Impulsive Suicide Attempts Research Articles

Comparison of Outpatient and Inpatient Consultations Requested from Child and Adolescent Psychiatry

Objective: This study aims to examine the sociodemographic and clinical characteristics of child and adolescent psychiatry consultations and to compare characteristics of outpatient and inpatient consultations. Methods: A total of 354 patients who were consulted to child and adolescent psychiatry department of a university hospital were included in the study. Data were collected regarding sociodemographic characteristics of patients, departments requesting consultation, diagnoses, and treatment methods. Results: The cases included in the study had a mean age of 10.6±4.8 years,with 51.4% being girls. Adolescent girls formed the majority of the inpatient group. The pediatric neurology outpatient clinic had the highest frequency of requested consultations (22.3%), and the most common reason for consultation was a suicide attempt (12.1%). Of the cases for which consultation was requested, 67.8% were diagnosed with at least one psychiatric disorder, and the most common diagnoses were anxiety disorders, with 12.7%. In the inpatient group, impulsive suicide attempts and depressive disorders were more frequent compared to the outpatient group, while intellectual disability was less common. Parent education was provided for 97.2% of the cases, pharmacological treatment was recommended for 44.6% of the cases, and the most commonly prescribed medications were selective serotonin reuptake inhibitors. Psychotherapy and special education were significantly more common in the outpatient group compared to the inpatient treatment group. Conclusion: The current study revealed significant differences in consultations requested from child and adolescent psychiatry between the outpatient and inpatient groups regarding consultation reasons, diagnoses, and treatment modalities. The findings provide valuable information for clinical practice and service development.

Stressful Life Events in Impulsive and Non-impulsive Suicide Attempters: A Cross-sectional Study

Background: Suicide is a significant public health issue, yet it can be avoided with prompt, evidence-based, and frequently inexpensive interventions. There are distinctions between the profiles of impulsive suicide attempters (ISA) and non-impulsive suicide attempters (NISA), and a significant number of suicide attempts are impulsive. A thorough multisectoral suicide prevention strategy is necessary for an effective national response. Methods: This observational cross-sectional study was conducted at a tertiary healthcare center in Karnataka. Sixty inpatients above the age of 18 years with an alleged history of suicide attempts were enrolled in the study. Their stressful life events in the past year were assessed using the Presumptive Stressful Life Events Scale (PSLES). Impulsive and non-impulsive attempters were considered based on the time gap between the suicidal ideation and the suicidal attempt with the presence or absence of plans regarding the act. They were compared using appropriate inferential statistical tests. Results: The majority of the suicide attempts were impulsive (63.3%). The ISA and NISA did not differ in socio-demographic characteristics except for age and family type, with impulsive attempters being more common at younger ages than the non-impulsive attempters ( p = .02). The majority of ISA were from joint families (44.7%), while 72.7% of NISA were from nuclear households ( p = .04). Compared to ISA, NISA recollected a higher number of stressors. Conclusion: The ISA and NISA differ in aspects of age, family type, and stressors. Characteristic distinctions between ISA and NISA should be recognized and understood in order to design policies for suicide prevention and minimize morbidity and mortality. Exploring and addressing the stressors and helping patients to overcome them through better coping skills helps in suicide prevention.

Abrupt Terminations In The Treatment of Suicidal and Self‐Harming Young People: The Negativel in the Therapeutic Relationship

Psychotherapy with suicidal and self‐harming young people is complex, as this population group is difficult to engage in treatment and their internal reactions may remain concealed, leading to impulsive suicide attempts or abandonment of treatment. The resulting countertransference reactions of confusion, guilt and shame are most distressing and often cause psychotherapists to avoid treating this population group. Safety concerns increase when self‐destructive patients abandon therapy, or their condition worsens despite the therapist's best efforts. The vicissitudes of the adolescent developmental process suggest that, in some cases, withholding information, rejection of the therapist's caring interventions, and abrupt termination of treatment arise from the need for separation and independence and are ego syntonic and therefore suicide protecting. In other cases, the risk for suicide may be increased because of the transference experience of hostile abandonment. A negative therapeutic reaction (NTR) is a disturbing development in the course of psychotherapy that has not been adequately explained in the treatment of suicidal young people. This article is a consideration of whether these negative reactions associated with abrupt, unplanned terminations, in the treatment of self‐destructive young people, should appropriately be thought of as an NTR or as a developmental stage in separation.

Mania and Hemiballismus: A rare presentation of subthalamic stroke (P12-5.008)

<h3>Objective:</h3> Mania and hemiballismus are rare presenting features of acute ischemic stroke. We present a unique case of acute subthalamic stroke presenting with mania preceding hyperkinetic movements by several days making the diagnosis challenging and precluding the patient from acute stroke care. <h3>Background:</h3> 66 year old patient presented with abnormal movements. The patient’s symptoms began with sudden onset of increased activity levels, pressured speech, and insomnia. Four days later he presented to the hospital with acute onset of uncontrolled flailing and pain in the left arm and leg. MRI brain revealed an acute right subthalamic infarct. He was diagnosed with post stroke mania and hemiballismus. <h3>Design/Methods:</h3> NA <h3>Results:</h3> NA <h3>Conclusions:</h3> Hemiballismus is a rare presenting symptom of acute stroke. Widely accepted pathophysiology behind hemiballismus is a structural lesion in the subthalamic nucleus. The subthalamic nucleus contains glutaminergic neurons with projections to the globus pallidus interna. The glutaminergic neurons increase the activity of the globus pallidus interna, which contains GABAergic neurons that, in turn, decrease the activity of the thalamus and inhibit movement. Lesions of the subthalamic nucleus can disrupt the inhibition of movement by the globus pallidus interna and results in hyperkinetic movements like hemiballismus. The subthalamic nucleus has a role is mood, memory and behavior. Studies have shown to have variable effects of subthalamic deep brain stimulation on working memory and response inhibition performance and some reported cases with aggressive impulsive episodes, suicide and suicidal attempts, apathy, severe depression, psychosis, and hypomania following bilateral sub thalamic nucleus DBS. Our patient presented with acute onset of mania preceding development of hemiballismus by several days making the case diagnostically challenging. On literature review, we could not find a case with this presentation. With this case, we add to the multitude of presentation of acute stroke since acute stroke is a medical emergency and requires prompt management. <b>Disclosure:</b> Dr. Mann has nothing to disclose. Dr. Kelly has nothing to disclose. Dr. Leichliter has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Neurocrine.

Low global frontal brain activity is associated with non-planned or impulsive suicide attempts. A preliminary study

BackgroundSuicide prevention is limited by the frequent non-planned or impulsive nature of suicidal behavior. For instance, 25–62 % of suicide attempts, occur within 30 min of the onset of suicidal ideation. We aimed to examine frontal brain activity in depressed patients following a suicide attempt and its relationship with the duration of the suicidal process. MethodsWe recruited 35 adult patients within three days of a suicide attempt of at least moderate lethality. Duration of the suicidal process was recorded in a semi-structured interview, including suicide contemplation (time from onset of suicidal ideation to decision to kill oneself) and suicide action intervals (time from the decision to kill oneself to suicide attempt). Resting state EEG data from AF7, AF8, TP9 and TP10 leads was collected with a portable MUSE 2 headband system. The average frequency values throughout a 5-minute portable EEG recording were extracted for delta (1–4 Hz), theta (4–8 Hz), alpha (8–13 Hz), and beta (13–30 Hz) waves. ResultsDelta (r = 0.450, p = 0.021) and theta power (r = 0.395, p = 0.044) were positively correlated with the duration of the suicide action interval. There were no significant correlations of the suicide contemplation interval with clinical or EEG measures. Patients with suicide action interval shorter than 30 min showed lower delta power (U = 113, p = 0.049) compared with those with longer duration. ConclusionsLower theta and delta activity may reflect hindered cognitive control and inhibition in impulsive suicide attempters. Portable EEG may provide a valuable tool for clinical research and in the management of acutely suicidal patients.

Suicide in Switzerland: why gun ownership can be deadly

There is a great deal of empirical evidence that owning a firearm increases the risk of dying from suicide. Most suicides are impulsive. Nearly 50% of survivors of suicide attempts report that they took less than 10 minutes between the decision to die and their suicide attempt. The great majority of these suicide survivors never make another attempt and die of natural causes. Because nearly 90% of firearm suicide attempts have a deadly outcome, gun owners are unlikely to have such a second chance. These impulsive suicide attempts are typically carried out with the means at hand. Swiss men have much higher firearm suicide rates than men in other European countries and this excess is likely to be due to their easy access to guns, because army conscripts have to keep their guns at home. When the number of conscripts was nearly halved in 2003/4 as a result of the Swiss Army Reform XXI, the number of army-issued firearms was reduced by an estimated 20%. An analysis of suicide rates before and after the reform indicated that male (but not female) suicide rates decreased by 8%, with no evidence of substitution with other means of suicide. If the army would require that the remaining half of conscripts had to keep their weapons at their barracks rather than at home, a further decrease in male suicide rates could be expected.

Repeated impulsive suicide attempts in patient with Parkinson disease treated with ropinirole

Repeated impulsive suicide attempts in patient with Parkinson disease treated with ropinirole

An Impulsive Suicide Attempt in a Patient with No Psychiatric History and a Recent COVID-19 Diagnosis: A case report

IntroductionThe coronavirus disease 19 (COVID-19) pandemic has prompted concerns regarding increased suicide rates and exacerbation of underlying mental illness symptoms. •There is evidence suggesting neurocognitive changes as well as immune response in COVID-19 infection may increase a patient’s propensity for suicidal ideation. • Patients who are diagnosed with COVID-19 may be affected by psychological factors of anxiety, stress related to having this novel virus as well as depression, post-traumatic stress disorder and sleep disorders throughout treatment and post-treatment of continued concerns. •The combination of psychiatric, neurological, and physical symptoms associated with COVID-19 may elevate suicide riskObjectivesWe present a case of a female with no prior psychiatric history who impulsively attempted suicide after a recent COVID-19 diagnosis and subsequent quarantine. Will explore possible link between increase of suicidal ideation and COVID-19 infection.MethodsA case report.ResultsLink between increase of suicidal ideation and COVID-19 infection has not been clearly established but there have been reports, as in our case, of the possible vulnerability to mental illness and new onset suicidal ideation that COVID-19 survivors may experience. It may be useful to screen all patients for depressive symptoms after a COVID-19 infection. Early identification and treatment of depression in recovered COVID-19 patients will help to improve psychological impact on COVID-19 survivors and potentially reduce suicide rates.Conclusions As COVID-19 infection may trigger new onset mental illness, exacerbate symptoms of underlying mental illness, and may increase suicidal ideation, further research is needed to evaluate links between COVID-19 infection and depression with suicidal ideationDisclosureNo significant relationships.

P705. Low Global Frontal Brain Activity is Associated with Non-Planned or Impulsive Suicide Attempts

Effective suicide prevention is limited by the non-planned or impulsive nature of suicidal behavior. Approximately 50% of individuals who attempt suicide, do so within 10 minutes of suicidal ideation onset. We aimed to examine brain activity following a recent suicide attempt and its relationship with the duration of the suicidal process.

The profile of amphetamine users in a substance abuse treatment center in Mexico

Introduction: in Mexico, amphetamine use is a public health problem. Objective: to describe the profile of consumers of amphetamines. Method: it was retrospective and cross-sectional study. The medical records of those admitted to the state Cúspide substance abuse treatment center, during the period 2016-2018, were reviewed. Results: 112 patients (89 men, 23 women) were analyzed. The profile included a patient with high school (40.2%), coming from an unstructured (67.9%) and dysfunctional family (93.8%) with poor parental affective relationship, alcoholism in the family nucleus (55.3%), early onset of sexual activity, alcohol and tobacco consumption; impulsive personality, suicide attempts (35.7%), and injuries to third parties and theft (73.2%). Discussion and conclusions: amphetamine use and rising prevalence behavior are a reality; the problem goes beyond the field of health and becomes a social problem that potentially involves the entire population to a greater or lesser extent. Knowing the epidemiological profile of the amphetamine consumer is a reference for implementing health policies and establishing preventive and therapeutic measures in order to solve the problem.

Free Papers Compiled

Introduction:suicide is one of the ten major causes of death in India. 90%of the persons who die from suicide satisfy the criteria for one or more psychiatric disorders. Most people have notably mood, substance related, anxiety, psychotic, and personality disorders, with co-morbidity being common. A considerable proportion of suicide attempts are the result of sudden ideation. Understanding impulsive suicide attempts is necessary for effective interventions.Objectives:To study socio-demographic profile, psychiatric morbidities and to assess the risk and impulsivity of suicidal attemptsMaterials & Methods:A cross sectional study was done for 1year among 65 suicide attempted patients. Socio demographic and clinical details were obtained using semi structured proforma. Psychiatric morbidity was assessed using Brief Psychiatric Rating scale, ICD10. Suicidal risk assessment was done by Becks scale for suicidal ideation. Attempter impulsivity was measured by the total score of the Barratt Impulsiveness Scale.Results-Among 65 attempted suicide patients, majority belong to 18-25yr age group (38.46%) and were females (63.07%). 36.9% were diagnosed with adjustment disorder. History of previous suicidal attempt was present in 32.7%. Majority of individuals attempted suicide out of impulsivity (70.7%).Conclusion-The results suggested that a considerable proportion of suicide attempts were due to result of sudden inclinations and were made in relatively earlier stages of suicidal ideation. So, early identification of those at risk and appropriate interventions may be helpful.

Suicidality in schizophrenic psychosis: a current overview

Suicidality in schizophrenic psychosis is an important topic but stands in clinical everyday work behind the perception of suicide especially in affective disorders. Schizophrenic psychosis is recognized as an independent risk factor for suicide attempts and suicides, whereas it poses particular challenges to the clinical professional due to the frequent unpredictability, abruptness and brutality of the methods used. For this reason, the suicide of apsychotic patient often leaves the professional and non-professional environment disturbed. An overview of the existing relevant literature on suicide in psychosis is given. Explanations on the psychodynamics, indications on pharmacotherapy and psychotherapy and considerations on prevention round off this article and provide an up to date overview of this topic for clinicians. Asearch was carried out in PubMed and Google scholar using the terms "suicide", "suicidality", "schizophrenia", "suicide AND schizophrenia", "suicide AND psychosis", "suicidality AND schizophrenia", "suicidality AND psychosis", "suicidality AND psychosis AND prevention", "suicide AND psychosis AND prevention", "suicidality AND schizophrenia AND prevention", "suicide AND schizophrenia AND prevention". Clinicians must have knowledge of the specific risk factors for suicide in psychotic patients, the characteristics of suicide in terms of design and temporal connection with treatment. The exploration and assessment of suicidality is often more difficult in psychotic patients than in affective or personality disorder patients, as there are often impulsive suicide attempts that can be explained by (suddenly occurring) psychotic symptoms and are therefore difficult or even impossible to foresee.

Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak?

Multiple suicide attempts in an individual with opioid dependence: Unintended harm of lockdown during the COVID-19 outbreak?

F77. Ventromedial Prefrontal Functional Connectivity During Value-Based Decision Making in Impulsive vs. Non-Impulsive Older Suicide Attempters

F77. Ventromedial Prefrontal Functional Connectivity During Value-Based Decision Making in Impulsive vs. Non-Impulsive Older Suicide Attempters

Sociodemographic correlates, stressful life events and hopelessness among impulsive suicide attempters- A hospital based study from North Kerala

Sociodemographic correlates, stressful life events and hopelessness among impulsive suicide attempters- A hospital based study from North Kerala

Impulsive suicide attempts among young people–A prospective multicentre cohort study in Sweden

BackgroundWe aimed to compare the prevalence of impulsive suicide attempts (ISA) among young adults and those over 25 who present at hospital in connection with attempted suicide. We also aimed to identify factors associated with ISA in young adults and to assess medical severity as well as the probability of repeated suicide attempts in this age group. MethodA prospective multicentre cohort study included hospital known cases of suicide attempt (N = 666). The prevalence of ISA was compared between young adults (18–25) and adults aged > 26. We used logistic regression models to identify factors associated with ISA, associations of ISA with high medical severity and prediction of new fatal or non-fatal suicide attempts within 6 months. Results43.7% of the young patients had made an ISA, and 30.2% among those aged > 26 (p = 0.001). Among the young, substance use disorder was associated with ISA; crude odds ratio (OR) 2.0 (1.0–4.2), and adjusted OR 2.1 (0.99–4.4). Affective disorder and unemployment/ sickness absence implied lower odds of ISA. ISA resulted in injuries of high medical severity as often as more planned attempts and non-fatal or fatal repetition within 6 months was equally common (30%) in both groups. LimitationsThe study was set in psychiatric emergency services, which limits the generalizability. ConclusionsClinicians should acknowledge that suicide attempts among youth often occur without previous planning and may result in medically severe injuries. The probability of new fatal or non-fatal suicide attempts should be kept in mind also after an impulsive suicide attempt.

Is Suicidal Behavior in Mood Disorders Altered by Comorbid PTSD?

Suicide is a leading cause of death among US veterans. Associations between depression, posttraumatic stress disorder (PTSD), and suicidal behaviors have been found in this population, yet minimal research has explored how manifestations of self-injurious behavior (SIB) may vary among different diagnostic presentations. This study aimed to identify clinically useful differences in SIB among veterans who experience comorbid mood disorder and PTSD (CMP) compared with those who experience a mood disorder alone (MDA). Participants were 57 US military veterans who reported an incident of intentional SIB. The semistructured Post Self-Injury/Attempted Self-Injury Debriefing Interview was used to examine characteristics of the SIB. Veterans diagnosed with CMP were more likely than those with MDA to (a) report that the SIB was impulsive and (b) to be under the influence of substances at the time of self-injury. Generalizability may be limited by small sample size and predominantly European American, male demographics. While highly relevant to routine clinical practice, caution is recommended, as study diagnoses were attained from medical records rather than structured interviews. Safety planning that emphasizes protection against impulsive suicide attempts (e.g., means restriction) may be especially important among veterans with comorbid mood disorder and PTSD.

Association study on interaction effects of 5-HT receptor related genes and suicidal behavior in major depressive disorder

Objective To investigate the single nucleotide polymorphisms(SNPs) of 5-HT1BR(rs6298), 5-HT2AR(rs6311, rs6313) and 5-HT2BR(rs765458) gene, and their gene-gene interactions on suicidal behavior in major depressive disorder. Methods The blood samples were taken from 281 depression patients with impulsive suicide attempt and 281 age-matched healthy controls from a hospital in Harbin city, Heilongjiang province.The DNA isolated from blood samples and was genotyped using TapMan SNP genotyping probe.χ2 test was used to compare differences in the distribution of gene alleles between cases and controls.Haplotype and linkage disequilibrium(LD) analysis was performed using Haploview 4.0 software.GMDR was used to analyze the gene-gene interaction. Results The rs6313 and rs6311 of the 5-HT2AR gene were in strong linkage disequilibrium (D=0.756, r2=0.375). There was a significant gene-gene interaction of 5-HT1BR (rs6298), 5-HT2AR (rs6311, rs6313) and 5-HT2BR(rs765458) on suicidal behavior(P<0.05). In this model, the test accuracy was 0.6182 and CV value was 10/10. Conclusion A haplotype containing rs6311 and rs6313 of 5-HT2AR gene is associated with suicidal behavior.The interaction of 5-HT1BR gene (rs6298), 5-HT2AR gene (rs6311, rs6313) and 5-HT2BR gene (rs765458) are associated with depression suicidal behavior. Key words: Depression; 5-TH receptor; Single nucleotide polymorphism; Gene interaction; Haplotype; Linkage disequilibrium

475. Gender Differences in the Impact of Childhood Trauma on Impulsive Behaviors and Suicide Attempts in Pediatric Bipolar Disorder

475. Gender Differences in the Impact of Childhood Trauma on Impulsive Behaviors and Suicide Attempts in Pediatric Bipolar Disorder

Relation of binge eating disorder with impulsiveness in obese individuals.

AIMTo investigate the levels of impulsiveness, and the relationship between the binge eating disorder (BED) and the levels of impulsiveness in obese individuals.METHODSTwo hundred and forty-one obese patients who were included in the study and candidate for bariatric surgery (weight loss surgery) were clinically interviewed to identify the BED group, and patients were divided into two groups: Those with BED and those without BED. The comorbidity rate of groups was determined by using structured clinical interview for DSM-IV (SCID-I). A sociodemographic data form including the story of previous psychiatric treatment, structured clinical interview for DSM-IV (SCID-I), Beck Anxiety Inventory, Beck Depression Inventory (BDI) and Barratt Impulsiveness Scale-11 were applied to both of the groups.RESULTSIn regard to 241 obese individuals included in the study, total score and score of attention subscale for BED (+) group were significantly high (P < 0.05). In addition, suicide attempt, story of psychiatric consultation, and score for BDI were again significantly high in the BED (+) group (P < 0.05).CONCLUSIONIn assessment of obese individuals, assessment of associated psychopathology such as impulsive characteristics and suicide attempt in addition to disrupted eating behaviors will allow to have a more extensive view.