Self-injurious Behavior In Patients Research Articles

Healthcare Utilization, Physical and Psychiatric Comorbidities Before Self-Injurious Behavior in Patients with Asthma: A Nested Case-Control Study.

Patients with asthma experience more physical, psychological, and financial burdens; a link between asthma and suicidality has been reported in research. This study analyzed the medical utilization and comorbidity before their self-injurious behavior in patients with asthma. We enrolled 186,862 patients newly diagnosed with asthma between 1999 and 2013 from the National Health Insurance Research Database in Taiwan. A total of 500 case subjects had ever conducted self-injurious behaviors during the study period. Based on a nested case-control study, each case was matched with 10 controls derived from the asthma cohort to analyze differences between them and their medical use models. The results indicated that, compared to the control group, the cases presented higher frequencies of outpatient visits and hospitalizations. Regarding comorbidity, the cases had more cardiovascular diseases (adjusted odds ratio [aOR]=1.58; p<0.001), bipolar disorder (aOR=2.97; p<0.001), depression (aOR=4.44; p<0.001), and sleep disorder (aOR=1.83; p<0.001) than the controls. The evidence-based information serves as a reference for medical staff to reduce the occurrence of self-injurious behavior in patients with asthma.

The Prevalence of Self-injurious Behavior in Patients With Schizophrenia Spectrum Disorders: A Systematic Review and Meta-analysis.

In patients with schizophrenia spectrum disorder (SSD), the lifetime prevalence of self-harm (SH) and non-suicidal self-injury (NSSI) is currently uncertain. The primary aim of this review was to provide a synthesis of the existing literature concerning the prevalence of SH/NSSI in individuals with SSD, and individuals at clinical high risk of psychosis (CHR-P). Secondary aims were to investigate methods, severity, and functions of self-injurious behavior in these populations. Studies quantifying the prevalence of SH/NSSI in individuals with SSD or at CHR-P were included in this review. MEDLINE, EMBASE, and PsycInfo were searched for eligible studies June 10, 2022 and systematically screened by two independent reviewers. Risk of bias was assessed using the Joana Briggs Institute Critical Appraisal Checklist for Prevalence Studies by two independent reviewers. A meta-analysis of the lifetime prevalence of SH/NSSI was conducted using generalized linear mixed model with the logit transformation. Thirty-two studies were included in this review (n = 15 440), 4 of which included individuals at CHR-P (n = 397). The meta-analysis showed a pooled lifetime prevalence of SH of 31.0% (95% CI: 22.1%; 41.6%) in individuals with SSD (n = 2822) and 39.7% (95% CI: 17.5%; 70.0%) in individuals at CHR-P (n = 397). These estimates should be interpreted with caution due to substantial heterogeneity. Cutting was the most frequent method of SH/NSSI and SH command hallucinations may be an overlooked cause of self-injurious behavior in these patients. Self-injurious behavior is a highly prevalent, and possibly overlooked concern, in individuals with SSD and at CHR-P.

Staff Beliefs Toward Self-Injurious Behavior in Patients: A Study of Secure Services.

Staff beliefs toward patient self-harm in secure forensic services are explored, capturing forensic nurses and other clinical staff from four secure units from one National Health Service trust, comprising high through low and forensic learning disability. One hundred fifty-five respondents took part (overall completion rate: 61%). The Theory-Driven Measure of Self-Injurious Behavior and the Suicide Competency Assessment Form were completed. It was predicted that higher competency and increased levels of training would associate with beliefs toward patient self-harm. Beliefs differed in accordance to location; perceiving self-injurious behavior as planned and within patient control was endorsed more in high-security settings by forensic nurses, with nurses in high security also more likely to endorse the perception that patients engaging in such behaviors were able to cope and felt valued. Competence and training experience were identified as factors of relevance. The study offers suggestions for future research, including a focus on capturing the environment, exploring "endorsed beliefs" as opposed to "negative attitudes," and proposing the concept of "professional exposure to self-harm" as an important variable.

Self-injurious behaviour in patients with bipolar disorder and attention deficit hyperactivity disorder after central stimulant start– a retrospective study based on the lisie cohort

IntroductionCurrently, our understanding remains limited of how co-occurring bipolar disorder and attention deficit hyperactivity disorder (ADHD) should be treated.ObjectivesTo evaluate the impact of central stimulant treatment on self-injurious behaviour in patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD.MethodsRetrospective cohort study (LiSIE) into effects and side-effects of lithium as compared to other mood stabilisers. Here, using a mirror-image design, we compared suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after central stimulant treatment start.ResultsOf 1564 eligible patients, 206 patients met inclusion criteria; having a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD at first central stimulant initiation. In these, suicide attempts and non-suicidal self-injury events decreased significantly within both 6 months (p = 0.004) and 2 years (p = 0.028) after central stimulant start. After multiple adjustments, this effect was preserved 2 years after central stimulant start (OR 0.63, 95% CI; 0.40 – 0.98, p = 0.041).ConclusionsCentral stimulant treatment may reduce the risk of self-injurious behavior in patients with a dual diagnosis of bipolar disorder or schizoaffective disorder and ADHD. However, to reduce the risk of manic switches, concomitant mood stabilising treatment remains warranted.DisclosureMichael Ott has been a scientific advisory board member of Astra Zeneca Sweden, Ursula Werneke has received funding for educational activities on behalf of Norrbotten Region (Masterclass Psychiatry Programme 2014–2018 and EAPM 2016, Luleå, Sweden): Astra

Suicidal and non-suicidal self-injurious behaviour in patients with bipolar disorder and comorbid attention deficit hyperactivity disorder after initiation of central stimulant treatment: a mirror-image study based on the LiSIE retrospective cohort

Background:Currently, our understanding regarding treatment of adult attention deficit hyperactivity disorder (ADHD) co-occurring with bipolar disorder (BD) remains limited. The aim of this study was to evaluate the impact of central stimulant (CS) treatment on suicidal and non-suicidal self-injurious behaviour in patients with a pre-existing diagnosis of BD or schizoaffective disorder (SZD). Specifically, we tested the hypothesis that CS treatment significantly decreased the number of suicide attempts and non-suicidal self-injury events.Methods:A mirror-image study in patients with a dual diagnosis of BD or SZD and ADHD, comparing suicide attempts and non-suicidal self-injury events within 6 months and 2 years before and after CS initiation. This study was part of a retrospective cohort study (LiSIE) into effects and side-effects of lithium for maintenance treatment of BD as compared with other mood stabilisers.Results:Of 1564 eligible patients, 206 patients met the inclusion criteria. Within the 6 months after CS initiation, suicide attempts and non-suicidal self-injury events decreased significantly, both in terms of numbers of patients having such events (p = 0.013) and numbers of events experienced (p = 0.004). These effects were preserved 2 years after CS initiation.Conclusions:CS treatment may reduce the risk of suicide attempts and non-suicidal self-injury events in patients with a dual diagnosis of BD or SZD and ADHD. Based on our findings, clinicians should not withhold CS treatment from patients with concomitant ADHD for fear of deterioration of the underlying BD. However, to minimise the risk of manic episodes concomitant mood stabiliser treatment and close monitoring remains warranted.

Self-injurious behaviour in patients with anorexia nervosa: a quantitative study

BackgroundMany patients with an eating disorder report difficulties in regulating their emotions and show a high prevalence of self-injurious behaviour. Several studies have stated that both eating disorder and self-injurious behaviour help emotion regulation, and are thus used as coping mechanisms for these patients. We aimed to determine the prevalence of self-injurious behaviour, its characteristics and its emotion-regulation function in patients with anorexia nervosa or an eating disorder not otherwise specified (n = 136).MethodsA cross-sectional design using a self-report questionnaire. Mann–Whitney U-tests were conducted to compare the background and clinical variables between patients with self-injurious behaviour and patients without this type of behaviour. Changes in emotional state before and after self-injurious behaviour were tested by Wilcoxon signed rank tests.ResultsOur results showed a 41% prevalence of self-injurious behaviour in the previous month. Patients who performed self-injurious behaviour had a statistically significant longer treatment history for their eating disorder than those who did not. Whereas 55% of self-injuring patients had a secondary psychiatric diagnosis, only 21% of participants without self-injurious behaviour did. Regarding the impact of self-injurious behaviour, our results showed a significant increase in “feeling relieved” and a significant decrease in “feeling angry at myself”, “feeling anxious” and “feeling angry at others”. This indicates that self-injurious behaviour can be regarded as an emotion-regulation behaviour. Participants were usually aware of the causes of their self-injurious behaviour acts.ConclusionsProfessionals should systematically assess the occurrence of self-injurious behaviour in eating disorder patients, pay special attention to patients with more severe and comorbid psychopathology, and those with a long treatment history. This assessment should be followed by a functional analysis of the self-injurious behaviour and by effective therapeutic interventions alongside the eating disorder treatment.

Clozapine for self-injurious behavior in individuals with borderline personality disorder

Prior reports suggest that clozapine can markedly reduce aggression and self-injurious behavior in patients with borderline personality disorder (BPD). We present a series of four patients with BPD and persistent self-injurious behavior treated with clozapine at a state psychiatric hospital. After treatment with clozapine these patients ceased self-injurious behaviors and aggression, and no longer required intensive levels of observation or restrictive procedures. All were successfully discharged from the hospital soon after initiation of clozapine. Clozapine appears to be efficacious in the management of chronic suicidality, self-injurious behaviors and aggression in patients with severe BPD.

Hypoxanthine-guanine phosphoribosyltransferase deficiency in a patient with a Madrid II mutation

The hypoxanthine-guanine phosphoribosyltransferase deficiency is an inborn error of purine metabolism, linked to the X chromosome. The clinical phenotypes associated with HPRT deficiency varied according to the level of enzyme deficiency, with a large spectrum of neurologic features like self-injurious behaviour in patients with complete deficiency. We report a 20-year-old man who had asymmetric polyarthritis, tophi, hyperuricemia, nephrolithiasis and mild neurologic symptoms with undetectable levels of HPRT activity in lysed erythrocytes. The genetic study identified the c.143G>A mutation in exon 3, GAA CGT (CTT>GAA CAT CTT (48arg>his). The presence of gouty arthropathy and chronic hyperuricemia in a young patient with neurological symptoms, suggests HPRT deficiency for which it is necessary its enzyme and molecular determination.

Naltrexone use for self-injurious behavior in patients with developmental disabilities

Self-injurious behavior (SIB) is a serious problem seen in individuals with developmental disabilities (DD). Evidence-based options for the treatment of SIB in patients with DD are limited and no medication is approved for this indication. Non-pharmacotherapeutic options including environmental change and behavioral therapy are generally recommended for use as first line therapy. However, these options are sometimes inadequate. Despite lack of strong evidence, a variety of medications are used for SIB in DD. These include: antipsychotics (typical and atypical), antiepileptic drugs (e.g. divalproex, carbamazepine, etc.), lithium, and antidepressants (particularly selective serotonin reuptake inhibitors). First line agents include atypical antipsychotics (e.g. risperidone, olanzapine) and mood stabilizers (e.g. divalproex, carbamazepine). However, if a patient fails to respond to these agents or has contraindications to these options, other agents may occasionally be utilized. One such agent is the opioid antagonist naltrexone. Using naltrexone for the treatment of SIB comes from the theory that SIB is influenced by the release of endogenous opioids. Therefore, blocking the effects of these opioids could attenuate these behaviors. This article briefly summarizes the evidence for safety and efficacy of naltrexone for SIB in DD.

An Open-Label Trial of Topiramate in the Treatment of Skin Picking in Pervasive Developmental Disorder Not Otherwise Specified

An Open-Label Trial of Topiramate in the Treatment of Skin Picking in Pervasive Developmental Disorder Not Otherwise Specified

Self-Injurious Behavior in Women With Eating Disorders

The authors assessed lifetime and 6-month occurrence and phenomenology of self-injurious behavior in patients with eating disorders. Women (N=376) in inpatient treatment for an eating disorder (anorexia: N=119, bulimia: N=137, eating disorder not otherwise specified: N=120) were assessed for self-injurious behavior and completed the Traumatic Life Events Questionnaire, the Dissociative Experience Scale, the Barratt Impulsiveness Scale, and the Yale-Brown Obsessive Compulsive Scale. The lifetime rate of self-injurious behavior occurrence was 34.6%, with the highest rates found in subjects with eating disorder not otherwise specified (35.8%) and bulimia (34.3%); the 6-month rate of self-injurious behavior occurrence was 21.3%. Multivariate comparisons were computed for the factors of self-injurious behavior and diagnostic subgroup: self-injuring patients reported a significantly higher number of traumatic events, showed significantly higher dissociation scores, and exhibited significantly more obsessive-compulsive thoughts and behaviors. Bulimic patients showed significantly higher impulsivity scores. This study strongly supports the assumption that patients with eating disorders are at risk for self-injurious behavior and points to the necessity of a routine screening for self-injurious behavior as well as the development of a standardized questionnaire. Group comparisons point to the relevance of traumatic experiences and comorbid dissociative phenomenology.

Self-Injurious Behavior in Patients with Borderline Personality Disorder: Biological Perspectives

Self-injurious behavior (SIB) in patients with borderline personality disorder (BPD) has traditionally been understood in psychodynamic (Kafka, 1969: Menninger, 1935; Pao, 1969; Simpson, 1975) and behavioral (Linehan, 1989) terms. More recently, investigators have suggested that specific biological mechanisms are significantly related to SIB in patients with BPD. We review the neurochemical, electrophysiological, and psychopharmacological data that directly and indirectly address this issue.

Evidence that lack of brain dopamine during development can increase the susceptibility for aggression and self-injurious behavior by influencing D 1-dopamine receptor function

Breese, George R., Hugh E. Criswell and Robert A. Mueller: Evidence That Lack of Brain Dopamine During Development Can Increase The Susceptibility for Aggression And Self-Injurious Behavior By Influencing D 1-Dopamine Receptor Function. Prog. Neuro-Psychopharmacol. & Biol. Psychiat. 1990, 14 (Supple): S65–S80. 1. 1. Lesch-Nyhan disease has a defined neurological lesion that is accompanied by abnormal motor function, aggression and self-injurious behavior. 2. 2. The dopamine deficiency in Lesch-Nyhan disease has been modelled by destroying dopamine-containing neurons in neonatal rats with 6-hydroxydopamine. 3. 3. Because D 1-dopamine antagonists will block self-injurious behavior induced by L-DOPA in neonatal-6-OHDA-lesioned rats, D 1-dopamine antagonists are proposed as a potential therapy for aggression and self-injurious behavior in patients with these symptoms. 4. 4. The determination that the drug SCH-12679, which exhibited effectiveness against aggressiveness in mentally retarded patients, is a D 1-dopamine antagonist supports the view that new D 1-dopantine antagonists being developed will be an effective therapy for some types of aberrant behavior in this population.