Recurrent Suicide Attempts Research Articles

Adjunctive lithium treatment in the prevention of suicidal behaviour in depressive disorders: a randomised, placebo‐controlled, 1‐year trial

Evidence based on controlled studies is still limited for treatment strategies that prevent recurrence of suicide attempts. Findings from observational as well as meta-analytic studies strongly suggest that lithium may have suicide-protective properties. Patients with a recent suicide attempt in the context of an affective spectrum disorder (n = 167) were treated with either lithium or placebo during a 12-month period. Survival analysis showed no significant difference of suicidal acts between lithium and placebo-treated individuals (adjusted hazard ratio 0.517; 95% CI 0.18-1.43). However, post hoc analysis revealed that all completed suicides had occurred in the placebo group accounting for a significant difference in incidence rates (P = 0.049). Results indicate that lithium treatment might be effective in reducing the risk of completed suicide in adult patients with affective disorders. Our findings contribute to the growing body of evidence suggesting a specific antisuicidal effect of lithium.

Bipolar disorders across the lifespan

Bipolar disorders across the lifespan

Thoughts of Nurses and Actual Nursing Care for Schizophrenia Patients Hospitalized for Attempted Suicide : Consideration of Nursing Care Designed to Prevent Recurrence of Suicide Attempts

Thoughts of Nurses and Actual Nursing Care for Schizophrenia Patients Hospitalized for Attempted Suicide : Consideration of Nursing Care Designed to Prevent Recurrence of Suicide Attempts

Kindling and behavioral sensitization: are they relevant to recurrent suicide attempts?

Background Data from a sample of suicidal young adults were used to examine the relevance of the kindling and behavioral sensitization models to suicide attempts. Three predictions derived from the kindling and sensitization models were tested: a higher number of suicide attempts would be associated with (a) lower levels of pre-attempt stress; (b) higher suicidal intent; and (c) greater lethality of the current attempt. Methods Measures of life stress and suicidal intent were collected among 123 young adults who attempted suicide just prior to entering treatment. Data on the total number of suicide attempts and the lethality of the current attempt were also collected. Results Number of suicide attempts was significantly and positively associated with pre-suicidal crisis life stress and suicidal ideation, but was not significantly associated with lethality of the most recent attempt. Limitations The young sample drawn from a military medical setting may not accurately represent suicide attempters in the general population. Only total negative life events in the year preceding suicide attempt were examined, not the increase in negative life events immediately prior to suicide attempt. Conclusions The kindling and sensitization models may not accurately describe the progression of recurrent suicide attempts.

Defense Styles, Impulsivity and Suicide Attempts in Major Depression

Background: The aim of our study was to identify if defense mechanisms are associated with impulsivity and lifetime suicide attempts in depressed patients. Sampling and Methods: The Defense Style Questionnaire, the Impulsivity Rating Scale and the Impulse Control Scale were used in 77 depressed inpatients. Results: Impulsivity was correlated positively with immature and neurotic styles and negatively with mature style. Some but not all defense mechanisms were relevant in this respect. The number of lifetime suicide attempts was positively correlated not only with impulsivity, but also with immature style and to a lesser extent with neurotic style. Several defense mechanisms were involved in these correlations: undoing, projection, passive aggression, acting out, splitting and somatization. Conclusions: Like impulsivity, defense styles may be relevant to discriminate recurrent suicide attempters in depression. Prospective assessment of defense styles and suicide attempts in depression is needed.

Anxiety and impulsivity levels identify relevant subtypes in adolescents with at-risk behavior

Background: Impulsivity (I) and anxiety (A) were hypothesized to be crucial clinical features in adolescents with at-risk behavior. We therefore classified them into sub-groups according to these two major dimensions. The study examined the relevance of these groups by describing their major diagnoses and behavioral characteristics. Methods: During a 1-year period, all in-patients consecutively admitted for at-risk behavior, except those with a previous psychotropic treatment and/or schizophrenic disorders, were rated for anxiety and impulsivity, and categorized into four groups: impulsive and anxious (IA), impulsive and non-anxious (Ia), non-impulsive and anxious (iA), non-impulsive and non-anxious (ia). We assessed the main behavioral disturbances (suicide attempt, carving, violence, delinquency, substance abuse, and eating disorder) and the main current axis I disorder in each sub-group. Results: A total of 69 patients were included. In the IA group 62% exhibited hypomanic episodes and 87% recurrent suicide attempts. In the Ia group all exhibited conduct disorders, 93% were males, 80% delinquents, and 100% violent with others. Both groups reported a high percentage of cannabis use (67%). The iA group exhibited anorexia nervosa (73%) with a major depressive episode. The ia patients were mainly non-violent, first suicide attempts with low risk. Limitations: Long-term data are needed to assess the stability of these groups. Conclusions: We found that sub-typing adolescents with at-risk behavior into four groups according to their level of anxiety and impulsivity was highly predictive of being suicidal with mood disorders (AI), delinquent with conduct disorder (Ia), anorectic or depressed (Ai), and with substance abuse associated only to impulsivity. It is likely that this sub-typing of patients may be useful for prevention and therapeutics. The impulsive-anxious group (IA) appears closely related to the soft bipolar spectrum. A replication and follow-up data are now needed.

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

The last decade has seen an explosive growth in the use of dialectical behavior therapy (DBT) for the treatment of borderline personality disorder (BPD). This combined individual and group therapy blends elements of learning theory, cognitive-behavioral therapy, self-psychology, and Zen Buddhism in a coherent, teachable, replicable fashion to achieve significantly lower rates of self-injurious behavior among patients with BPD. Moreover, it has increased interest among clinicians in treating this often-challenging group of patients. The following is a case report of a chronically suicidal woman treated using the DBT model in multiple settings (outpatient, partial hospital, and group home). Case material is presented along with sufficient explanation to allow readers unfamiliar with DBT to follow the formulation and interventions. Rather than being written by multiple authors, this report summarizes the experience of one clinician in presenting her clinical work to a group of nationally recognized senior DBT clinicians at the University of Washington in Seattle,* where this form of treatment originated.

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

A Description of a Psychosocial/Psychoeducational Intervention for Persons with Recurrent Suicide Attempts

This paper gives a description of a psychosocial/psychoeducational group intervention for individuals with a history of recurrent suicide attempts. The intervention was conceived to reduce the risk of future suicidal behavior and to modify the client's psychopathology. Three features are felt to make the intervention unique from others described in the literature. First, the intervention is targeted at both men and women from an inner-city population who are often underhoused, underemployed, and undereducated. 24 of 48 clients (50%) lived alone, and 24 of those (92%) were living in subsidized housing; 33% lived in supportive housing, and one lived on the street at the time of assessment. 48% had a high-school education or less. Second, the principles of our approach stressed client validation and participation in the development and delivery of the therapy. Our frame of reference was to name ourselves as professionals with a set of skills and access to some kinds of information and clients as the experts on the experience in their lives. Third, the group content incorporated a multimodal approach to meet the varied needs of the clients. Future reports will discuss the empirical evaluation of this intervention; however, the development of specific, targeted approaches for unique individuals with recurrent suicide attempts is clearly needed.

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

Recurrent Suicide Attempts, Self-Mutilation, and Binge/Purge Behavior: A Case Report

Mood correlates with blood serotonin, but not with glucose measures in patients with recurrent suicidal behavior

Depressive mood and impulsive-aggressive behavior are relevant to suicidal behavior and have been associated with decreased central serotonergic function. Impulsive behavior and aggression have also been related to abnormal glucose metabolism. To investigate these relationships further, blood serotonin (5-HT), blood glucose measures (glycated hemoglobin (HbA 1C) and fructosamine) and self-reported depressive symptoms and anger were repeatedly measured, during a 1-year follow-up, in 106 patients who had recently attempted suicide for at least a second time. A major DSM-III-R Axis I diagnosis or use of antidepressants were reasons for exclusion. Intra-individual variations in blood 5-HT were inversely correlated with variations in depressive mood, self-depreciation, and anger, and positively with variations in fructosamine. Intra-individual variations of HbA 1C or fructosamine were not correlated with mood. Mean blood 5-HT levels per patient were positively correlated with mean scores of depression and self-depreciation. The contrast between the intra-individual and the inter-individual correlations may reflect a difference between short- vs. long-term effects. The results do support an association between serotonergic function and mood, but not between glucose metabolism and mood, in recurrent suicide attempters.

Psychometric characteristics of the Self-Expression and Control Scale in a sample of recurrent suicide attempters

The Self-Expression and Control Scale (SECS), constructed to investigate the role of anger expression and anger control in somatic and mental diseases, was administered to patients with recurrent suicide attempts. The psychometric properties of the SECS proved to be highly acceptable and comparable with the psychometric properties of the instrument administered to a community sample. Suicide attempters scored higher on trait anger, higher on the internalization of anger and lower on both control of the internalization and the externalization of anger than controls in a community sample. Additionally, suicide attempters with a diagnosis of borderline personality disorder scored higher on the externalization of anger, and lower on both control of the internalization and the externalization of anger than suicide attempters without this diagnosis. Finally, the subgroup of patients with a psychiatric diagnosis of a“recurrent deliberate self-harm” scored higher on the internalization of anger than other patients with recurrent suicide attempts. These results show that the SECS is able to make a distinction between several subgroups of suicide attempters, and between suicide attempters and persons in a community sample with respect to the expression and control of anger. As such, the SECS can give indication for optimal psychotherapeutic treatment.

P.1.022 - Platelet serotonin, 3H-paroxetine binding and recurrent suicide attempts: A one-year follow up study

P.1.022 - Platelet serotonin, 3H-paroxetine binding and recurrent suicide attempts: A one-year follow up study

A pilot study of a short cognitive-behavioral group treatment for female recurrent suicide attempters.

To test the feasibility and effectiveness of a high-frequency short-term group cognitive-behavioral therapy (CBT) for recurrent suicide attempters. CBT consisting of eight weekly and two "booster" sessions was given to nine female out-patients who had attempted suicide at least twice, seven of whom had a personality disorder. Four patients dropped out during the treatment; either because they were "chronic repeaters" (i.e., had a history of more than 8 suicide attempts), or because the last suicide attempt was too long ago. Although the patients were generally positive about the content of the therapy, no effects on psychiatric symptomatology or repetition of suicidal behavior could be demonstrated. Based on this experience, and on the two controlled studies of CBT of recurrent suicide attempters published in the literature, it is tentatively concluded that it is difficult to organize a short-term high-frequency group treatment for recurrent suicide attempters with personality disorders, and that CBT may delay repetition of suicidal behavior, but that "major repeaters" (i.e., who made 4 or more suicide attempts) with a borderline personality disorder tend to stay major repeaters.

Borderline personality, impulsiveness, and platelet monoamine measures in bulimia nervosa and recurrent suicidal behavior

This study examined the relationship between borderline and impulsive personality traits on the one hand, and monoamine function on the other in 15 women with bulimia nervosa and 15 women with recurrent suicidal behavior. Platelet serotonin (5-HT) and platelet monoamine oxidase (MAO) activity were used as peripheral measures of monoaminergic function. All suicide attempters were diagnosed as having a borderline personality disorder, whereas this diagnosis was less frequent in bulimics. Bulimics with borderline comorbidity resembled recurrent suicide attempters with borderline personality disorder more closely in both psychological (anger, impulsive behavior) and biochemical characteristics (platelet 5-HT) than bulimics without borderline personality disorder. Platelet 5-HT was higher in patients with borderline personality than in normal female controls and was positively correlated with the disposition to experience anger. Impulsive personality traits were consistently negatively correlated with platelet MAO activity. Our findings support the subdivision of bulimics according to the presence of borderline or "multi-impulsive" personality disorder.

Suicidality, circadian activity rhythms and platelet serotonergic measures in patients with recurrent suicidal behaviour.

The circadian activity rhythm was assessed over a one-week period using a wrist-worn activity monitor in 59 patients with a history of recurrent suicide attempts. In 40 of these patients a second recording was made 6 months later. Platelet serotonin (5-HT) and monoamine oxidase-B activity (MAO) were measured. Suicidal ideation, borderline personality disorder and impulsiveness were associated with the absence of a clear 24-hour periodicity in motor activity. Depressive mood and hopelessness were associated with a less regular bed-in time and a lower daytime activity. Platelet 5-HT as well as MAO correlated negatively with the amplitude of the circadian activity rhythm. Our results support the suggested link between suicidality, altered circadian activity and serotonergic function.

Suicidal Children Grow Up: Rates and Psychosocial Risk Factors for Suicide Attempts during Follow-up

Rates and psychosocial risk factors for suicide attempts during a 6 to 8-year follow-up period were compared for 25 predominantly prepubertal inpatient suicide attempters, 28 inpatient suicidal ideators, 16 nonsuicidal inpatients, and 64 nonpatients. Standard research instruments were used to interview subjects and parents. Cox proportional hazard regression analyses were used to identify risk factors for a suicide attempt in the follow-up. No deaths occurred during follow-up. Suicide attempters were six times and suicidal ideators were three times more likely than were nonpatients to attempt suicide during follow-up. Poor social adjustment and mood disorder close to a recurrent suicide attempt were the strongest risk factors. Risk assessment should focus on identifying symptoms of mood disorders and impaired social adjustment in children with histories of suicide attempts and psychiatric hospitalization.

Extraversion, neuroticism, and intent in attempted suicides.

124 subjects completed the Eysenck Personality Inventory soon after a suicide attempt. For males there was an association between low intent to die and impulsivity while for both sexes there was an association between recurrent suicide attempts and neuroticism.