-day post-treatment follow-up phase. Efficacy and safety assessments were performed. SETTING The study was conducted at 37 study centres in the US from April 2009 through January 2010. PARTICIPANTS Men and women aged 18-55 years with an established diagnosis of ADHD as confirmed by clinician and self-report diagnostic measures were enrolled. INTERVENTION Participants were randomly assigned equally to one of six treatment groups: placebo, bavisant 1 mg/day, 3 mg/day or 10 mg/day, atomoxetine hydrochloride 80 mg/day or osmotic-release oral system (OROS) methylphenidate hydrochloride 54 mg/day. MAIN OUTCOME MEASURE The primary efficacy endpoint was the change in the Attention Deficit Hyperactivity Disorder Rating Scale, Version IV (ADHD-RS-IV) total score from baseline (day 1) to the end of the treatment phase (day 42), and included all randomized participants who received one or more doses of study drug and had baseline and one or more post-baseline assessments (intent-to-treat [ITT] population). Safety assessments included treatment-emergent adverse events (TEAEs), laboratory tests and ECG readings. RESULTS 430 participants were randomized, 424 received one or more doses of study medication and 335 (78%) of those randomized completed the study. Study participants had a mean age of 33.9 years and were predominantly White men. Mean treatment duration ranged from 31.4 to 38.8 days across groups. Mean change from baseline in the total ADHD-RS-IV score at day 42 (primary efficacy endpoint) was -8.8 in the placebo group versus -9.3, -11.2 and -12.2 in the bavisant 1 mg/day, 3 mg/day and 10 mg/day groups, respectively; the change in the 10 mg/day group was not statistically superior to placebo (p=0.161), and hence statistical comparisons of the 1 mg/day and 3 mg/day groups with placebo based on a step-down closed testing procedure were not performed. Mean change from baseline in the total ADHD-RS-IV score at day 42 was superior to placebo in the atomoxetine (-15.3) and OROS methylphenidate (-15.7) groups (p<0.005). Secondary efficacy assessments demonstrated a similar pattern with a non-significant trend towards improvement in the bavisant groups. The two lower dosages showed a good tolerability profile, but the higher dosage of bavisant was less well tolerated, as evidenced by the incidence of total TEAEs (61.8%, 82.4%, 89.0%), and discontinuations due to TEAEs (4.4%, 7.4%, 19.2%) in the bavisant 1 mg/day, 3 mg/day and 10 mg/day groups, respectively, compared with 58.9% and 2.7%, respectively on placebo. In the atomoxetine and OROS methylphenidate groups, the incidence of total TEAEs was 83.8% and 82.4% and discontinuations due to TEAEs was 10.8% and 8.8%, respectively. CONCLUSION Bavisant, a highly selective, wakefulness-promoting H3 antagonist, did not display significant clinical effectiveness in the treatment of adults with ADHD. CLINICAL TRIAL REGISTRATION NUMBER NCT00880217.
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Skinner R, McFaull S. Suicide among children and adolescents in Canada: trends and sex differences, 1980-2008. CMAJ 2012; 184:1029-34. [PMID: 22470172 DOI: 10.1503/cmaj.111867] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Suicide is the second leading cause of death for young Canadians (10-19 years of age)--a disturbing trend that has shown little improvement in recent years. Our objective was to examine suicide trends among Canadian children and adolescents. METHODS We conducted a retrospective analysis of standardized suicide rates using Statistics Canada mortality data for the period spanning from 1980 to 2008. We analyzed the data by sex and by suicide method over time for two age groups: 10-14 year olds (children) and 15-19 year olds (adolescents). We quantified annual trends by calculating the average annual percent change (AAPC). RESULTS We found an average annual decrease of 1.0% (95% confidence interval [CI] -1.5 to -0.4) in the suicide rate for children and adolescents, but stratification by age and sex showed significant variation. We saw an increase in suicide by suffocation among female children (AAPC = 8.1%, 95% CI 6.0 to 10.4) and adolescents (AAPC = 8.0%, 95% CI 6.2 to 9.8). In addition, we noted a decrease in suicides involving poisoning and firearms during the study period. INTERPRETATION Our results show that suicide rates in Canada are increasing among female children and adolescents and decreasing among male children and adolescents. Limiting access to lethal means has some potential to mitigate risk. However, suffocation, which has become the predominant method for committing suicide for these age groups, is not amenable to this type of primary prevention.
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Affiliation(s)
- Robin Skinner
- Injury Section, Health Surveillance and Epidemiology Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, Ottawa, Ont.
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Gassmann-Mayer C, Jiang K, McSorley P, Arani R, DuBrava S, Suryawanshi S, Webb DM, Nilsson M. Clinical and Statistical Assessment of Suicidal Ideation and Behavior in Pharmaceutical Trials. Clin Pharmacol Ther 2011; 90:554-60. [DOI: 10.1038/clpt.2011.144] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Findling RL, Kafantaris V, Pavuluri M, McNamara NK, McClellan J, Frazier JA, Sikich L, Kowatch R, Lingler J, Faber J, Rowles BM, Clemons TE, Taylor-Zapata P. Dosing strategies for lithium monotherapy in children and adolescents with bipolar I disorder. J Child Adolesc Psychopharmacol 2011; 21:195-205. [PMID: 21663422 PMCID: PMC3111866 DOI: 10.1089/cap.2010.0084] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The primary goal of this exploratory study was to obtain data that could lead to evidence-based dosing strategies for lithium in children and adolescents suffering from bipolar I disorder. METHODS Outpatients aged 7-17 years meeting Diagnostic and Statistical Manual of Mental Disorders, 4th edition, diagnostic criteria for bipolar I disorder (manic or mixed) were eligible for 8 weeks of open label treatment with lithium in one of three dosing arms. In Arm I, participants began treatment at a dose of 300 mg of lithium twice daily. The starting dose of lithium in Arms II and III was 300 mg thrice daily. Patients in Arms I and II could have their dose increased by 300 mg/day, depending on clinical response, at weekly visits. Patients in Arm III also had mid-week telephone interviews after which they could also have their dose of lithium increased by 300 mg per day. Youths weighing <30 kg were automatically assigned to Arm I, whereas youths weighing ≥30 kg were randomly assigned to Arm I, II, or III. Randomization was balanced by age (7-11 years, 12-17 years) and sex in approximately equal numbers. A priori response criteria were defined as a Clinical Global Impressions-Improvement scale score of ≤ 2 and a 50% decrease from baseline on the Young Mania Rating Scale. RESULTS Of the 61 youths [32 males (52.5%)] who received open-label lithium, 60 youths completed at least 1 week of treatment and returned for a postbaseline assessment. Most patients had a ≥ 50% improvement in Young Mania Rating Scale score, and more than half of the patients (58%) achieved response. Overall, lithium was well tolerated. All three treatment arms had similar effectiveness, side effect profiles, and tolerability of lithium. CONCLUSIONS On the basis of these results, a dosing strategy in which pediatric patients begin lithium at a dose of 300 mg thrice daily (with an additional 300 mg increase during the first week), followed by 300 mg weekly increases until a priori stopping criteria are met, will be used in an upcoming randomized, placebo-controlled trial.
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Affiliation(s)
- Robert L. Findling
- Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Vivian Kafantaris
- Long Island Jewish Health System, The Zucker Hillside Hospital, The Feinstein Institute for Medical Research of the North Shore, Long Island, New York
| | - Mani Pavuluri
- Department of Psychiatry, University of Illinois at Chicago, Chicago, Illinois
| | - Nora K. McNamara
- Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Jean A. Frazier
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Linmarie Sikich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Robert Kowatch
- Department of Psychiatry, Cincinnati Children's Hospital, Cincinnati, Ohio
| | - Jacqui Lingler
- Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Jon Faber
- Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Brieana M. Rowles
- Child and Adolescent Psychiatry, University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Perdita Taylor-Zapata
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Rockville, Maryland
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Abstract
When treatments are ordered for adolescent major depression, or for other adolescent medical illnesses, adherence and clinical outcomes are likely to be unsatisfactory, unless 4 basic principles of the medical treatment of adolescent illness are implemented. These comprise providing effective patient and parent/caregiver education, establishing effective patient and caregiver therapeutic alliances, providing effective treatment, and managing other factors associated with treatment adherence as indicated. The goals of treatment are to achieve the earliest possible response and remission. Failure to treat adolescent major depression successfully has potentially serious consequences, including worsened adherence, long-term morbidity, and suicide attempt. Accordingly, prescribed treatment must be aggressively managed. Doses of an antidepressant medication should be increased as rapidly as can be tolerated, preferably every 1-2 weeks, until full remission is achieved or such dosing is limited by the emergence of unacceptable adverse effects. A full range of medication treatment options must be employed if necessary. Treatment adherence, occurrence of problematic adverse effects, clinical progress, and safety must be systematically monitored. Adolescents with major depression must be assessed for risk of harm to self or others. When this risk appears significant, likelihood of successful outcomes will be enhanced by use of treatment plans that comprehensively address factors associated with treatment nonadherence. Abbreviated and comprehensive plans for the treatment of potentially fatal adolescent illnesses are outlined in this review.
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Skljarevski V, Zhang S, Desaiah D, Alaka KJ, Palacios S, Miazgowski T, Patrick K. Duloxetine versus placebo in patients with chronic low back pain: a 12-week, fixed-dose, randomized, double-blind trial. THE JOURNAL OF PAIN 2010; 11:1282-90. [PMID: 20472510 DOI: 10.1016/j.jpain.2010.03.002] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Revised: 02/11/2010] [Accepted: 03/04/2010] [Indexed: 12/20/2022]
Abstract
UNLABELLED This randomized, double-blind, placebo-controlled study assessed efficacy and safety of duloxetine in patients with chronic low back pain (CLBP). Adults (n = 401) with a nonneuropathic CLBP and average pain intensity of ≥ 4 on an 11-point numerical scale (Brief Pain Inventory [BPI]) were treated with either duloxetine 60 mg once daily or placebo for 12 weeks. The primary measure was BPI average pain. Secondary endpoints included Patient's Global Impressions of Improvement (PGI-I), Roland Morris Disability Questionnaire (RMDQ-24), BPI-Severity (BPI-S), BPI-Interference (BPI-I), and response rates (either ≥ 30% or ≥ 50% BPI average pain reduction at endpoint). Health outcomes included Short Form-36, European Quality of Life-5 Dimensions, and the Work Productivity and Activity Impairment questionnaire. Safety and tolerability were assessed. Compared with placebo-treated patients, duloxetine-treated patients reported a significantly greater reduction in BPI average pain (P ≤ .001). Similarly, duloxetine-treated patients reported significantly greater improvements in PGI-I, BPI-S, BPI-I, 50% response rates, and some health outcomes. The RMDQ and 30% response rate showed numerical improvements with duloxetine treatment. Significantly more patients in the duloxetine group (15.2%) than patients in the placebo group (5.4%) discontinued because of adverse events (P = .002). Nausea and dry mouth were the most common treatment-emergent adverse events with rates significantly higher in duloxetine-treated patients. PERSPECTIVE This study provides clinical evidence of the efficacy and safety of duloxetine at a fixed dose of 60 mg once daily in the treatment of chronic low back pain (CLBP). As of December 2009, duloxetine has not received regulatory approval for the treatment of CLBP.
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Shapiro M, Silva SG, Compton S, Chrisman A, DeVeaugh-Geiss J, Breland-Noble A, Kondo D, Kirchner J, March JS. The child and adolescent psychiatry trials network (CAPTN): infrastructure development and lessons learned. Child Adolesc Psychiatry Ment Health 2009; 3:12. [PMID: 19320979 PMCID: PMC2673205 DOI: 10.1186/1753-2000-3-12] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Accepted: 03/25/2009] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In 2003, the National Institute of Mental Health funded the Child and Adolescent Psychiatry Trials Network (CAPTN) under the Advanced Center for Services and Intervention Research (ACSIR) mechanism. At the time, CAPTN was believed to be both a highly innovative undertaking and a highly speculative one. One reviewer even suggested that CAPTN was "unlikely to succeed, but would be a valuable learning experience for the field." OBJECTIVE To describe valuable lessons learned in building a clinical research network in pediatric psychiatry, including innovations intended to decrease barriers to research participation. METHODS The CAPTN Team has completed construction of the CAPTN network infrastructure, conducted a large, multi-center psychometric study of a novel adverse event reporting tool, and initiated a large antidepressant safety registry and linked pharmacogenomic study focused on severe adverse events. Specific challenges overcome included establishing structures for network organization and governance; recruiting over 150 active CAPTN participants and 15 child psychiatry training programs; developing and implementing procedures for site contracts, regulatory compliance, indemnification and malpractice coverage, human subjects protection training and IRB approval; and constructing an innovative electronic casa report form (eCRF) running on a web-based electronic data capture system; and, finally, establishing procedures for audit trail oversight requirements put forward by, among others, the Food and Drug Administration (FDA). CONCLUSION Given stable funding for network construction and maintenance, our experience demonstrates that judicious use of web-based technologies for profiling investigators, investigator training, and capturing clinical trials data, when coupled to innovative approaches to network governance, data management and site management, can reduce the costs and burden and improve the feasibility of incorporating clinical research into routine clinical practice. Having successfully achieved its initial aim of constructing a network infrastructure, CAPTN is now a capable platform for large safety registries, pharmacogenetic studies, and randomized practical clinical trials in pediatric psychiatry.
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Affiliation(s)
- Mark Shapiro
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA.
| | - Susan G Silva
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Scott Compton
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Allan Chrisman
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph DeVeaugh-Geiss
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - Alfiee Breland-Noble
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Douglas Kondo
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA
| | - Jerry Kirchner
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
| | - John S March
- Department of Psychiatry and Behavioral Sciences, Duke University Medical Center, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina, USA
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Findling RL, Frazier JA, Kafantaris V, Kowatch R, McClellan J, Pavuluri M, Sikich L, Hlastala S, Hooper SR, Demeter CA, Bedoya D, Brownstein B, Taylor-Zapata P. The Collaborative Lithium Trials (CoLT): specific aims, methods, and implementation. Child Adolesc Psychiatry Ment Health 2008; 2:21. [PMID: 18700004 PMCID: PMC2531078 DOI: 10.1186/1753-2000-2-21] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2008] [Accepted: 08/12/2008] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Lithium is a benchmark treatment for bipolar illness in adults. However, there has been relatively little methodologically stringent research regarding the use of lithium in youth suffering from bipolarity. METHODS Under the auspices of the Best Pharmaceuticals for Children Act (BPCA), a Written Request (WR) pertaining to the study of lithium in pediatric mania was issued by the United States Food and Drug Administration (FDA) to the National Institute of Child Health and Human Development (NICHD) in 2004. Accordingly, the NICHD issued a Request for Proposals (RFP) soliciting submissions to pursue this research. Subsequently, the NICHD awarded a contract to a group of investigators in order to conduct these studies. RESULTS The Collaborative Lithium Trials (CoLT) investigators, the BPCA-Coordinating Center, and the NICHD developed protocols to provide data that will: (1) establish evidence-based dosing strategies for lithium; (2) characterize the pharmacokinetics and biodisposition of lithium; (3) examine the acute efficacy of lithium in pediatric bipolarity; (4) investigate the long-term effectiveness of lithium treatment; and (5) characterize the short- and long-term safety of lithium. By undertaking two multi-phase trials rather than multiple single-phase studies (as was described in the WR), the feasibility of the research to be undertaken was enhanced while ensuring all the data outlined in the WR would be obtained. The first study consists of: (1) an 8-week open-label, randomized, escalating dose Pharmacokinetic Phase; (2) a 16-week Long-Term Effectiveness Phase; (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. The second study consists of: (1) an 8-week, double-blind, parallel-group, placebo-controlled Efficacy Phase; (2) an open-label Long-Term Effectiveness lasting either 16 or 24 weeks (depending upon blinded treatment assignment during the Efficacy Phase); (3) a 28-week double-blind Discontinuation Phase; and (4) an 8-week open-label Restabilization Phase. In December of 2006, enrollment into the first of these studies began across seven sites. CONCLUSION These innovative studies will not only provide data to inform the labeling of lithium in children and adolescents with bipolar disorder, but will also enhance clinical decision-making regarding the use of lithium treatment in pediatric bipolar illness. TRIAL REGISTRATION NCT00442039.
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Affiliation(s)
- Robert L Findling
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA.
| | - Jean A Frazier
- Cambridge Health Alliance and Department of Psychiatry, Harvard Medical School, Cambridge, MA , USA
| | - Vivian Kafantaris
- The Feinstein Institute for Medical Research of the North Shore—Long Island Health System, Manhasset, NY, USA
| | - Robert Kowatch
- Division of Psychiatry, Cincinnati Children’s Hospital, Cincinnati, OH, USA
| | - Jon McClellan
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Mani Pavuluri
- Department of Psychiatry, University of Illinois at Chicago, Chicago, IL, USA
| | - Linmarie Sikich
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Stefanie Hlastala
- Department of Psychiatry, University of Washington, Seattle, WA, USA
| | - Stephen R Hooper
- Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Clinical Center for the Study of Development and Learning of the Carolina Institute of Developmental Disabilities, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christine A Demeter
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Denise Bedoya
- Department of Psychiatry, University Hospitals Case Medical Center/Case Western Reserve University, Cleveland, OH, USA
| | - Bernard Brownstein
- Best Pharmaceuticals for Children Act-Coordinating Center, Premier Research, Philadelphia, PA, USA
| | - Perdita Taylor-Zapata
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
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