Parasuicidal Behavior Research Articles

Psychopathological Aspects of Parasuicidal Behavior in Adolescents and Young Adults

Objective. The aim of this study was to determine the psychopathological symptoms associated with self-harming behavior in order to develop preventive measures.Materials and Methods. We included individuals aged 18 to 35. The main group consisted of individuals with a history of self-harming behavior, while the control group included individuals without any history of self-harming behavior. All participants completed a structured interview and the following questionnaires: SCL-90-R, the questionnaire of propensity to deviant behavior, and the «Coping Behavior Methods» questionnaire. We assessed the severity of psychopathological symptoms, motivation, and other characteristics of self-harming behavior.Results. A total of 77 participants were included, divided into the main (n=39) and control (n=38) groups. Correlations were identified between the main characteristics of self-harming behavior. According to the SCL-90-R questionnaire, individuals with a history of self-harming behavior had higher scores in somatization, obsessions, sensitivity, depression, anxiety, hostility, phobic anxiety, paranoia, and psychoticism (p<0.01). The «avoidance» coping strategy was more prevalent in the main group (p<0.05). According to the questionnaire of propensity to deviant behavior, individuals in the main group had higher scores in overcoming rules, aggression and violence, volitional control, and addictive, self-destructive, and delinquent behavior (p<0.05). There were correlations between the regularity of self-harming behavior and the use of multiple types of self-harming behavior (r=0.497; p<0.01), pursuit of internal goals (r=0.333; p<0.05), occurrence of positive emotions after self-harm (r=0.352; p<0.05), increasing desire to stop this behavior (r=0.359; p<0.05), and difficulty achieving remission (r= –0.553; p<0.01). Experiencing negative emotions after an act of self-harm was negatively associated with the use of multiple types of self-harming behavior (r= –0.412; p<0.01) and addictive behavior (r= –0.408; p<0.05).Conclusion. Adolescents and young adults with a history of self-harming behavior differ significantly from their peers in the presence of concomitant psychopathological symptoms. The regularity of self-harming behavior is associated with the use of multiple types of self-harming behavior and difficulty achieving remission. Our findings have clinical significance and may be incorporated into the development of preventive measures.

Effects of borderline personality disorder symptoms on dialectical behavior therapy outcomes for eating disorders.

Existing literature on the effects of borderline personality disorder (BPD) and eating disorder (ED) comorbidity in terms of clinical presentation and treatment outcome has been limited and inconclusive. The present study examined whether clients with EDs and varying levels of BPD symptoms presented with more severe ED symptoms at admission, and whether they responded to dialectical behavior therapy (DBT)-based treatment. Participants (N = 176) were adults in a DBT-based partial hospitalization program for EDs at an academic medical center. Participants completed self-report measures at admission, 1-month postadmission, discharge, and 6-month follow-up. Results suggested that patients with elevated BPD symptoms at admission had greater ED symptoms during treatment, evidenced by small to moderate effect sizes. However, patients with high BPD symptoms demonstrated steeper declines in binge eating, fasting, and parasuicidal behavior early during treatment compared to patients with low BPD symptoms. Individuals with high BPD symptoms at admission (i.e., probable BPD diagnosis) were as likely to meet remission criteria and relapse as individuals with low BPD symptoms, though this null finding may be influenced by small cell sizes. Our findings also suggest that DBT skills use does not predict changes in symptoms. In sum, our findings suggest that while clients with higher BPD symptoms may improve during DBT-based partial hospitalization, their ED symptoms may remain more severe. Future studies are needed to determine whether adjunctive treatments improve outcomes for clients with EDs and comorbid BPD symptoms in DBT programs and whether skills use quality is a better predictor of ED symptom changes. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The effectiveness of psychological interventions for borderline personality disorder for those who misuse substances: a systematic review and narrative synthesis

Purpose This study aims to identify and critically appraise literature exploring the effectiveness of psychological interventions in improving borderline personality disorder (BPD) symptomatology for individuals who misuse substances. Design/methodology/approach Systematic searches across six databases (PsycINFO, Embase, Scopus, Medline, CINAHL and ProQuest), hand searching and citation chaining were conducted between June and August 2021. Key search terms included BPD, substance use, therapy and effect. Study and sample characteristics, interventions, outcome measures and key findings were extracted. Quality assessment and a narrative synthesis approach were used to explore strengths, limitations and relationships between and within studies. Findings Seven eligible reports were included and showed mostly adequate quality. Mixed samples, designs, outcomes, definitions and implementation varied. Treatment completion did not differ significantly between those who did and did not misuse substances. Interventions demonstrated effectiveness in relation to psychiatric symptoms, hospital admissions, self-efficacy and impulsive and self-mutilating (cutting, burning, etc.) behaviours. No effects were found for suicidal or parasuicidal (threats, preparation and attempts) behaviours. Research limitations/implications This review only considers individuals with diagnoses of BPD who are not accessing substance misuse treatment. Radically open dialectical behaviour therapy (DBT), therapeutic communities and other interventions are available as interventions for substance misuse (Beaulieu et al., 2021). Based on the findings of this review, it should not be assumed that such interventions affect substance misuse rather than BPD symptomatology. Therefore, future research might explore the effectiveness of these interventions on BPD symptomatology despite this not being the primary target for intervention. Practical implications Despite McCrone et al. (2008) noting the cost of this population’s difficulties to both themselves and services, the limited number of studies in this area is astonishing. Despite a lack of quality in the data available, there i some evidence to support the use of DBT and general psychiatric management (GPM) interventions for those with BPD and concurrent substance misuse. It is therefore of principal importance that health and social care services action Public Health England’s (2017) recommendations. Individuals with coexisting BPD and substance misuse would then receive support from any professional they see, who could then refer for psychological therapies. Originality/value Although the reports appear to show that DBT, integrated therapies and GPM may be effective for this population, conclusions cannot be drawn with high levels of confidence due to heterogeneity among studies. The findings indicate that future, high-quality research is needed to test the effects of interventions on BPD symptomatology for those who misuse substances. Randomised controlled trials with sufficient statistical power, homogeneous outcomes and standardised methodological approaches are needed.

Parasuicidal behavior in early stages of psychosis

IntroductionPsychotic experiences (PE) are strongly associated with non-suicidal self-harm (NSA). NSA are present throughout life, but are more frequent during adolescence and young adulthood. Early psychotic episodes (PEP) are a particularly vulnerable group compared to later phases of psychosis psychosis.ObjectivesAnalyze risk factors for suicide attempts and NSA, in order to improve early detection and prevention of suicides in adolescents and young adults with PDMethodsReview in the literature of the different risk factors associated with parasuicidal behaviors in early psychosisResults•Presence of positive psychotic symptoms: auditory hallucinations, Delusional ideation.•Social isolation•Longer duration of untreated psychosis.•Comorbid symptoms: irritability, depression, anxiety, psychotic distress, insomnia.•Traumatic events in childhood•Difficulty in regulating emotional, impulsivity and sensitivity to reward.•Consumption of substances.•Psychosocial stress.ConclusionsWe consider essential the inclusion of early intervention programs aimed at the prevention of suicide and NSA, evaluating all risk factors for suicide and NSA among individuals with a PEP and high-risk mental states.Initial assessment and ongoing assessments of suicide risk and parasuicidal behaviors, positive psychotic symptoms, depression, and the other related risk factors mentioned are required. Integrating trauma management into PEP care is critical.Bibliography:1.- Honings S, et al. Psychotic experiences and risk of self-injurious behaviour in the general population: a systematic review and meta-analysis. Psychol Med. 2016;46(02):237–51. doi: 10.1017/S00332917150018412.- Honings S, et al. Psychotic experiences and incident suicidal ideation and behaviour: Disentangling the longitudinal associations from connected psychopathology. Psychiatry Res. 2016;245:267–75. doi: 10.1016/j.psychres.2016.08.0023.- Nishida A, et al. Risk for suicidal problems in poor-help-seeking adolescents with psychotic-like experiences: Findings from a cross-sectional survey of 16,131 adolescents. Schizphr Res. 2014;159(2–3):257–62. doi: 10.1016/j.schres.2014.09.030 39.Disclosure of InterestNone Declared

Unusual case of intentional ingestion of foreign body in patient with mental retardation

Introduction: In developing countries the problem of foreign bodies in Otorhinolaryngology Services (ENT) is poorly studied. The foreign body is common in children but may occur in adults with mental disorders or in prisoners. Objective: To describe the case of a patient with psychiatric problems who ingested a metallic object. Psychiatric observation was requested that diagnosed an "anxiety crisis" after family conflict. Results: Esophagoscopy was performed for uncomplicated extraction. Discussion: Voluntary (intentional) ingestion of objects occurs in patients with psychiatric disorders, especially schizophrenia, mental retardation or in the inmate population. However, the ingestion of a large foreign body is related to parasuicidal behaviour. Conclusions: Always suspect the presence of a foreign body in patients with psychiatric disorders with odynophagia in the absence of pharyngotonsillitis.

Indian Academy of Pediatrics Consensus Guidelines on Prevention and Management of Suicidal Behavior in Adolescents

Suicide is an important cause of adolescent mortality and morbidity in India. As pediatricians are often the first point of contact for adolescents and their families in the healthcare system, they need guidelines to screen, assess, manage and prevent adolescent suicidal behavior to ensure survival, health and mental well-being of this vulnerable population. To formulate guidelines to aid pediatricians for prevention and management of adolescent suicidal behavior. Indian Academy of Pediatrics, in association with Adolescent Health Academy, formed a multidisciplinary committee of subject experts in June, 2019 to formulate guidelines for adolescent suicide prevention and management. After a review of current scientific literature and preparation of draft guidelines, a national consultative meeting was organized on 16 August, 2019 for detailed discussions and deliberations. This was followed by refining of draft guidelines, and discussions over e-mail where suggestions were incorporated and the final document was approved. Pediatricians should screen for mental distress, mental disorders and suicidal and para-suicidal (non-suicidal self-injury) behavior during adolescent health visits. Those with suicidal behavior should be referred to a psychiatrist after providing emergency healthcare, risk assessment, immediate counselling and formulation of a safety plan. Pediatricians should partner with the community and policymakers for primary and secondary prevention of adolescent suicide.

Suicidal Ideation in a Group of Italian Love Addicts: A Qualitative Research

Love addiction is a debated concept, generally considered as an addiction toward an object of love and can lead to deeply negative consequences, among which are self-harm and suicidal ideation. Our study aims to provide empirical evidences about love addiction etiology and characteristics, and to analyze its relation to suicidality. Our result confirmed the phenomenological depiction of love addiction that so far has mainly been hypothesized in literature, also providing a deeper understanding of its characteristics. An association with suicidal and parasuicidal behaviors has been observed, highlighting the dramatic consequences love addiction can have and the importance of preventing them.

Iconic Therapy for the reduction of borderline personality disorder symptoms among suicidal youth: a preliminary study

BackgroundIconic therapy (IT) is a new therapy that uses images to teach skills with the aim of improving the symptoms of borderline personality disorder. Preliminary results are promising, and there is indication that IT may be effective. The purpose of this preliminary study was to test the effectiveness of IT compared to a psychological supportive intervention (SI).MethodsThe study was carried out at the University Regional Hospital of Malaga. Young patients (N = 40; 15–30 years) with suicidal or parasuicidal behavior and borderline personality traits were randomized into IT (N = 20) or SI (N = 20). The main outcome variable was a change in the symptoms of borderline personality disorder (BSL-23) at the end of treatment. The secondary outcome variables were suicidal ideation and behavior, self-harm, the need for medication, the number of visits to mental health professionals, maladaptive behavior, satisfaction with therapy and perceived improvement, both at the end of the intensive treatment and at the 12-month follow-up.ResultsAs expected, the two therapies produced a reduction in BPD symptoms at 10 weeks post-treatment and at the 12-month follow-up. Contrary to expectation, there were no statistically significant differences in the effectiveness of the two therapies (p > 0.05). However, at the 12-month follow-up, the effect sizes for the difference between the effectiveness of the two therapy groups on BSL-23 scores (d = 0.33) and on maladjustment to daily life (d = 0.39) was found to exceed the commonly used convention for a small effect (d = 0.20). Besides, participants in the IT group showed greater satisfaction with therapy than those who received SI. The mean difference between groups was statistically significant after the 10-week treatment period (p < .01), with a large effect size (d = 1.11). Nevertheless, this difference was not maintained at the 12-month follow-up (p > .05), although the effect size for this analysis (d = 0.34) was found to exceed a small effect.ConclusionsThis preliminary study did not find a statistically significant difference in the effectiveness of the two therapies, probably due to the small sample of participants, but there are some indicators (effect sizes) suggesting that perhaps IT may be superior for reducing BPD symptoms and maladjustment in daily life. Future studies with larger samples and comparisons with established treatments for borderline personality disorder are necessary to confirm that IT effects are significant and persistent in the long term.Trial registrationClinicalTrials.gov identifier: NCT03011190. First posted 05/01/2017. Last update posted 15/05/2018.

Self-harm behavior: hierarchical and network analysis

In the article, the problem of self-harm behavior is considered in a comparative aspect from the standpoint of hierarchical, traditional for psychiatry, and innovative network analysis. The rationale for highlighting non-suicidal behavior as an independent diagnosis is discussed. It is concluded that the analysis of the problem of self-harm behavior demonstrates the presence of many unresolved issues from defining the boundaries of normative (based on youth style preferences) and psychopathological self-harm to finding correlations between suicidal and parasuicidal behavior. An innovative network analysis of psychopathology in the evaluation of this phenomenon needs further substantiation.

The Use of ECT in a Geriatric Patient with a Deep Brain Stimulator

<h3>Introduction</h3> Electroconvulsive therapy (ECT) is a commonly used and effective treatment for major depressive disorder with psychosis, especially in the geriatric population. Depressive disorders have significant prevalence in those with movement disorders including Parkinson's disease. Deep-brain stimulators are an effective treatment for Parkinson's disease, however, few cases in the literature exist about the use of ECT in patients with deep-brain stimulators. <h3>Methods</h3> A 68-year-old man with Parkinson's disease with a deep-brain stimulator (DBS) is seen in an outpatient geriatric psychiatry clinic. He has severe major depressive disorder with psychosis. The patient's clinical features include depressed mood, hopelessness, anhedonia, poor sleep, and poor appetite with weight loss. He endorses delusions of worsening physical and functional ability as well as delusions of abandonment and impoverishment. The patient experienced suicidal thinking and had impulsive para-suicidal behavior. The patient's symptoms are minimally responsive to treatment with antidepressants (Escitalopram, Mirtazapine, and Duloxetine) as well as psychotherapy. The patient's Parkinson's disease is treated with carbidopa-levodopa and a St. Jude DBS in his subthalamic nucleus, which was placed almost two years earlier. An ECT consultation was pursued in conjunction with discussion with the patient's neurologist. The patient begins undergoing acute bifrontal ECT with his DBS switched off for his treatments. <h3>Results</h3> The patient has, thus far, had 12 bifrontal acute phase ECT treatments, with the first 10 treatments occurring biweekly and then weekly. He is tolerating ECT well with minimal cognitive impairment immediately after the treatment and no complications relating to his DBS. After three treatments, the patient began experiencing significant improvements in mood, appetite, and sleep noted by himself and collateral sources. After 10 treatments the patient's suicidality and psychotic symptoms had resolved. The patient is much more active and has an improved level of functioning. His family notes that after over a year of severe depression, he finally is "back to himself." <h3>Conclusions</h3> ECT is an appropriate and effective treatment for major depressive disorder with psychosis in patients with concomitant Parkinson's disease who have a DBS. Although there are very few case reports of prescribing ECT to treat patients with Parkinson's disease that have a DBS device, this case demonstrates that it is a safe and efficacious treatment that should be considered. It is especially important to consider this treatment if there is a lack of response to antidepressants. When patients with DBS are not offered ECT due to reluctance and safety concerns, these patients are deprived of a valuable treatment option. <h3>Funding</h3> Not applicable

Zespół Münchausena - studium przypadku

INTRODUCTION Munchausen Syndrome is a type of sham disorder, which causes difficulties in diagnosing process. ICD-10 describes it as psychiatric disorder which is characterized by physical or psychological symptoms that are intentionally produced in order to assume the sick role. However, in order to diagnose someone with ZM, the simulation must be discluded. There cannot be any direct external motivation such as financial benefits. Patients with MS are known by lack of awareness of real motivation for their behavior. They take risk, harmful action in order to interact with the Health Service. It seems that the care they get in medical facilities is a form of gratification for them. Kaplan i Sadock (1995) devided MS into three types: phisical, mental and mixed. Munchausen Syndrome By Proxy is featured, when a patient is projecting symptoms to his or her close one, in most cases – child. CASE STUDY The article is about 26 years old patient, brought up in adoption family. She has been diagnosed with myasthenia gravis and Devica Syndrome and, therefore, currently uses a wheelchair. During her life, patient was undertaking and giving up multiple jobs and studies. What is more, she shows several difficulties in interpersonal relations. The patient was hospitalized for the first time at the beginning of her high school due to self-harm. Second hospitalizations happened two years later, also due to self-harm. Afterwards, during seven years she was hospitalized about 30 times, in only 2019 – 13 times, in multiple medical facilities all over the country. Most of the tome, stays in wards were caused by suicidal thoughts or acts, however, often there were parasuicidal behaviors. Her hospitalizations often had a turbulent course, which was caused by her manipulative and claim attitude. Sometimes the patient had asked for discharge from the hospital on request, and, few days later, was re-admitted to hospital. Moreover, the patient was undertaking several stationary and outpatient therapies, but she was ending them before the therapeutic process was finished. She was diagnosed with border-line personality disorder. In this case both neurological burden and personality disorder are an additional difficulty in diagnostic process.

The Study of Motivation in the Suicidal Process: The Motivational Interview for Suicidality.

Introduction: Suicide is the outcome of a process starting with the experiences of an unbearable pain or hopelessness, passing from suicidal ideation and planning, to possible para-suicidal behaviors or actual attempts. Recent studies have evidenced the necessity to integrate approaches based on the identification of psychopathological diagnoses and other variables as possible predictors of suicidal conduct with a more clinically based approach. A clinical assessment is needed that focuses on the patients' mental state with respect to thoughts concerning death and suicide. In particular, a qualitative assessment of motivations underlying the suicidal process could represent an effective guide for clinicians engaged in the difficult field of preventing adolescents' suicidal gestures. Most instruments investigating the suicidal motivation are self-report measures, possibly resulting in a lack of sufficiently valid assessment of this area. In the present work, we present the Motivational Interview for Suicidality in Adolescence (MIS-A) aiming at identifying the motivational areas sustaining suicidal ideation and gestures in this phase of development.Materials and Methods: The identification of the different areas derives from a thorough review of the empirical literature subsequently vetted by expert clinicians who selected specific reasons behind suicidal ideation and gesture.Result: The MIS is a semi-structured clinician-report interview. The interview is composed of seven areas and 14 sub-areas, evaluated on a four-point Likert scale: illness motivated attempts area, chronic presence of internal pessimistic criticism area, sense of defeat and entrapment area, relational area, external motivated crisis area, extreme and unusual cases area, and lack of control area.Conclusions: The path followed in the creation of the MIS reflects both an empirically orientated and a clinically informed approach. Creating this MIS is the first step within a wider research project that will allow one to test the reliability of the instrument.

Characterological depression in patients with narcissistic personality disorder

Background: Depressive symptoms often occur in patients with personality disorders. Along the lines of the precious concepts of reactive and melancholic forms of depression, two different patterns of depressive symptoms can be identified. Reactive forms of depression is considered to be related to dysfunction of emotional regulation and social functioning, and to personality disorders. This study aimed at exploring the pattern of depressive symptoms in patients with Narcissistic Personality Disorder (NPD) compared to a group of depressed patients without Personality Disorder (PD). The Newcastle Diagnostic Depression Scale (NDDS) is a clinical instrument designed to differentiate reactive depression from melancholic depression.Method: The study investigated patterns of depressive symptoms in 117 out-patients, divided into two groups. One group containing 56 patients with depressive symptoms by no PD and the other group comprised of 61 patients with depressive symptoms and NPD. The participants were interviewed using the Newcastle Diagnostic Depression Scale.Results: There was a significant difference between the groups, as the NPD group suffered from reactive forms of depression. The NPD group showed a pattern of depressive symptoms characterized by fluctuation of the depressive state, without time demarcation of depressive episode, ruminations preoccupied with hostility and accusatory feelings towards other, but not self-accusatory feelings, fluctuation suicidal ideation triggered by external events accompanied by parasuicidal behavior, lack of neuro-vegetative symptoms such as insomnia with early wakening, loss of appetite and weight loss. The No PD group showed the opposite pattern.Conclusion: Based on these results NDDS is considered to be an applicable instrument for identifying personality pathology in patients with depressive symptoms, by recognizing the specific pattern. This is thought to be important for adequate treatment planning.

Parasuicidal behavior and neuroinflammation: A genetics and gene expression approach

Parasuicidal behavior and neuroinflammation: A genetics and gene expression approach

Thinking About (Completed) Suicide

Suicide is a major cause of mortality, and research over the last 50 years has identified many factors found to accompany both suicide-associated behaviors and completed suicide. Why then, has accurate assessment and prediction of suicide risk remained such an intractable clinical problem? Part of the answer is that weak predictors and relatively low base rate combine to impair predictive accuracy. Another factor is that, despite many studies, it has proven very difficult to study suicide prospectively, such that proxy endpoints such as suicidal ideation or parasuicidal behaviors must often be relied upon. [ Psychiatr Ann . 2017;47(9):460–465.]

Recurrent Foreign Body Ingestions Following Rapid Methadone Taper: Neurological Aspects of Self-Injury and Opioid Therapy

Recurrent Foreign Body Ingestions Following Rapid Methadone Taper: Neurological Aspects of Self-Injury and Opioid Therapy

Terapia comportamental dialética: um protocolo comportamental ou cognitivo?

A terapia comportamental dialética (DBT) é um protocolo clínico inicialmente desenvolvido para o tratamento de comportamentos suicidas e parassuicidas, e posteriormente estendido para algumas psicopatologias, como o transtorno da personalidade borderline. O tratamento envolve a aprendizagem de comportamentos pré-requisitos, divididos nos estágios (1) “alcançando as habilidades básicas”, (2) “redução do estresse pós-traumático” e (3) “resolvendo problemas de vida e aumentando o respeito próprio”. O presente artigo analisa se, e em que medida, a DBT preenche os critérios filosófico-aplicados de inclusão nas terapias baseadas na análise do comportamento. Para isso analisou sua concepção filosófica de base, bem como as estratégias de avaliação e intervenção. Argumentou-se que o embasamento filosófico adotado se aproxima do behaviorismo, devido a sua definição de comportamento, concepção de causas e de seleção. Foram identificadas também estratégias de avaliação e intervenção, com foco na aceitação e na mudança, baseadas em análises funcionais, no reforçamento e na modelagem para a aprendizagem de novas habilidades.

Association of parasuicidal behaviour to early maladaptive schemas and schema modes in patients with BPD: The Oulu BPD study.

The present study aimed to examine which early maladaptive schemas (EMSs) and schema modes emerged in parasuicidal and non-parasuicidal patients with BPD participating in the Oulu BPD study. The patients' EMSs were assessed using the Young Schema Questionnaire, and schema modes using the Young Atkinson Mode Inventory. Sixty patients with BPD responded to both the schema and schema mode questionnaires; of these, 46 (76.7%) fulfilled the criteria for parasuicidality. In BPD patients with parasuicidality, the EMSs of emotional deprivation, abandonment/instability, mistrust/abuse and social isolation were the most prevalent, and the schema modes of vulnerable child, angry child, detached protector and compliant surrender were prominent. In patients without parasuicidality, the schema modes of healthy adult and happy child were the most prevalent. Significant correlations were observed between the schema modes of detached protector, vulnerable child, punitive parent and angry child and almost every EMS in BPD patients with parasuicidality. Our preliminary findings suggest that associations between certain EMSs and schema modes to parasuicidality in BPD patients may provide valuable information when planning and implementing their treatment.

Community-based strategy to prevent deliberate self-harm in adolescence: an inquiry to find risk factors at school.

Background:Self-harm behaviors consist of parasuicidal behaviors, which represent “a deliberate destruction of body tissue, with or without suicidal intent”. A theoretical model is the Experiential Avoidance Model. The most frequent risk factors are school distress, poor social integration, poor social and family support, drugs use, sexual abuse, altered sense of life and death, bad relationship with the body and unsolved body mentalization process.Objectives:The objective of the present study was to perform an analysis of risk factors for self-harm behaviors, to help plan preventive actions.Patients and Methods:One questionnaire with specific scales was employed for students, whereas three semi-structured interviews were employed for teachers, all on distress perception and self-harm in school.Results:Data analysis confirms an association between self- cutting and alcohol use, sexual harassments, school dropout, threatening people, incommunicability with family members and negative relationship with the body and suicide attempts, with a clear tendency for males. In the interviews, teachers highlight self-injury as a dysfunctional relationship with the body and observe several risk markers of psychological distress.Conclusions:The results confirm the available literature data, while noting that self-harming is a preponderantly male behavior. The results also signal the need to create opportunities to instruct teachers to combat the resistances and stereotypes of psychological distress.

Faut-il hospitaliser les patients suicidants avec trouble de personnalité borderline après leur prise en charge aux urgences (étude prospective FRENCH CRISIS) ?

Le trouble de personnalité borderline (TPB) se définit notamment par l’instabilité des relations interpersonnelles et de l’image de soi, ainsi que l’impulsivité des sujets qui en souffrent. Certains auteurs soutiennent que l’hospitalisation de ces patients ne réduit pas leurs comportements suicidaires et pourrait leur être délétère (régression ou renforcement des comportements auto-agressifs). Pour déterminer si l’orientation hospitalière des patients suicidants à haut risque de TPB au décours des urgences influence les récidives des comportements suicidaires à 6 mois, nous avons utilisé les données de l’étude prospective multicentrique FRENCH CRISIS. Le risque de présence d’un TPB a été évalué par un autoquestionnaire de dépistage, le PDQ-4+. Nous avons mesuré la récurrence des comportements suicidaires à 6 mois dans le groupe des patients hospitalisés et celui des non-hospitalisés. Trois cent vingt sujets ont été inclus et répartis entre un groupe ayant un risque élevé d’avoir au moins un TPB ( n = 197), un groupe ayant un risque élevé d’avoir au moins un TP non TPB ( n = 84) et un groupe ayant un faible risque d’avoir un TP ( n = 39). L’hospitalisation au décours des urgences n’est pas associée à une différence de récidive des comportements suicidaires à 6 mois entre les groupes. Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. There is a high prevalence of BPD patients among those admitted to the emergency department for suicide attempts. However, little empirical research exists to assist clinicians in deciding whether to hospitalize a suicidal patient. Some authors have argued that hospitalization does not prevent suicide and could actually harm these patients, thereby leading to psychosocial regression. Parasuicidal behaviors could be reinforced by the attention given during hospitalization. Our purpose was to determine whether the hospitalization of suicidal patients who have a high risk of BPD after discharge from the emergency department is associated with a recurrence of suicidal behavior at 6 months. We designed a prospective study, acquiring patients from three emergency hospitals. The participants were suicidal subjects admitted for voluntary drug intoxication and were 18 years of age or older. The participants completed the Personality Disorder Questionnaire (PDQ-4+) to assess BPD symptomatology. Information on the recurrence of suicidal behavior at 6 months was obtained by interview of patients and the review of the charts from the 3 hospitals involved in the study. Other assessments included the BDI-13 (severity of depression), the Hopelessness Scale (hopelessness), the TAS-20 (alexythymia), the AUDIT (alcohol disorder) and the MINI (axis I disorders). A total of 606 subjects admitted for a suicide attempt participated in this study. A total of 320 (52.8 %) of the subjects completed the PDQ-4+. The sample was divided into three groups: participants at high risk of having at least one BPD ( n = 197), a group at high risk of having at least one non-BPD PD ( n = 84) and a group with low risk of having a PD ( n = 39). Hospitalization following an emergency was not associated with a recurrence of suicide attempts at 6 months among patients at high risk of BPD. A logistical regression analysis showed pre-hospitalization antidepressant prescription to be associated with recidivism (OR = 2.1, P = .037). Our exploratory study suggests that hospitalization may not increase suicide attempts among patients with BPD when the health organization does not include a specific device such as DBT.