Suicidal Behavior In Patients Research Articles

Premenstrual exacerbation and suicidal behavior in patients with panic disorder

This study examined the relationship between premenstrual exacerbation and suicidal behavior in patients with panic disorder. Twenty-eight patients who reported a premenstrual exacerbation of panic disorder and 42 patients who reported never having an exacerbation were included in the study. The subjects completed a self-rating instrument assessing the 13 DSM-III-R panic symptoms on a 5-point scale (0 = absent, 1 = mild, 2 = moderate, 3 = severe, and 4 = very intense). They also completed the severity scale of the Clinical Global Impression. The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that patients with premenstrual exacerbation of panic disorder had higher SADS suicidality scores than patients with panic disorder without premenstrual exacerbation. They were also more likely to be classified as suicidal than the others. It may be that premenstrual exacerbation is a risk factor for suicidal behavior independent of major depression in patients with panic disorder.

Suicidal behavior in patients with schizophrenia and other psychotic disorders.

Patients with schizophrenia are known to be at high risk for suicide attempts and dying by suicide. However, little research has been conducted to determine whether the risk for suicidal behavior is elevated among patients with psychosis in general. This study evaluated 1-month and lifetime rates of suicidal behavior among 1,048 consecutively admitted psychiatric inpatients (ages 18 to 55 years) with DSM-III-R psychotic disorders. Demographic, clinical, and diagnostic correlates of suicidal behavior were examined. A high rate of suicidal behavior was found in the group: 30.2% reported a lifetime history of suicide attempts, and 7.2% reported a suicide attempt in the month before admission. The highest 1-month and lifetime rates were found in patients with schizoaffective disorder and major depression with psychotic features. Ratings of the medical dangerousness of the most recent suicide attempt on the basis of the extent of physical injury were higher in patients with schizophrenia spectrum psychoses. Agreement was high between emergency room assessments and semistructured interview assessments of suicidal behavior. Rates of suicidal behavior were high across a broad spectrum of patients with psychotic disorders; patients with a history of a current or past major depressive episode (as a part of major depressive disorder or schizoaffective disorder) were at a greater risk for suicide attempts, but patients with schizophrenia, on average, made more medically dangerous attempts. Risk factors for suicidal behavior in patients with psychosis appear to vary compared to those for the general population.

Premenstrual exacerbation and suicidal behavior in patients with panic disorder

Premenstrual exacerbation and suicidal behavior in patients with panic disorder

Disease, pain, and suicidal behavior

Contents Foreword (Knud Jensen) * Chapter 1. General Aspects of Suicidal Behavior * Chapter 2. Psychosocial Aspects of Chronic Somatic Disorders * Course and Prognosis * Prediagnostic Period * The Diagnostic Period * Crisis Reaction * Postdiagnostic Period * Conclusion * Chapter 3. Suicidal Behavior and Mental Disorders * Forensic Studies * Risk Factors of Suicide in Patients Who Have Made A Suicide Attempt * Follow-Up Studies of Psychiatric Populations * Conclusion * Chapter 4. Methodological Problems * Methodological Problems in Evaluating Suicidal Risk * Chapter 5. Suicide in Patients with Neurological Disorders * General Risk of Suicide in Neurological Disorders * Multiple Sclerosis * Epilepsy * Huntington's Chorea * Spinal Cord and Brain Injuries * Brain Tumors * Parkinson's Disease * Cerebral Stroke * Amyotrophic Lateral Sclerosis (Motor Neuron Disease) * Conclusion * Chapter 6. Cancer and Suicide * Studies Based on Patient Registers * Studies Based on Forensic Material * Conclusion * Chapter 7. Suicide in Patients with Other Somatic Disorders * Heart and Lung Conditions * Gastrointestinal Disorders * Liver Transplant * Kidney Disorders * Endocrinological Disorders * Rheumatological and Related Disorders * Tinnitus * AIDS * Conclusion * Chapter 8. Suicide Attempts and Somatic Disorders * The Frequency of Somatic Disorders Among Suicide Attempters and in Follow-Up Studies * Comparison of Suicide Attempters and Control Groups * Conclusion * Chapter 9. Pain and Suicidal Behavior * Why Is It Obvious to Assume That Pain Conditions Are Associated with an Increased Suicide Risk? * The Association of Pain Conditions and Mental Disorders * Methodological Problems * Studies on Suicidal Behavior and Pain * Chapter 10. General Aspects of Suicidal Behavior, Pain, and Somatic Disorders * Suicidal Risk and Somatic Disorders * Suicidal Risk as a Measure of Life Quality and Coping Ability * Prevention of Suicidal Behavior in Patients with Somatic Disorders * Conclusion * Bibliography * Index

Repetitive and frightening dreams and suicidal behavior in patients with major depression

The purpose of the present study was to examine the association between repetitive and frightening dreams and suicidal tendency in patients with major depression. Depressed patients who reported frequent nightmare (N = 29) and depressed patients who reported dreaming but never nightmares (N = 34) were evaluated using the Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale to rate the severity of active suicidality. The patients with frequent nightmares, particularly women, had higher mean SADS suicide subscale scores and were more likely to be classified as suicidal than the others. The findings demonstrate that frequent nightmare are associated with suicidal tendency in patients with major depression. Theoretical and clinical implications for the function of dreaming are discussed.

Recurrent sleep panic, insomnia, and suicidal behavior in patients with panic disorder

The purpose of this study was to examine the association between recurrent sleep, panic, and suicidal behavior in panic disorder. We compared the recurrent sleep panickers (N = 33) with other panickers (N = 34). The Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale was used to rate the severity of active suicidality. We found that recurrent sleep panickers also had a higher percentage of insomnia and comorbid major depression than the others. A multivariate analysis demonstrated an association between recurrent sleep panic and suicidal tendencies in patients with panic disorder. Although recurrent sleep panic alone is not an independent risk factor for suicidal behavior, it may modify the severity of illness in patients with panic disorder.

Sleep disturbances and suicidal behavior in patients with major depression.

The purpose of this study was to examine the association between sleep disturbances and suicidal behavior in patients with major depression (N = 113). The sleep symptomatology of each patient was ascertained from the Schedule for Affective Disorders and Schizophrenia (SADS) questions concerning sleep in the section on major depression. The patients were retrospectively classified as having hypersomnia (N = 20), insomnia (N = 69), and no sleep disturbance (N = 24). The SADS suicide subscale was used to rate the severity of active suicidality. The patients with hypersomnia and insomnia had significantly (p < .05) higher scores on the SADS suicide subscale than those without sleep disturbance. We also found that the patients with insomnia and hypersomnia were significantly (p < .001) more likely to become suicidal than the others. These data demonstrate that both insomnia and hypersomnia are associated with suicidal behavior in patients with major depression.

Subjective sleep quality and suicidality in patients with major depression

The purpose of this study was to examine the association between sleep quality and suicidality in major depressive disorder. We evaluated 41 patients with major depression by using the Pittsburgh Sleep Quality Index (PSQI) and the Schedule for Affective Disorders and Schizophrenia (SADS) suicide subscale. We found that suicidal depressive patients had significantly higher scores of subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency and PSQI global scores than nonsuicidal patients. We also found significant correlations between the SADS suicide subscale scores and most measures of the PSQI. These data suggest that there is an association between poor subjective sleep quality and suicidal behavior in patients with major depressive disorder.

Suicidal behavior in patients with major depression and comorbid personality disorders

We investigated the relationship of DSM-III-R personality disorder (PD) diagnoses and traits to suicidal behavior in patients with Major Depressive Disorder (MDD). Axis I and Axis II criteria and suicidal behavior were assessed using structured interviews of 102 psychiatric inpatients. Subjects with comorbid MDD and Borderline PD (BPD; n = 30) were more likely than other patients to have a history of multiple suicide attempts, and were equally likely to have made a highly lethal attempt. Number of BPD and other Cluster B (dramatic/erratic) criteria were better predictors of past suicidal behavior than were depressive symptoms. We conclude that patients with BPD symptomatology are at risk for serious suicide attempts. Moreover, severity of comorbid Cluster B PD psychopathology should be considered when assessing suicide risk in MDD patients even in those without a PD diagnosis.

Suicidality in hospitalized patients with a primary diagnosis of personality disorder.

In this investigation the frequency and clinical importance of suicidal behavior in patients with a primary diagnosis of personality disorder was studied. The sample was drawn from a group of over 8000 psychiatric inpatients admitted to a university psychiatric hospital. Only patients with a primary diagnosis of personality disorder were included. In the subgroup of 226 patients with this diagnosis, it was found that the rate of suicidality was almost as great as that of patients with a primary diagnosis of major affective disorder (39% as opposed to 41%), despite the absence in all but 3% of these patients of an additional diagnosis of affective disorder. Further, this figure was considerably higher than that for all psychiatric inpatients (24%). Suicidal patients had more suicide attempts in their history and had a more serious depressive syndrome, despite the fact that only 3% fulfilled the criteria for major affective disorder. The conclusion which can be drawn is that a high degree of suicidality should not be regarded as exclusively linked to a primary diagnosis of major affective disorder.

Suicidal behavior in patients with panic disorder: retrospective and prospective data

This paper examines factors associated with suicidal behavior in patients with anxiety disorders. HARP is a naturalistic, prospective, longitudinal follow-up study. This paper examines 527 subjects with panic disorder (with or without agoraphobia). 9% of the subjects reported past suicidal behavior. Factors associated with suicidal behavior were depressive disorders, substance abuse, eating disorders, PTSD and personality disorders as well as having early onset of the first anxiety or depressive disorder. Subjects had a 4.5% P of suicidal behavior during the first 30 months of follow-up. All prospectively recorded suicidal behavior occurred in subjects with depressive disorders. In these panic disorder patients, suicidal behavior rarely occurred in the absence of affective disorders. Certain nondepressive disorders also substantially increased the risks of suicide attempts/gestures.

Risk factors for suicidal behavior in borderline personality disorder.

This study identified potential risk factors for suicidal behavior in patients with borderline personality disorder defined by the Diagnostic Interview for Borderline Patients and by DSM-III-R criteria for patients who did and did not attempt suicide. Histories of suicide attempts and attempt characteristics were obtained by Schedule for Affective Disorders and Schizophrenia interviews from 84 patients with borderline personality disorder and were related to severity of borderline pathology, diagnostic comorbidity, and state and trait symptoms. There were 61 patients with a lifetime history of suicide attempts (72.6%), with an average of 3.39 (SD = 2.87) attempts per patient. Attempters were significantly older than nonattempters, with more impulse actions, antisocial personality disorder comorbidity, and state depression. State depression was significantly less severe in patients who had attempted suicide in the present episode (or past year) than in patients who had attempted suicide only in the past. A comorbid diagnosis of major depression, alcoholism, or drug use disorder did not distinguish attempters from nonattempters. Suicide attempt in the present episode was best predicted by the number of prior lifetime attempts. A highly serious intent to commit suicide was predicted by the number of lifetime attempts and subjective depression, while a low intent was predicted by a mixed subtype of borderline personality disorder plus schizotypal personality disorder and paranoid ideation. A high degree of medical lethality was predicted by number of lifetime attempts, older age, and hysteroid dysphoria, while low lethality attempts were associated with high degrees of anger. Risk factors for suicidal behavior in patients with borderline personality disorder include older age, prior suicide attempts, antisocial personality, impulsive actions, and depressive moods but not comorbid affective disorder, alcoholism, or drug use disorders.

Panic disorder and suicidality: Prevalence and risk factors

Recent epidemiological research describes an increased risk of suicidal behavior in patients with panic disorder. In direct contrast, retrospective file reviews do not reveal significant suicidality among panic patients. The current study was designed to provide an initial rapproachment between these different methods and contradictory findings by assessing directly the parameters of suicidal behavior in a sample of 50 patients with panic disorder. Twenty-six percent of the sample endorsed suicidal ideation because of their panic attacks, and four percent of the total sample reported attempts due to their panics. Panickers with suicidal ideation reported specific methods, with a range of lethality. Their rationales tended to cluster into ending attacks and preventing future attacks. In comparison to nonideating panickers, ideators were younger, had earlier age of onset of panic disorder, were rated as having somewhat more severe panic, and reported significantly greater levels of distress and psychopathology across a variety of psychometric instruments. These initial results are discussed in terms of supporting the epidemiology of and the identification of risk factors for suicidality in panic samples.

Suicidal behavior in bipolar and unipolar affective disorders: a meta-analysis

A meta-analysis of studies of suicidal behavior in patients with bipolar and unipolar affective disorders found two possible trends: an excess of subsequent completed suicide in unipolar patients and an excess of subsequent attempted suicide in bipolar patients. Suggestions were made for future research

5-hydroxyindoleacetic acid in cerebrospinal fluid and prediction of suicidal behaviour in schizophrenia

Low concentrations of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in cerebrospinal fluid (CSF) are associated with suicidal behaviour in patients with depressive illness, but studies of the relation between CSF 5-HIAA and suicide in schizophrenia have been inconclusive and have not included long-term follow-up. In a prospective study, we measured 5-HIAA in CSF taken from 30 schizophrenic patients in a drug-free state, and followed these patients for 11 years. 10 patients made suicide attempts during follow-up. Suicide attempters had significantly lower concentrations of CSF 5-HIAA at initial evaluation than non-attempters (mean [SE] 6·7 [2·2] vs 23·6 [5·6] ng/ml, p<0·05). Our findings provide further evidence of the relation between serotoninergic dysfunction and suicide, and suggest a role for drugs with serotoninergic effects in schizophrenia.

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The duration, nature and recurrence rate of brief depressions

1. 1. It has been shown in placebo controlled studies of prophylactic treatment of suicidal behaviour in patients not suffering from major depression that brief episodes of depression predict further suicidal behaviour. 2. 2. In a prospective follow up study of patients with a history of repeated suicidal behaviour it appears that almost all suffered recurrent episodes of brief depression, mainly of moderate to severe intensity. Two thirds of the episodes lasted between two and four days. The recurrences were frequent, irregular, and apparently unpredictable. 3. 3. The episodes were distinguishable from major depression only by the short duration.

CSF monoamine metabolites in patients and controls: support for a bimodal distribution in major affective disorders

The monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF) were measured in 38 patients with major affective disorder and 48 age- and sex-matched controls by means of liquid chromatography. Statistical analysis using maximum likelihood normal mixture computations provided evidence for a subgroup of patients characterized by low CSF levels of both 5-HIAA and HVA. In controls, CSF 5-HIAA and HVA levels appeared to be normally distributed when fitted separately, whereas a subgroup of controls characterized by higher values of 5-HIAA and HVA could be discerned when metabolite data were fitted simultaneously. No relationship was found between monoamine levels and suicidal behaviour in patients. A statistically significant relationship was found between CSF 5-HIAA and HVA levels in patients and controls. These data provide supportive evidence for the existence of a subgroup of patients with an abnormal serotonin metabolism as reflected by 5-HIAA, and probably HVA, in CSF.

Parasuicide: interaction between inadequate parenting and recent interpersonal stress.

We report a controlled study in which we searched for links between early family adversity and recent interpersonal stress in parasuicidal patients. Our subjects reported fewer adverse experiences in childhood than did the younger, predominantly female, patients investigated in previous studies. Nevertheless, 47% of our parasuicidal group, as compared to 19% of control subjects, reported a sequential pattern of relationship difficulties starting in childhood. The pattern of early exposure to neglectful and overprotective parenting followed by recent conflict or separations in adulthood was found to discriminate most clearly between the parasuicidal and control groups. We suggest that factors such as low self-esteem, a sense of helplessness in the face of adversity and an abiding insecurity in intimate relationships may variously account for this heightened vulnerability. We conclude that a history of adverse relationships beginning in childhood should alert primary care-givers to the risk of suicidal behaviour in patients who are exposed to distressing separations or interpersonal conflict.

Suicidal behavior in bipolar manic-depressive patients and their families

There is a high risk of suicidal behavior in patients with primary affective disorder. An extensive investigation in patients with primary affective disorder reported attempted suicide in 26% of bipolar patients and 21% of unipolar patients, the highest rate occurring in female bipolar patients. 1 Woodruff et al. 20 found attempted suicide in 14% of unipolar patients as against 32% of bipolar patients with the highest rate in male bipolar patients. Winokur 18 in a study of bipolar manic depressive patients found that 25% of patients had made at least one suicidal attempt and 70% had made threats of suicide at least some time in their lives. Venkabo Rao 16 reported that suicidal ideas occurred in 75% of patients with recurrent affective disorder. Family studies have also reported a high incidence of suicide in the relatives of patients with affective disorder. 8 Mendlewicz et al. 7 studying a matched group of bipolar probands with and without a family history of manic depressive illness, found high rates of suicide in first and second degree relatives but there was no significant difference in relation to sex or family history. The diagnosis of the relative that suicided was not stated. A study of relatives of patients with primary affective disorder 10 reported that 79% of the suicides in first degree relatives were associated with a diagnosis of probable affective disorder and 10% by a diagnosis of probable alcoholism in the relative. Fathers in index cases were more likely to have committed suicide than mothers. A family history of suicide is considered a major risk factor in assessment of potentially suicidal patients, 13 however, the relationship between attempted suicide in patients and suicide or attempted suicide in relatives has received little attention and the nature and predictability of this association is uncertain. The following report concerns an analysis of suicidal behavior in a population of bipolar manic-depressive patients and the relationship of this attempt to suicide or attempted suicide in their first and second degree relatives.