The mediating effect of dysmorphic concern in the association between avoidant restrictive food intake disorder and suicidal ideation in adults

BACKGROUND

Reflecting on the existing literature on suicidal ideation and Avoidant/Restrictive Food Intake Disorder (ARFID), this article investigates the complex relationship between them, hypothesizing about the possibility of dysmorphic concerns, being a mediator linking ARFID to suicidal ideation.

METHODS

Using a snowball sampling approach, a survey was created on Google Forms and circulated across messaging applications and social media networks (WhatsApp, Instagram, Messenger). The sample involved 515 participants recruited between February and March 2023. The questionnaire included the following scales: Nine-items Avoidant/Restrictive Food Intake Disorder screen (NIAS), Dysmorphic Concern Questionnaire (DCQ), and Columbia-Suicide Severity Rating Scale (C-SSRS). When filling the questionnaire, respondents were warned that they can experience distress when answering certain questions and received information about mental health services. Five hundred fifteen adults participated in this study, with a mean age of 27.55 ± 10.92 years and 60.1% females.

RESULTS

After adjusting over potential confounders (i.e., age, education, marital status, and household crowding index), analyses showed that dysmorphic concerns fully mediated the association between avoidant restrictive eating and suicidal ideation. Higher avoidant restrictive eating was significantly associated with more dysmorphic concerns, and higher dysmorphic concerns were significantly associated with the presence of suicidal ideation. Finally, avoidant restrictive eating was not significantly associated with suicidal ideation.

CONCLUSION

This study highlights the potential indirect link between ARFID and suicidal ideation mediated by dysmorphic concerns. While no direct connection was observed between ARFID and suicidal ideation, the presence of dysmorphic concerns appeared to be a crucial factor in amplifying the risk of suicidal ideation in individuals with ARFID. This emphasizes the importance of addressing dysmorphic concerns alongside ARFID treatment to enhance mental health interventions and outcomes.

Child abuse and aggressiveness in individuals diagnosed with schizophrenia in Lebanon

OBJECTIVES

To identify individual and clinical risk factors of aggressiveness, including exposure to different forms of childhood trauma, in a sample of Lebanese patients with schizophrenia.

METHODS

A total of 131 patients diagnosed with schizophrenia participated in this cross-sectional study.

RESULTS

Higher physical (Beta = 0.24, p < 0.001) and sexual (Beta = 0.29, p = 0.003) abuse, alcohol drinking (Beta = 1.46, p = 0.008), having a history of head trauma (Beta = 1.10, p = 0.041), and male gender (Beta = -1.59, p = 0.009) were significantly associated with higher mean aggression scores.

PRACTICAL IMPLICATIONS

Our investigation of the factors linked to aggressiveness in patients with schizophrenia complement those of earlier findings, showing that the relationship between interacting individual and environmental risk factors and later aggressiveness is quite complex, and needs further longitudinal and prospective studies.

"Inadvertent" thrombolytic administration in patients without myocardial infarction: clinical features and outcome

STUDY OBJECTIVES

Increasing pressure to deliver thrombolytic agents quickly to patients with suspected myocardial infarction (MI), along with expanded indications, may contribute to inappropriate administration of these agents, with potentially catastrophic results. We sought to identify the extent to which MI is ruled out in patients given thrombolytic therapy for acute MI and to characterize the clinical course and outcome in such patents.

METHODS

We studied 609 consecutive patients admitted to the CCU of an urban teaching hospital who were treated with thrombolytic agents for suspected acute MI between January 1986 and December 1993. In 35 (5.7%), MI was ruled out on the basis of persistently normal serum creatine kinase-MB isoenzyme levels. Hospital course and alternative diagnoses were established by means of chart review and database inquiry.

RESULTS

Patients in whom MI was ruled out were similar to those with MI with regard to baseline demographic and clinical features. Presenting ECGs in patients without MI were less likely to show Q waves (43 versus 64%, P < .02) but more likely to show left ventricular hypertrophy (26 versus 7%, P = .001) and nonspecific ST-segment and T-wave changes (54 versus 32%, P < .01) compared the ECGs of MI patients. Transient ST-segment elevation was detected in 51%. Hospital complications of patients without MI were similar to those of MI patients. No patient in whom MI was ruled out sustained a major hemorrhage. Final diagnoses of patients without MI included unstable angina (n = 20, 57%) undefined chest pain (n = 8, 17%) pericarditis (n = 3), pancreatitis (n = 2), esophagitis (n = 1), and aortic dissection (n = 1). Two patients died, one of aortic dissection and another of pericarditis.

CONCLUSION

In a consecutive series of CCU patients in whom MI was ruled after thrombolysis, we found no demographic or presenting clinical features to distinguish them from patients in whom MI was diagnosed. Transient ST-segment elevation potentially justifying thrombolytic therapy was present in more than half of the patients in whom MI was ruled out but may have represented transient coronary occlusion, coronary spasm, or other manifestations of unstable angina. In this study, patients in whom MI was ruled out had a high incidence of coronary disease and risk of in-hospital complications similar to that of patients with acute MI. Our findings support the rationale and safety of policies to rapidly and aggressively administer thrombolytic agents in the emergency department.