The long-term stability of temperament traits measured after a suicide attempt. A 5-year follow-up of ratings of Karolinska Scales of Personality (KSP)

The main aim of the present study was to investigate whether or not temperament dimensions are stable over time. Twenty-six patients (21 women and five men) filled in the Karolinska Scales of Personality (KSP) both at admission after a suicide attempt (index) and at follow-up 5 years later. KSP changes were significantly associated with low severity of psychiatric symptoms and no reported reattempts at follow up. There were significant changes of all five groups of KSP, most prominently in anxiety-related scales. At index, KSP scores did not differ between those who later would repeat a suicide attempt (repeaters) and not, but repeaters more often tended to have a personality disorder and their 24-h urinary cortisol tended to be lower. In this limited sample, repeaters seem to have a protracted high anxiety level as mirrored by high and stable KSP scores over time.     

Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis

Background: People with schizophrenia have an increased risk of suicide and attempted suicide is suggested to be an important risk factor. Aim: Our objective was to assess the cumulative survival, predictive values and odds ratios of attempted suicide for suicide in a long-term cohort of patients with schizophrenia spectrum psychosis with and without previous attempted suicide. Method: Inpatients (n=224) hospitalized with schizophrenia spectrum psychosis were followed for a mean of 25 years. All patients were followed up for causes of death. Information on suicide attempt before the end of the observation period was retrieved from medical records. Results: Eight percent died by suicide during the follow-up. Eighteen percent of suicide attempters died by suicide. Two percent of non-attempters died by suicide. There was a strong association between previous suicide attempt and suicide in men and women. Odds ratio for attempters vs. non-attempters was 10. Suicide risk was almost three times higher in male than female suicide attempters. Conclusion: Previous attempted suicide is an important risk factor for suicide in both men and women with schizophrenia spectrum psychosis, particularly in male suicide attempters. The suicide risk remains high over a long period. Continuous assessment of risk factors and appropriate treatment are crucial for this patient group to prevent suicide.     

Suicide-preventive activities in psychiatric care: Evaluation of an educational programme in suicide prevention

To promote implementation of suicide-preventive activities, the Swedish National Centre for Suicide Research and Prevention of Mental Ill-Health (NASP) introduced a 200-h academic, postgraduate educational programme (based on the training-of-trainers model) in suicide prevention. This programme was provided at Karolinska Institute, Stockholm, for key persons in psychiatric care. Twenty-nine key persons from 11 psychiatric intervention clinics in Stockholm County attended the first course. Preconditions for implementing suicide-preventive activities were assessed by means of semi-structured interviews with all course participants still working in the intervention clinics (n=10). In all but one of these 10 clinics, a wide range of suicide-preventive activities had been implemented as a result of the NASP course. Activities varied in scope, but the key persons seemed to have succeeded in pinpointing the key elements in suicide prevention – the need for specific knowledge about the suicidal process and for well-defined suicide-preventive routines. However, organizational factors and staff turnover were obstacles to maintaining and making the activities routine. There is a need to strengthen the course participants’ formal roles as implementers and encourage the clinical management in their continuous implementation of suicide-preventive activities.     

Core features of suicide. Gender,age, alcohol and other putative risk factors in a low-incidence population

The aim of the study was to elucidate some supposed core features of suicide through a study of suicide in a low-incidence population. The material covered all suicides and undetermined deaths 1945–2004 in the Faroe Islands (a low-incidence population) and the study made use of all available information. Results showed that suicide rate had been low since the Second World War. However, there was an increase throughout the 1970s and 1980s. Supposed core features of suicide, such as gender, marital status, former psychiatric admittance, former suicidal behaviour, alcohol and method preference were confirmed. Others were not, such as an increasing rate with old age. In diagnostics, the role of psychiatric disorders was confirmed, but so was a substantial role of “no disorder”. Increase period revealed a high proportion of cases with alcohol involved and a substantial part included males, in age groups 25–64 years, unmarried, divorced and alcohol intoxicated. The main conclusion was that a low-incidence population of suicide population confirmed some supposed core features of the suicide phenomenon. Others, related to age and psychiatric disorders, were only partially confirmed. In periods of increase, the most vulnerable were the young and middle-aged males, unmarried, divorced, and alcohol played a crucial role.     

Gender dysphoria and homosexuality: A patient series

PurposeTo present the clinical course of adolescents who presented to the child and adolescent psychiatry outpatient clinic due to gender dysphoria and homosexuality through a patient series.MethodsThe clinical features, comorbidities, and the treatment process of 10 patients who presented to the outpatient clinic and were followed up over a period were presented.ResultsThe average age of the 10 patients, 5 girls and 5 boys, was 14.3 years for the girls and 16 years for the boys. Nine patients were admitted by their families primarily with the desire for the elimination of gender dysphoria or homosexual orientation. Only one female patient was brought by her family because of her intense depressive symptoms and suicidal thoughts. All of the patients had comorbid psychiatric diseases, nine had depression, and one had bipolar affective disorder comorbidity. The anxiety levels of all patients were high. Psychiatric management in each patient focused on the emotional, cognitive and social difficulties of the case. The treatment of two girls was interrupted suddenly by the family because they saw that the homosexual orientation of the patients was continuing. Two male patients were not brought back for treatment after the evaluation process.ConclusionsGender dysphoria and homosexual orientation are situations that families still find it difficult to accept and that they think it can be eliminated by pressure, coercion or psychiatric treatment. Patients show a high rate of psychiatric comorbidity due to family pressure and social exclusion. Although psychiatric support can cure comorbid disorders in a relatively short time, strains of family and social relationships continue to affect patients.     

青少年抑郁障碍患者与双相情感障碍患者睡眠特征及其对自杀风险的影响

目的 比较青少年抑郁障碍患者和双相情感障碍患者睡眠结构特征的差异,探讨睡眠指标等因素对患者自杀风险的影响。方法 回顾性查阅广州医科大学附属脑科医院2019年1月1日-2021年6月30日符合《国际疾病分类（第10版）》（ICD-10）诊断标准的抑郁障碍（n=97）和双相情感障碍（n=52）住院青少年患者病历资料,收集患者的年龄、性别、体质量指数（BMI）、精神科诊断、自杀风险评估量表（NGASR）评分及多导睡眠监测（PSG）结果。根据NGASR评分结果,将患者分为两组：0~5分为自杀低风险组（n=32）,>5分为自杀高风险组（n=117）。以既往文献中80例正常青少年的PSG数据作为对照组资料。建立多元线性回归模型探讨青少年情感障碍患者自杀风险的影响因素。结果 自杀高风险组睡眠效率和N2期睡眠占比均低于自杀低风险组（Z=-2.138、-2.520,P均<0.05）。抑郁组总睡眠时间、N2期睡眠时间以及REM期睡眠时间均少于双相组（t=-2.822、-3.087、-2.277,P<0.05或0.01）;抑郁组和双相组REM期睡眠占比均低于对照组（t=-2.369、-2.069,P均<0.05）。线性回归分析显示,青少年情感障碍患者自杀风险的影响因素包括N1期睡眠时间（β=0.019,P<0.05）、性别（男性vs.女性,β=-4.051,P<0.01）以及诊断（双相情感障碍vs.抑郁障碍,β=-1.429,P<0.05）。结论 与青少年双相情感障碍患者相比,青少年抑郁障碍患者存在睡眠连续性差、浅睡眠更少的特点。N1期睡眠时间、女性以及诊断为抑郁障碍是青少年情感障碍患者自杀的影响因素。     

Seasonality and suicide in Italy: amplitude is positively related to suicide rates

BACKGROUND: Recent studies have reported changes in the time patterns of suicide, with conflicting findings regarding the direction of these changes: data from Italy were investigated to evaluate the influence of recent social and medicine-related changes on the seasonality of suicides in the country. METHODS: A total of 71,227 male suicides and 26,466 female suicides occurring in Italy from 1974 to 2003 were investigated with harmonic spectral analysis to extract their monthly seasonal dispersion by five-year intervals. RESULTS: The suicide rates of both males and females showed a rising trend, with an evident peak in the 1987-1994 period and a decrease thereafter. Seasonality of suicides, with a clear peak in spring as against the other seasons, accounted for a statistically significant proportion of total variance: around 40% among males and 39% among females. Seasonality did not change across time in a relevant way; however, an anticipation of the peak was observed in both males and females over time, with amplitude increasing or decreasing as a function of yearly suicide rates. LIMITATIONS: Data could not be analysed according to age or to the method of suicide, since this information was not available across the whole time interval. CONCLUSION: The seasonal effect on mortality by suicide is positively related to suicide rates, so much that changes in suicide rates over time correspond to changes in suicide seasonality.     

The concept of violent suicide,its underlying trait and neurobiology: A critical perspective

Suicide is one of the leading causes of death and represents a significant public health problem world-wide. Individuals who attempt or die by suicide represent a highly heterogeneous population. Recently, efforts have been made to identify sub-populations and variables to categorize them. A popular dichotomy in suicide research of the past years is violent versus non-violent suicide - based on the method. This dichotomy is important given that there is an association between method of attempted suicide and risk of subsequent death by suicide. The differentiation concerning suicide methods is also critical regarding preventive efforts. In this review, we have tried to approach the concept of violent suicide from different perspectives, including a discussion about its definition and overlapping categories. In addition, we have critically discussed aggression as underlying trait, the question of intent to die, and sociodemographic, environmental, neuropsychological, and neurobiological factors potentially associated with violent suicide.     

Transmission des certificats de décès au CépiDc-Inserm en cas de mort suspecte en France,depuis 2000

Background

The purpose of this study is to assess variability in death certificates’ transmission related to suspicious deaths.