Clinical Characteristics and Precipitating Factors of Adolescent Suicide Attempters Admitted for Psychiatric Inpatient Care in South Korea

Objective

We aimed to examine the rates, correlates, methods, and precipitating factors of suicide attempts among adolescent patients admitted for psychiatric inpatient care from 1999 to 2010 in a university hospital in Korea.

Methods

The subjects consisted of 728 patients who were admitted for psychiatric inpatient care in a university hospital over a 12-year period and who were aged 10-19 years at the time of admission. We retrospectively investigated the information on suicidal behaviors and other clinical information by reviewing the subjects'' electronic medical records. Whether these patients had completed their suicide on 31 December 2010 was determined by a link to the database of the National Statistical Office.

Results

Among 728 subjects, 21.7% had suicidal ideation at admission, and 10.7% admitted for suicidal attempts. Female gender, divorced/widowed parents, and the presence of mood disorders were associated with a significantly increased likelihood of suicide attempts. Most common method of suicide attempts was cutting, and most common reason for suicide attempts was relationship problems within the primary support group. A diagnosis of schizophrenia was associated with increased risk of death by suicide after discharge.

Conclusion

These results highlight the role of specific psychosocial factor (e.g., relational problems) and psychiatric disorders (e.g., mood disorders) in the suicide attempts of Korean adolescents, and the need for effective prevention strategies for adolescents at risk for suicide.     

长沙市农村社区老年人群自杀率的流行病学调查

目的　掌握农村社区老年人群自杀率的第一手资料 ,为预防农村老年人自杀提供依据。　方法　采取分层整群抽样方法 ,以长沙近郊浏阳市和望城县的 8个乡 (镇 )的全部 14 5个行政村1996～ 2 0 0 0年自杀死亡的老年人为调查对象 ,调查农村老年人自杀率 ,对自杀者的性别、年龄、地区等差异运用 χ2 检验和 (或 )u检验方法进行统计学推断。　结果　 (1) 5年平均标化自杀率 10 3 18/10万 ,男性 116 38/ 10万、女性 90 73/ 10万 ,性别差异无显著性 (P >0 0 5 ) ;(2 )自杀死亡占农村老年人群意外死亡的 6 7 6 8% ,为意外死亡的第一位死因 ;(3)望城县历年的老年人群自杀率呈直线上升趋势 (P <0 0 0 5 )。　结论　农村老年人群是自杀的高危人群之一 ,自杀为其意外死亡的首位死因     

抑郁症自杀行为简易预测模型构建及其预测价值研究

背景　抑郁症作为最常见的心境障碍之一,具有患病率高、复发率高、致残率高和致死率高等特点,给患者造成巨大的疾病负担,甚至出现自杀行为。但是,目前快速筛查抑郁症患者自杀行为的手段相对有限。目的　调查影响抑郁症患者出现自杀行为的心理社会因素,建立抑郁症患者自杀行为简易预测模型,为抑郁症患者自杀防治工作提供参考依据。方法　采用整群抽样方法选择2018年1-12月在南昌大学第二附属医院和南昌大学第一附属医院就诊的抑郁症患者为调查对象,采用一般情况问卷、抑郁自评量表（SDS）、焦虑自评量表（SAS）和Landeiman社会支持量表进行调查,采用多因素Logistic回归分析探讨抑郁症患者出现自杀行为的影响因素,Risk score法构建抑郁症患者自杀行为简易预测模型,并检测其预测效果。结果　共发放问卷2 233份,回收有效问卷2 090份,问卷有效回收率为93.60%。2 090例抑郁症患者中,142例（6.79%）出现自杀行为。经常吸烟、重度饮酒、既往抑郁发作次数≥1次、既往因抑郁症住院次数≥1次、伴焦虑症状、伴精神病性症状、伴自杀意念、有精神障碍家族史、正在用抗抑郁药物、有其他内外科疾病的抑郁症患者自杀行为比例高（P<0.05）。多因素Logistic回归分析结果显示,既往抑郁发作次数≥1次〔OR=4.308,95%CI（3.547,5.232）〕、伴焦虑症状〔OR=2.329,95%CI（1.201,4.518）〕、伴精神病性症状〔OR=2.492,95%CI（1.448,4.287）〕、伴自杀意念〔OR=4.044,95%CI（2.305,7.096）〕、SAS标准分高〔OR=1.036,95%CI（1.003,1.071）〕均是抑郁症患者自杀行为的危险因素（P<0.05）,正在用抗抑郁药物〔OR=0.110,95%CI（0.057,0.212）〕是抑郁症患者自杀行为的保护因素（P<0.05）。基于Logistic回归建立的Risk score预测模型为：Risk score=40.56×既往抑郁发作次数+23.50×伴焦虑症状+25.36×伴精神病性症+38.81×伴自杀意念-61.25×正在用抗抑郁药物+1.00×SAS标准分。按照Risk score预测模型绘制的受试者工作特征曲线（ROC）下面积（AUC）为0.920〔95%CI（0.907,0.931）〕,Youden指数最大时为0.7,截断值为193.23分,灵敏度为76.8%,特异度为94.2%。结论　抑郁症患者自杀行为发生率较高,既往抑郁发作次数≥1次、伴焦虑症状、伴精神病性症状、伴自杀意念、SAS标准分高均为抑郁症患者自杀行为的危险因素。基于Logistic回归建立的Risk score预测模型预测抑郁症患者自杀行为的灵敏度为76.8%,特异度为94.2%。     

Crise suicidaire et maladie d’Alzheimer débutante : intérêt d’une analyse neuropsychologique détaillée

IntroductionThe role of Alzheimer's disease as a risk factor for suicide is unclear. The aim of this study was to understand neuropsychological component of the suicidal crisis in Alzheimer's disease.MethodUsing an extensive neuropsychological battery, different aspects of cognitive inhibition were particularly examined: Access to relevant information (using the Reading with distraction task), suppression of no longer relevant information (Trail Making Test, Rule Shift Cards), and restraint of cognitive resources to relevant information (Stroop test, Hayling Sentence Completion test, Go/No-Go). One female Alzheimer depressed case was assessed before and after a suicide attempt.ResultsTen days after the patient's suicide attempt, dementia was still moderate with a MMSE score at 21/30 but with a worsening of executive functions (FAB at 8/18) in the context of depression and suicide. The Hamilton-Depression Rating Scale was at 24 (maximal score at 52), and the Cornell Scale for Depression was at 21 (maximal score at 38). Suicidal intent was moderate with a score of 9 on the Beck Suicide Intent Scale (maximal score at 25). The patient did not present a delirium, psychotic symptoms, or anosognosia. Her episodic memory was altered as shown by her semantic performance on verbal fluency (naming 12 animals in 120 seconds) and on lexical fluency (naming 8 words beginning with the letter P). Initially preserved, executive function declined during a suicidal crisis in a context of depression in Alzheimer's disease case. Neuropsychological testing confirmed a dysexecutive syndrome (FAS at 8/18), with an impairment in her conceptualization capacity (MCST) and a deficit in cognitive inhibition and its access (reading task in the presence of distractors), deletion (TMT) and restraint (Stroop, Go/No-Go, Hayling) functions. Computed tomography has shown no signs of intracranial expansive process.ConclusionAssessing predictors of suicide and means of completion in patients with dementia may help the development of interventions to reduce risk of suicide among the growing population of individuals with dementia. Because of Alzheimer's-related cognitive inhibition impairment, identification and intervention addressing the complex issues of depression, executive dysfunction and dementia may help clinicians to mitigate the risk of suicide in patients with Alzheimer's disease.     

Obésité et bypass gastrique,impact sur la qualité de vie et le risque suicidaire : revue de la littérature

In the last few years, the flourishing number of surgery for morbid obesity induces a growing interest in the short, medium and long-term consequences of the operative procedures. Both massive overweight and its surgical treatment such as gastric bypass can influence the mental health of patients and have an impact on their risk of suicide and suicide rates. Indeed, the suicide rate after the surgical treatment of obesity is increased; although medical literature is prolific on the subject of quality of life after gastric bypass surgery, less is known about the causes of postoperative suicide. There are few theories that allow discussion or hypothesis making and among these none can explain alone the excess of preventable deaths. This raises many questions about the management of candidates for gastric bypass: Is it possible to improve preoperative screening of patient's compliance? Should psychiatric follow-up become compulsory after surgery? It appears obvious from the current literature that suicide rates are higher among gastric bypass patients than the general population. It is reasonable to assume that this finding is related to the psychological difficulties experienced by patients, the impact on their quality of life and social functioning, on emotional and on a professional level. The intervention and massive weight loss can often destabilize an already precarious balance. It seems necessary to strengthen the psychiatric treatment of candidates for bariatric surgery and discuss the value of mandatory postoperative follow-up, as well as to promote patient compliance. Bariatric surgery patients with a history of psychiatric comorbidities should benefit from strict preoperative consultations and appropriate medication in order to rigorously balance their condition before surgery. Postoperative measures should include monitoring of high-risk populations such as patients with psychiatric comorbidity, as well as considering couple psychotherapy or support groups for patients and their relatives.     

The role of genetics in suicide and the link with major depression and alcoholism

A clear genetic influence in suicide has been established. In addition, both the serotonergic and noradrenergic systems appear to have a role in suicide, mood disorders and alcoholism. This paper reviews some of the genes that may possibly be involved in suicide and their link to major depression and alcoholism. The genes that are reviewed act on various enzymes within the serotonergic and catecholaminergic systems. With further study, these entities may form a spectrum along the same disease process associated with variable expressivity of the responsible genes.     

Intravenous iron sucrose for restless legs syndrome in pregnant women with low serum ferritin

We report on two pregnant women who either had de novo restless legs syndrome (RLS) or had marked enhancement of preexisting RLS symptoms during pregnancy. Both patients had ferritin values <50 μg/L at baseline. The patients had relevant sleep disorders and daytime symptoms caused by RLS. The women were treated in an open paradigm with intravenous iron sucrose. A few weeks after therapy, both patients experienced a significant reduction or even remission of RLS symptoms. Their quality of life and sleep substantially improved and no treatment-related adverse effects were observed. According to our initial experience, intravenous iron sucrose administration appears to be an effective therapy in RLS patients with low ferritin values during pregnancy.     

Suicidal and violent behaviour in mood disorders: A major public health problem. A review for the clinician

Abstract

Suicide attempt, and particularly completed suicide are relatively rare events in the community, but they are very common among psychiatric patients. Since over 90% of suicide victims suffer from (mostly untreated) current major mental disorders (particularly from major depressive episode), psychiatric risk factors are the clinically most useful predictors, especially if psychosocial and demographic risk factors are also pesent. Violent behaviours associated with mood disorders constitute a related yet independently also important aspect of this illness, and assessment and management of violence is a key component of everyday psychiatric practice. While most people with current mental disorder are not violent, violence is more common among seriously mentally ill individuals than in healthy persons. This is particularly true for untreated schizophrenics and untreated patients with major mood disorders, first of all in the cases of comorbid substance use disorders, mainly among those with current mania or postpartum depression. Although specific clinical studies are lacking, it is very lilely that successful acute and long-tem treatment of mood disorders can reduce the risk of violent behaviour in this patient population.