Intentional Self Research Articles

A study of individuals with intentional self-harm referred to psychiatry in a tertiary care center.

Background:Intentional self- harm (ISH) is one of the commonest yet neglected entities of Consultation liaison Psychiatry. More researches in the field of ISH are needed to effectively manage this problem.Aim:To study the socio-demographic and clinical profile of subjects of ISH referred to Psychiatry in a tertiary care hospital.Materials and Methods:All subjects of ISH referred to department of Psychiatry, of a tertiary centre, on specified days were recruited in to the study after obtaining an informed consent. Socio-demographic details, details of psychiatric assessment were documented using a semi structured proforma. Appropriate management was done.Results:Forty one subjects were included in the study. About two third of them belonged to the age group of 18 to 35 years. 56% of them were males, and 71% were married. House wives and students formed a significant proportion of sample. Most common method of ISH was self-poisoning. About two third of the patients had no diagnosable psychiatric illness. Interpersonal conflicts with family members (47%), conflicts with spouse (22%), broken emotional relationship (18%) were common causes for impulsive acts of ISH.Conclusions:ISH is common amongst young, married males. About two third of those who attempt ISH have no diagnosable psychiatric illness, in rest, neurotic stress related disorders, personality disorders and substance use disorders were predominant.

Consultation-Liaison Psychiatry in Tertiary Level Hospital In Nepal

Background: Consultation-liaison (C-L) psychiatry has emerged as a separate specialty in psychiatry in developed countries. It is an important component of a multidisciplinary hospital. In developing countries, this specialty is being underused and less emphasized. The reason for this could also be due to scarcity of study in this field in developing countries.Objective: To assess the socio-demographic and clinical variables of patients referred for C-L psychiatry in a tertiary hospital in western region of Nepal.Methods: One hundred consecutive inpatients referred for C-L psychiatry were assessed for socio demographic referrals, reason for referral and their attitude towards psychiatric referral. Each patient was evaluated in detail by consultant psychiatrists and the psychiatric diagnosis made according to the International Classification of Disease-10 (ICD-10) criteria.Results: The mean age of the sample was 40.28 years (±18.76) with male to female ratio of 1.27:1. The department of internal medicine was the most referring department (56%) andmajority of the patients referred had positive attitude towards psychiatric referral (94%). Alcohol dependence syndrome (ADS) and intentional self harm (21% each) were the most common psychiatric diagnoses made. Conclusions: psychiatry consultation was done mostly by the department of internal medicine and majority of patient had positive attitude toward psychiatric referral.Health Renaissance 2014;12(3): 170-174

A Mixed-Methods Exploration of Intentional Self Regulation and Youth Beliefs about the Chances of Achieving Future Aspirations

Using a mixed methods approach, the connection between Intentional Self Regulation (ISR) and feelings about the chances of achieving future aspirations among 94 Scottish youth (56% female) was examined. Regression analyses demonstrated ISR, as measured by the SOC 9-item scale, was predictive of youths’ feelings about their chances of achieving future aspirations. Qualitative data collected from 26 interviews suggested the use of ISR skills among adolescents, even when those skills were not evident quantitatively. Results indicated the need to employ mixed methodologies when conducting research on ISR with young adolescents, and suggest the need for further testing and development of measures for both ISR and beliefs about the chances of achieving future aspirations. Potential programmatic implications for youth development and character education programs are also discussed.This is a correction to the original article. For information about the changes made, please see the erratum https://doi.org/10.5195/jyd.2017.500.

Intentional Self Regulation and Positive Youth Development: Implications for Youth Development Programs

Character education programs are mission-aligned with the positive youth development (PYD) perspective, which, in research with American youth suggests that intentional self-regulation (ISR) develops through mutually beneficial interactions between youth and their environment. Cross-cultural studies of Western youth suggest an adolescence-specific ISR process may exist. We begin to extend this work to assess the relationship between ISR and positive development in young Scottish adolescents (approximately 7th grade, N = 82; 50% male), a previously unexamined group. ISR was correlated with the Five Cs of PYD and OLS regression analyses demonstrated that ISR predicted two of the Five Cs: Character and Connection. We discuss implications for youth development programs of the findings that ISR and some indices of PYD were linked in a sample of Scottish youth.

Trends of Intentional Self Harm in a Tertiary Care Hospital in Sikkim-An Autopsy based Study

Sikkim, a peaceful and mountainous terrain state shows an increasing trend of suicides This trend is not only shocking but predicts an unhealthy trend. This study was done for profiling of the post mortem cases with special emphasis to suicides and pattern based on the socio-epidemiological parameters. In our study we found that in 15.2% of total autopsies, death was due to a natural disease process where 84.81% were classified as unnatural deaths. Accidental deaths, Intentional self-harm and Homicides comprised 65.55%, 28.82% and 5.6% of unnatural death respectively. The findings point out that the deaths due to hanging are alarmingly high comprising 77.27% of total cases of suicides followed by poisoning with 16.66% of cases. Hanging was most common in age group of 21–30 years with 27.45% of total cases. About 60.7% of the hanging victims showed a male predominance.

A Prefrontal-Hippocampal Comparator for Goal-Directed Behavior: The Intentional Self and Episodic Memory.

The hypothesis of this article is that the interactions between the prefrontal cortex and the hippocampus play a critical role in the modulation of goal-directed self-action and the strengthening of episodic memories. We describe various theories that model a comparator function for the hippocampus, and then elaborate the empirical evidence that supports these theories. One theory which describes a prefrontal-hippocampal comparator for voluntary action is emphasized. Action plans are essential for successful goal-directed behavior, and are elaborated by the prefrontal cortex. When an action plan is initiated, the prefrontal cortex transmits an efference copy (or corollary discharge) to the hippocampus where it is stored as a working memory for the action plan (which includes the expected outcomes of the action plan). The hippocampus then serves as a response intention-response outcome working memory comparator. Hippocampal comparator function is enabled by the hippocampal theta rhythm allowing the hippocampus to compare expected action outcomes to actual action outcomes. If the expected and actual outcomes match, the hippocampus transmits a signal to prefrontal cortex which strengthens or consolidates the action plan. If a mismatch occurs, the hippocampus transmits an error signal to the prefrontal cortex which facilitates a reformulation of the action plan, fostering behavioral flexibility and memory updating. The corollary discharge provides the self-referential component to the episodic memory, affording the personal and subjective experience of what behavior was carried out, when it was carried out, and in what context (where) it occurred. Such a perspective can be applied to episodic memory in humans, and episodic-like memory in non-human animal species.

Profile of Patients Attending as Psychiatric Emergency at General Hospital

Introduction: Scaling of services in any area requires knowledge of the pattern of illnesses and their various presentations. We therefore conducted this study aiming to see the pattern of neuropsychiatric illness in an emergency department of tertiary care center. Methods: A prospective study was carried out to assess the pattern of psychiatric morbidity as well as pattern of presenting symptoms in the general emergency room services. Total 340 patients were sought for psychiatric consultation over a period of one and half years from Emergency Room of Tribhuvan University Teaching hospital, Kathmandu.Results: Out of these patients, 281 patients (82.7%) were found to have diagnosable psychiatric disorder. Most of the patients were in the age group of 31-40 years (25.6%), and from valley itself (56.2%).Males (55.9%) outnumbered females. Most common presenting symptoms were disturbed behavior and intentional self harm. Out of the patients who received the diagnosis of Category F- Mental and Behavioral disorders of the ICD-10 (82.7%), 26.8% were suffering from the Neurotic, stress-related and somatoform disorders and 26.5% were suffering from Mental and behavioral disorder due to psychoactive substance use. From the remaining 17.3% of patients, 14.1% of cases belonged to who attempted intentional self harm and rest were suffering from systemic disorder.Conclusion: Thus, this study emphasizes the importance of clinical and demographic characteristics of patients seeking psychiatric care in emergency service in order provide proper management.J Psychiatric Association of Nepal Vol .3, No.2, 2014, pp: 31-36DOI: http://dx.doi.org/10.3126/jpan.v3i2.12387

On a Pathway Towards Thriving: Evaluating the Effectiveness of Tools to Promote Positive Development and Intentional Self Regulation in Youth

This article provides initial data about the reliability and validity of tools aimed at promoting youth intentional self regulation (ISR) within mentoring programs. Based on the translation of the theory-based research about ISR and youth thriving conducted within the 4-H Study of Positive Youth Development (PYD), the GPS to Success tools use the metaphor of a car’s GPS navigational system to enhance goal-directed behaviors among youth. The core GPS tools are “growth grids,” designed to help mentors appraise ISR skill development and to link these skills to other grids assessing the Five Cs of PYD and Contribution. Data from 152 mentor and youth pairs from 4-H program sites in Oregon and North Carolina indicated that the growth grids were generally reliable. Although validity evidence was mixed, rubrics for “G” and “P” and for a global GPS score were related to a well-validated measure of ISR.

Self Inflicted Injuries among Children in United States - estimates from a nationwide emergency department sample.

ObjectiveThe objectives of the current study are to provide nationally representative estimates of hospital based emergency department visits (ED) attributed to self inflicted injuries and attempted suicides among children in United States; and to identify potential methods of such intentional self inflicted injuries and attempted suicides.MethodsThe Nationwide Emergency Department Sample (year 2007) was used. All ED visits occurring among children (aged ≤18 years) with an External Cause of Injury for any of self inflicted injuries were selected. Outcomes examined include hospital ED charges and hospitalization charges. All estimates were projected to national levels.Results77,420 visits to hospital based emergency departments were attributed to self inflicted injuries among children (26,045 males and 51,370 females). The average age of the ED visits was 15.7 years. 134 patients died in ED’s (106 males and 28 females) and 93 died in hospitals following in-patient admission (75 males and 18 females). A greater proportion of male ED visits were discharged routinely as opposed to female ED visits (51.1% versus 44%). A greater proportion of male ED visits also died in the emergency departments compared to female visits (0.4% versus 0.05%). 17,965 ED visits necessitated admission into same hospital. The mean charge for each ED visit was $1,874. Self inflicted injuries by poisoning were the most frequently reported sources accounting for close to 70% of all ED visits.ConclusionsFemales comprise a greater proportion of ED visits attributed to self inflicted injuries. 227 children died either in the ED’s or in hospitals. The current study results highlight the burden associated with such injuries among children.

Unconsummated Marriage and its Etiological Factors : A Case Series

Unconsummated marriage is a common medical and social problem in andrology clinics in conservative communities. However, its etiological factors remain unclear. Erectile dysfunction, vaginismus, premature ejaculation and desire disorders are factors, inherent in addition, to psychogenic, organic and social factors which represent etiological factors. This case series aimed to define the probable etiology of unconsummated marriage. With similar clinic picture, six couples were involved in this study, three males and three females, aged 17 - 36 years. Duration of marriage was 6 days to one and half years; arranged marriages used matched horoscopes. ICD-10 diagnosis- adjustment disorder -depressed type, intentional self harm, Dysthymia and Anxious Avoidant Personality Disorder; Specific Phobia with Anankastic traits and Bipolar Affective Disorder. Substance abuse among males. In women ignorance and lack of knowledge about anatomy and physiology of sex and misconceptions had contributed to the problem. The problems and resistance during therapy and its implications are discussed.

Special Section Introduction: Thriving in Context: Findings from the 4-H Study of Positive Youth Development

The positive youth development perspective, a strength-based relational developmental systems model that focuses on mutually influential relationships between individuals and contexts, has been used to study thriving across the second decade of life. However, more attention has been paid empirically to identifying the features of the individual (e.g., intentional self regulation, hope, or purpose) or to enumerating the role of context-general ecological assets than to the nature of individual-context relationships linked to thriving within specific contexts. The goal of this special section is to provide initial research reports about context-specific instances of the thriving process. The research focuses on two contexts where many youth spend a considerable amount, and often the majority, of their time-school and out-of-school time sports activities.

Mental illness as a contributor to intentional self inflicted suicidal burn injury

Self inflicted burn injuries are infrequent but very much distressing. It is a result of social, environmental and individual factors. Self-inflicted burns are usually an outcome of mental illness, and acute phase schizophrenia is considered as one of the major precipitating factor. The aim of this study was to find out and summarize the existing findings of different studies regarding mental illness as a contributor to suicide and/or intentional self inflicted injury. Literature review of some of previous studies from journals and databases were performed. Electronic database (Medline) was searched and twenty four studies were found to be related to the present objective. Among the 10 studies were randomly selected. The studies ranged from 1991-2005. The literature review suggested that quite a good number of incidents of self inflicted burns are committed by people having mental disorder. Among the self inflicted burns patient, the males were seen to be higher in number in most of the studies’ provided information. The range of the age was 14 to 90 years collectively. And among them a significant number of people are suffering from schizophrenia. Depression, substance abuse, personality disorder, psychosis were among the other mental health illness contributing to the incidence of self inflicting burns injury. Specific attention should be given in this aspect as for the vulnerable group depends heavily on their care givers. Since a number of inter-related risk factors may be involved, solving the problem from a new perspective-the safety promotion perspective should be initiated. DOI: http://dx.doi.org/10.3329/jdnmch.v18i1.12242 J. Dhaka National Med. Coll. Hos. 2012; 18 (01): 49-57

Pattern of Organophosphorous Poisoning: A Retrospective Community Based Study

Pesticide poisoning is very common in Nepal. Hospital based studies from various parts of Nepal have shown that poisoning with organophosphorus compounds is the most common type of poisoning. Current study is undertaken to see the pattern of organophosphorus poisoning and to identify the common risk factors among the cases. If the risk factors are modifiable, attempts in addressing the risk factors and decreasing the likelihood of poisoning will certainly be fruitful in reducing the morbidity and mortality associated with organophosphorus poisoning. To assess the risk factors of organophosphorus poisoning which is major public health problem in Nepal. A community based retrospective study of 75 cases of organophosphate poisoning who were brought to the emergency department of Dhulikhel hospital over the period of 3 years. Basic information was collected from hospital records and home visits were made to study the risk factors. Data were collected through interviews of the study population and their family members using a pre-designed questionnaire. In this study 75 cases and their families were interviewed of which there were 59% males and 42% females (M/F ratio of 1:1.4). The majority (40%) of the poisoning cases were in the age group 25-34 years. Lower literacy level showed positive association with the incidence of poisoning. Occupation wise vast majority (80%) of the cases were engaged in agricultural work. Suicidal attempts by ingesting organophosphate compounds were high in farmers and females. In this study, majority of the poisoning were attempts of intentional self harm. Agriculture workers and females are high risk groups and may be associated with the fact that they have easy access to the poison. Interventions directed towards health education, counseling, and enforcement of laws restricting the availability and use of harmful pesticides may help in reducing such events in future.

Psychiatric Illness in the Paediatric Population Presenting to a Psychiatry Clinic in a Tertiary Care Centre

A variety of psychiatric manifestations can be seen in children below the age of 18 years. Such cases rarely present directly to psychiatric care. Retrospective study in Tertiary care hospital . The study population included all the patients of paediatric age group presenting to Psychiatry Outpatient Department of Dhulikhel Hospital directly or referred by a paediatrician or other specialists from October 2008 to October 2010. Among the paediatric population evaluated in the psychiatry clinic for two years from October 2008 to October 2010 (N = 168), 66.7% were in the age group 15-18 years {mean = 14.77 (± 2.99)}, 71.4% were female and 42.3% belonged to Brahmin cast. The highest number of (15%) patients was seen during the month of August 2010. Six months analysis of the psychiatric illnesses of the patients from April 2010 up to October 2010 (n = 80) showed dissociative disorder (15%), and seizure disorder (15%) to be the most common diagnoses, followed by depressive disorder and intentional self harm (ISH) (13.8% each). 15% of patients were found to be treated by magico-religious means, with the majority of patients (66.7%) diagnosed as having dissociative disorder. The majority of the paediatric population presenting to a psychiatry clinic were in the age group 15-18 years and of female sex. Dissociative disorder was the most common diagnosis followed by depressive disorders. The majority of patients with dissociative disorder had previously been treated by magico-religious means.

Psychological distress among patients with organophosphorus or paraquat poisoning

Introduction: Recognition of psychological distress following intentional self poisoning is important. The most widely used screening test for psychological distress is the Goldberg's General Health Questionnaire (GHQ). It is available in versions as short as 12 items (GHQ-12) and as long as 60 (GHQ-60). Objective: The aim of the study was to determine the prevalence of psychological distress among patients with self poisoning with organophosphorus (OP) or paraquat (PQ) pesticides admitted to the General Hospital, Matara and the Teaching Hospital, Galle. Method: A case control study was conducted with matched controls. A self-administered validated Sinhala translation of the 12-item Goldberg's General Health Questionnaire (GHQ-12) was used as a general screening test to identify psychological distress. A score >15 indicates evidence of psychological distress and a score >20 is suggestive of severe psychological problems and distress. A score >15 is also considered as positive GHQ-12. : Results: GHQ-12 was administered to 143 (99 OP, 44 PQ) patients and 70 controls. Mean (SD) ages of the test and control group were 34 (14) and 33 (12) is respectively. The prevalence of psychological distress among the patients and the controls were 51% (73/143) and 10% (7/70), respectively. The median (inter-quartile range) of GHQ-12 scores among patients and controls were 16 (11 23) and 8 (5 11), respectively (P Conclusions: This study indicates the high prevalence of psychological distress among patients with self poisoning with OP or PQ and emphasizes the need of assessment, support and if required treatment in needy cases. DOI: http://dx.doi.org/10.4038/gmj.v17i1.4358 Galle Medical Journal , Vol 17: No. 1, March 2012 32-36

Constructing positive futures: Modeling the relationship between adolescents’ hopeful future expectations and intentional self regulation in predicting positive youth development

Intentional self regulation and hopeful expectations for the future are theoretically-related constructs shown to lead to positive youth development (PYD). However, the nature of their relationship over time has not been tested. Therefore, this study explored the associations between hopeful future expectations and intentional self regulation in predicting positive developmental outcomes. Participants were in Grades 7, 8, and 9 of the 4-H Study of PYD ( N = 1311), a longitudinal study involving U.S. adolescents. A cross-lagged panel analysis using Structural Equation Modeling assessed the relations among hopeful future expectations and intentional self regulation across time in predicting PYD. Results indicated that earlier hopeful expectations for the future may be influential for later intentional self-regulation abilities, although both constructs were strong predictors of PYD in middle adolescence. We discuss implications for research and practice of hopeful expectations in adolescents’ constructions of their positive futures.

Developmental trajectories of intentional self regulation in adolescence: The role of parenting and implications for positive and problematic outcomes among diverse youth

This study assessed 1574 Grades 5 to 11 youth (63.6% female) from the 4-H Study of Positive Youth Development (PYD), a longitudinal study involving U.S. adolescents, to assess if patterns of intentional self regulation (ISR) existed; whether these trajectories differed in relation to several Grade 5 parenting characteristics; and whether ISR trajectories were linked to positive and negative developmental outcomes at Grade 11. Growth mixture modeling identified a four-group solution of ISR trajectories: Steady Decline, Elevated, Late Onset, and Pronounced Decline. Most adolescents reported an incremental decrease in ISR from Grades 5 to 11 (Steady Decline). Lower levels of parental warmth, monitoring, and school involvement at Grade 5 predicted Late-Onset ISR development while Pronounced Decline adolescents reported lower levels of PYD and Contribution at Grade 11. We discuss the finding that youth at initially similar levels of ISR diverged over adolescence, while youth at initially disparate levels converged.

250 Characteristics of Females with Intentional Self Harm Attending a Tertiary Care Hospital in India

In the present study, an attempt has been made to ascertain the storage capacity of Mannapalla lake, Manipal, Udupi District, India, by conventional method, and to understand the change in the land use pattern. The work involved is of twofold. The actual field survey has been carried out by total station and the storage capacity is found. In the second step, Survey of India toposheet and Satellite data of 2002, 2009 and 2011 is used to generate the land use land cover map and the study has been carried out to identify the changes in land use land cover pattern in the vicinity of the lake. The volume of Mannapalla lake is obtained to be 690650.3m3 using prismoidal method. There is significant change in Land use pattern has been observed from 2002 to 2011, i.e. the area under vegetation has considerably decreased and more buildings and structures have sprung.

Adult mortality surveillance by routine health workers using a short verbal autopsy tool in rural north India

BackgroundMost of the standard verbal autopsy tools are long and are used in a research setting. This study aims to compare a short verbal autopsy (VA) tool developed at Ballabgarh,...

Suicidal behaviour among those who attempted suicide and their close relatives/friends

ObjectivesTo describe the repetition of suicidal attempts and the awareness of suicidal behaviour among close people.MethodsFrom 668 attempted suicides presented to National Hospital of Sri Lanka (April to December 2002),...