Chronic Suicidal Behavior Research Articles

Cognitive and behavioral factors in the chronification of suicidal behavior

Relevance. Suicide is one of the leading causes of death worldwide. Suicidal behavior is a complex phenomenon that includes suicidal thoughts, intentions and actions; and those actions do not always lead to death, but often turn into chronic suicidal behavior. The study of the factors in chronification of suicidal behavior is necessary for the development of evidence-based programs for the prevention of repeated suicide attempts.Aim of study. is to compare cognitive and behavioral strategies for coping with stress in patients with single suicide attempts and chronic suicidal behavior.The hypothesis of the study is that in patients with repeated suicide attempts, destructive cognitive and behavioral strategies for coping with stress are more pronounced.Materials and methods. The study included 119 patients treated at the somatopsychiatric and toxicology departments, 60 patients after the primary suicide attempt, 59 – after repeated ones. Patients were asked to complete the following procedures: Beck Depression Inventory (Beck, 1961; N.V. Tarabrina, 2001), Beck Anxiety Inventory (Beck, 1961; Tarabrina, 2001), Rumination Scale (Treynor W. et al., 2003; adaptation by O.D. Pugovkina et al., 2021), Alexithymia Scale (Toronto Alexithymia Scale G.J. Taylor et al., 1985; adaptation by Starostina E.G. et al. 2009), COPE Inventory (Ch.S. Carver et al., 1989; adaptation by P.A. Ivanov and N.G. Garanyan, 2013).Results. Patients after repeated suicide attempts, compared with patients who made the first attempt, are more likely to be diagnosed with borderline personality disorder, have more pronounced symptoms of depression and suicidal readiness, higher rates of ruminative thinking and alexithymia — reflecting a deceptive cognitive style, — as well as indicators of the use of destructive behavioral strategies for coping with stress in the form of various types of avoidance behavior.

Клинико-психологические и социодемографические факторы суицидального поведения и риска его хронификации: обзор исследований

<p><strong>Relevance.</strong> The article presents an overview of studies on clinical, psychological and socio–demographic factors of suicidal behavior and the risk of its chronicity. According to the WHO, 800,000 people die each year by suicide, and many others seek help from medical centers after a suicide attempt. Suicide and suicide attempts are a medical, social and psychological problem. <strong>Purpose of the study</strong>. Evaluation of the role of various factors in the chronification of suicidal behavior and an increase in its risk. <strong>Results.</strong> According to numerous studies, most often repeated suicide attempts are made by people with borderline personality disorder and other personality disorders, often in combination with depressive and anxiety symptoms. The motives for suicide in this group of patients may be emotional regulation, coping with dissociation, stress, and more often do not contain the desire to die. This group of patients tend to self-cut in the limbs or attempt self-poisoning. A distinctive feature of suicide attempts in individuals with schizophrenia, severe depression and bipolar disorder is the intention to die, combined with more severe methods of self-harm, in contrast to patients with personality disorders. The risk of chronification of suicidal behavior is higher in people of working age who have experience in the use of psychoactive substances, low social status and wealth, and the unemployed. This group of patients needs to be provided with medical, psycho-social assistance, since without treatment and psychological support, the risk of chronification of suicidal behavior, an increase in symptoms of depression and the completion of suicide increases. <strong>Conclusions.</strong> Chronic suicidal behavior requires active interdisciplinary team work with patients based on a biopsychosocial model already at the stage of the first hospital admission after a suicide attempt. It is important to take into account the specifics and characteristics of suicidal behavior, work styles may differ depending on the diagnoses, age and motives of suicidal behavior.</p>

Clinical Practice Guidelines for Management of Suicidal Behaviour.

Clinical Practice Guidelines for Management of Suicidal Behaviour.

Use of repeated intravenous ketamine therapy in treatment-resistant bipolar depression with suicidal behaviour: a case report from Spain.

The rapidly-acting antidepressant properties of ketamine are a trend topic in psychiatry. Despite its robust effects, these are ephemeral and can lead to certain adverse events. For this reason, there is still a general concern around the off-label use of ketamine in clinical practice settings. Nonetheless, for refractory depression, it should be an indication to consider. We report the case of a female patient admitted for several months due to a treatment-resistant depressive bipolar episode with chronic suicidal behaviour. After repeated intravenous ketamine infusions without remarkable side effects, the patient experienced a complete clinical recovery during the 4 weeks following hospital discharge. Unfortunately, depressive symptoms reappeared in the 5th week, and the patient was finally readmitted to hospital as a result of a suicide attempt.

Клинические и социально-психологические характеристики пациентов с суицидальными попытками

The article presents a retrospective analysis of medical records of 192 patients with suicide attempts who were treated in somatopsychology department for surgical patients in Scientific Research Institute of Emergency Care named after N.V. Sklifosovsky. The sample consisted of 64% men and 36% women. Most patients didn’t have higher education (82%), were not married (71%), and were in active working age from 15 to 45 years old (74%). The analysis of the medical records revealed that most patients were diagnosed with affective and personality disorder (56%), suffered from addiction and consumed alcohol and drugs regularly (11%), gave themselves stab and incision wounds of different localization (74%), a lot of them had hepatitis C virus (65%). Exasperation of severity of their mental state and growth of psychological and social maladjustment of patients after the initial auto-aggressive action often act as the factors of repetitive and multiple suicide attempts. We conclude that it is necessary to create special centers for the rehabilitation of patients who committed a suicide attempt and for the prevention of repeated auto-aggressive actions based on the model of centers of dialectical behavioral therapy, which provide specialized care for patients with chronic suicidal behavior.

Skills Practice in Dialectical Behavior Therapy for Suicidal Women Meeting Criteria for Borderline Personality Disorder

Dialectical Behavior Therapy (DBT) is an evidence-based practice for borderline personality disorder (BPD) and suicidal behavior that has been replicated with a variety of populations. Patients’ practice of behavioral skills taught in the group skills training component of DBT may be partly responsible for the positive treatment outcomes according to the skills deficit model of BPD that underlies DBT. This study was designed to examine the type and frequency of skills practiced by DBT patients. Participants were 49 women, who met criteria for BPD and current and chronic suicidal behavior, receiving 1 year of standard DBT as part of a clinical trial. Skills were recorded on the daily diary cards completed by participants each week and reviewed by their individual therapists. Results indicated that the majority of participants reported practicing skills most days throughout treatment. Crisis survival and mindfulness skills were practiced most frequently in our sample. Hierarchical linear modeling demonstrated that skills practice increased as a function of time in therapy. Directions for future research are discussed.

Narzisstische Persönlichkeitsstörungen und Suizidalität: $$ Behandlungsschwierigkeiten aus psychodynamischer Perspektive

Objectives: Suicidal threats, gestures and overt attempts and suicide are common problems in patients with narcissistic personality disorders and other severe personality disorders. From a psychodynamic perspective, suicidal behaviour is based on both aggression as well as narcissistic self-regulation. Challenges for the clinical treatment of patients with suicidal behaviour and narcissistic disorders are described and discussed from a psychodynamic perspective. Negative self-concept, the ambivalence of suicide and aggression in suicide attempters and other risk factors are discussed. Method: Empirical research findings, classical and newer psychodynamic theories and clinical experiences with psychotherapy for personality disorders are critically discussed. Results: Psychotherapeutic treatment should follow a suicide attempt. The therapist or psychiatrist must gauge the intensity of the patient's suicidal ideation, the existence of plans, the availability of means, the depth of depression, the extent of social isolation, the amount of alcohol or drug intake, and the degree to which the patient's communications are trustworthy to evaluate the situation. Broadly speaking, suicidal ideation in personality disordered patients has its primary source either in character pathology or affective illness. Different technical approaches apply when suicidality is primarily characterological or primarily affective. Besides the therapist's strong counter-transference reactions, which can include the extreme of hate, typical problems pertaining to his/her attitude and psychotherapeutic process can occur. The focus of the therapy is on the suicidal trigger and the roots of the narcissism. Suicide or the threat of suicide are called on by the patients as solutions to long-standing intrapsychic conflicts. When the patient's aggression, often due to traumatic experiences, is stimulated by current anger, frustration or envy, self-destruction provides a means to cope with the internalised tormentor or destructive schema. In many cases transferences related to the wish for revenge seem the prime motivator of suicidal behaviour. Chronic suicidal behaviour of more severely disturbed narcissistic patients is related to particular treatment difficulties. Conclusions: Suicidal behaviour presents therapists treating narcissistic disorders with significant treatment difficulties and risks. Yet, it is precisely the time following a suicide attempt which offers an opportunity to understand patients' narcissistic dynamics and to process them more intensively. Suicidality often necessitates action-oriented interventions and departures from technical neutrality on the therapist's part. Secondary gain from suicidality and learning history should carefully be considered by therapists. It seems possible to integrate both principal psychodynamic models of suicide risk, conflictual aggression problems and their impact on the ego, as well as narcissistic self-economy.

Is there a specific relationship between childhood sexual and physical abuse and repeated suicidal behavior?

Objective: Studies show that childhood sexual and physical abuse predict repeated suicide attempts and self-mutilation. Little is known about the importance of sexual and physical abuse when compared to other severe childhood adversities with respect to chronic suicidal behavior. Method: Seventy-four subjects, 65% of whom were women, consecutively admitted to a general hospital after having made a suicide attempt, were interviewed as part of the intake interview about prior suicide attempts and self-mutilation and received DSM-IV diagnoses. Sexual abuse, physical abuse, neglect, antipathy from parents, loss of parents, and severe discord in the family before the age of 18, were covered by the Childhood Experience of Care and Abuse (CECA) interview schedule. Results: The prevalence of severe sexual abuse was 35%, severe physical abuse 18%, neglect 27%, antipathy 34%, loss of caregiver 37% and exposure to family violence 31%. Physical and sexual abuse were independently associated with repeated suicide attempts when controlling for the effects of the other childhood adverse factors. No other childhood adversity was related to chronic suicidal behavior. The odds ratio of exposure to sexual or physical abuse was highest among those who both repeated suicide attempts and self-mutilated. Conclusion: Physical and sexual abuse are significantly and independently associated with repeated suicidal behavior.

Chronic suicidality among patients with borderline personality disorder.

This paper reviews research on chronic suicidality among patients with borderline personality disorder. MEDLINE and PsycINFO databases were searched for all English-language articles published between 1984 and 2000 containing the keywords "borderline personality disorder" and "suicide" or "suicidality." A total of 170 articles located through this search and additional key articles published before 1990 were reviewed. The most relevant articles were selected of review. One in ten patients with borderline personality disorder completes suicide, but this outcome is not readily preventable and does not necessarily occur during the course of treatment. In outpatient psychotherapy, chronic suicidal behavior by patients with borderline personality disorder can be best understood as a way of communicating distress. Hospitalization is of unproven value in preventing suicide by these patients and can sometimes have negative effects. Clinicians' fear of potential litigation resulting from a completed suicide should not be the basis for admission. With no evidence that full hospitalization prevents suicide completion by patients with borderline personality, suicidal risk is not a contraindication for day hospital treatment.

A dialectical behavioral formulation: The case of Katrina

Katrina is a 25-year-old woman who presents with multiple problems, among them chronic suicidal behavior. Clients like Katrina, who impress diagnostically with a Borderline Personality Disorder, are particularly suited to Dialectical Behavior Therapy (DBT). It is an appropriate approach because it was developed in the context of working with such individuals, and is one of the few treatments for this population for which there is outcome data to support its efficacy. A DBT approach helps the therapist identify the range of a client's problems and organize problems in order of priority. Treatment interventions, which are premised on a biosocial theory of the etiology and maintenance of a client's difficulties, are guided by a stage theory of treatment. The behavioral patterns that characterize borderline individuals and that often become obstacles to progress are an important focus of treatment. An overview of a DBT approach and the application of DBT formulation to the case of Katrina is presented.

Scientizing and routinizing the assessment of suicidality in outpatient practice.

Suicidal patients are difficult and challenging clinical problems. Conceptual tools aid the clinician in organizing and evaluating the clinical situation. The authors provide a framework for suicide risk assessment that emphasizes 2 domains—histor y of past attempt and the nature of current suicidal symptoms—that have emerged in suicide research as crucial variables. These domains, when combined with other categories of risk factors, produce a categorization of risk for the individual patient, leading, in turn, to relatively routinized clinical decision making and activity. Increasing numbers of patients manifesting acute or chronic suicidal behavior present for outpatient care, as managed care limits access to inpatient care and shortens the length of hospitalizations. For the general outpatient practitioner, then, the need for a consistent and empirically grounded assessment framework for suicidality has become crucial. In this article we summarize a general assessment framework, and supplement and elaborate it with reference to recent empirical work on the nature and assessment of suicidal symptoms. It is not our purpose to thoroughly restate the details of assessment frame

Creative coping: A cognitive-behavioral group for borderline personality disorder

Patients with borderline personality disorder (BPD) pose major therapeutic challenges to mental health professionals. Effective and practical treatment of the patient with BPD is needed in short-term inpatient settings, and psychiatric nurses are in a unique position to implement innovative treatment strategles for the borderline patient. The Creative Coping Group is a practice model designed by psychiatric nurses for patients with BPD, using a cognitive-behavioral framework. It is a group therapy intervention based on linehan's Dialectical Behavior Therapy (DBT) that addresses the ineffective coping of patients with BPD that results in chronic suicidal behavior. Linehan's framework focuses on deficits in emotional control, interpersonal effectiveness, and distress tolerance. The objective of the group sesslons is to foster insight and awareness into symptoms, feelings, and behaviors through psychoeducation, group exercises, discussion, and homework assignments.

Suicidal behavior in borderline patients: diagnosis and psychotherapeutic considerations.

This paper summarizes the experiences with suicidal and parasuicidal behavior of the psychotherapy research project on borderline patients in progress at the Westchester Division of the New York Hospital-Cornell Medical Center. In the diagnostic evaluation of these patients, it is important to differentiate acute and chronic suicidal behavior with the presence or absence of depression. The dominant psychodynamic features of chronic characterological suicidal behavior are reviewed, with a particular emphasis on the psychopathology of self-directed and projected primitive hatred, and the defenses against its conscious awareness on the part of the patient. A general psychotherapeutic strategy to deal with suicidal and self-destructive behavior is mapped out, centered upon the transformation of self-destructiveness into specific transference constellations that must be diagnosed, interpreted, and gradually worked through in the transference in the course of the treatment. The treatment of chronic, characterologically anchored suicidal behavior without depression requires the setting up of specific structuring of the psychotherapy from the very beginning of treatment, embodied in the establishment of a treatment contract that contributes to the organizing frame for the entire psychotherapy. The precondition for this psychotherapeutic work and limiting factors affecting its effectiveness are spelled out.

Dilemmas in the Management of Suicidal Behavior in Individuals with Borderline Personality Disorder

Managing suicidal behavior of individuals with borderline personality disorder presents both therapeutic and ethical/legal dilemmas. It is argued in this paper that clinicians treating borderline individuals need to carefully discriminate "acute" from "chronic" suicidal states. For "acute" suicidal situations, traditional management approaches are appropriate. However, for "chronic" situations, common among borderline individuals, traditional management approaches may be therapeutically counterproductive. A number of proposals for managing chronic suicidal behavior are reviewed. Unfortunately, current ethical standards and laws have evolved from considering suicide in an "acute" context and are insensitive to the "chronic" situation. Recommendations are made for clinicians to effectively manage chronic suicidal behaviors within present ethical and legal guidelines, and some suggestions for legal reform are offered.

Evaluation and Care of Suicidal Behavior in Emergency Settings

The author offers a sequential protocol for the evaluation and care of suicidal behavior in emergency settings. This protocol contains the following components: 1) a review of the limitations of clinical and demographic risk factors; 2) an exploration of frequent negative reactions that arise during the suicidal encounter in clinicians; 3) an objective schema for grading suicidal behavior; 4) an understanding of chronic suicidal behavior; and 5) a flexible treatment approach. Pertinent literature on suicide evaluation and management is reviewed with an emphasis toward the clinical applicability in emergency settings.