Smoking and suicidality in patients with a psychotic disorder

Cigarette smoking has been associated with an increased risk of suicide. Patients with psychosis are more likely to smoke cigarettes and are also at an increased risk of suicide. The aim of this study was to compare risk for suicidal behavior among patients with psychosis who were current smokers, previous smokers and nonsmokers. We studied 1812 of the 1825 participants who took part in the Australian Survey of High Impact Psychosis (SHIP) for whom smoking data was available. We identified predictors for lifetime suicide attempts using univariate logistic regression analysis. These variables were retained for the multiple logistic regression models if they were a significant predictor of lifetime suicide attempts. A series of multiple logistic regressions were then conducted to predict lifetime suicide attempts using current smoking status and lifetime smoking status as independent variables, respectively, while controlling for the retained predictor variables. Current smoking and lifetime smoking were statistically significant predictors of lifetime suicide attempts. However adding the covariates to a logistic regression model reduced this association to non-significance. The strongest predictors were self-harm in the past 12 months, the presence of lifetime depressive symptoms and a diagnosis of psychotic depression. Identification of suicide risk factors is essential for successful suicide prevention. While previous research highlights the importance of cigarette smoking as an important risk factor for suicidal behaviors including in patients with psychosis, these results must be interpreted within the context of methodological issues.     

Sleep and suicidality in psychotic patients

The purpose of the study was to determine whether polysomnographic rapid eye movement (REM) sleep parameters distinguish between psychotic patients with and without a history of suicidal behavior. We examined both hand-scored and automated measures of rapid eye movement (REM) sleep in psychotic patients with and without a history of suicidal ideation or attempts. Patients with suicidal behavior had significantly increased REM activity and time both in the whole night data and in the first REM period. These findings suggest an association between REM sleep abnormalities and suicidal behavior, perhaps related to alteration in serotonergic function.     

Symptoms and lifetime treatment experiences in psychotic patients with and without substance abuse

The main objective of this study was to compare symptom load and lifetime treatment experiences between psychotic patients with substance abuse problems and psychotic patients without substance abuse problems. This is a cross-sectional study of 48 patients (26 inpatients and 22 outpatients) in a clinic for early intervention in psychosis. Patients’ were grouped into two categories based on whether they had a substance abuse problem or not. Twenty-one (43.8%) had a substance abuse problem and 27 (56.2%) had not. We used the Positive and Negative Symptom Scale (PANSS) scale to measure symptoms and several scales to measure substance abuse. Parametric tests (independent t-tests) were used to compare continuous variables, and chi-square tests were used to compare frequencies. Positive symptoms, negative symptoms, general psychopathology symptoms and the total score of psychotic symptoms did not differ significantly between the groups with psychosis alone and psychosis with substance abuse. The delusion subscore was significantly higher in the group with psychosis alone (t=?2.3, df=41, P<0.05), and the anxiety subscore was significantly higher in the group with psychosis with substance abuse (t=?2.3, df=41, P<0.05). There were no significant differences in the subscores for negative symptoms. The absence of differences in psychotic symptoms between the two groups with psychosis does not imply a strong relationship between psychotic symptoms and substance abuse. These results do not support the self-medication hypothesis. The higher rates of institutionalization among substance abusers may be explained by mechanisms other than exacerbations of psychotic symptoms, as there are few differences in symptoms among abusers and non-abusers.     

Longitudinal relationships of religious worship attendance and spirituality with major depression, anxiety disorders, and suicidal ideation and attempts: findings from the Baltimore epidemiologic catchment area study

We present findings on the longitudinal relationships of religious worship attendance and seeking spiritual comfort with subsequent major depression, anxiety disorders and suicidal ideation/attempts using data from Waves 3 and 4 of the Baltimore Epidemiologic Catchment Area Study (N = 1091). Respondents who attended religious services at least once per year had decreased odds of subsequent suicide attempts compared with those who did not attend religious services (AOR = 0.33, 95% CI: 0.13-0.84). Seeking spiritual comfort at baseline was associated with decreased odds of suicidal ideation (AOR = 0.55, 95% CI: 0.31-0.99). These finding were independent of the effects of the presence of the suicidal ideation/attempts, comorbid mental disorders, social supports and chronic physical conditions at baseline. These results suggest that religious attendance is possibly an independent protective factor against suicide attempts.     

Religion/Spirituality and Adolescent Psychiatric Symptoms: A Review

The aim of the current article is to review the literature on religion and spirituality as it pertains to adolescent psychiatric symptoms. One hundred and fifteen articles were reviewed that examined relationships between religion/spirituality and adolescent substance use, delinquency, depression, suicidality, and anxiety. Ninety-two percent of articles reviewed found at least one significant (p < .05) relationship between religiousness and better mental health. Evidence for relationships between greater religiousness and less psychopathology was strongest in the area of teenage substance use. Methods of measuring religion/spirituality were highly heterogeneous. Further research on the relationship of religion/spirituality to delinquency, depression, suicidality, and anxiety is warranted. Measurement recommendations, research priorities, and clinical implications are discussed.     

Medication adherence among psychotic patients before admission to inpatient treatment

OBJECTIVE: Nonadherence to antipsychotic regimens is considered to be one of the main reasons for hospital readmission. This study assessed the extent of nonadherence in the month before inpatient treatment. METHODS: Ninety-five consecutive patients with an ICD-10 diagnosis of a psychotic disorder (F20) were surveyed about adherence at admission to psychiatric inpatient treatment at a hospital in Linz, Austria. Adherence was assessed on the basis of self-report and by interviewing multiple informants. Episodes of inpatient treatment during the year after discharge were assessed prospectively. RESULTS: Fifty-four patients (57 percent) were rated as partially or fully nonadherent. Compared with patients with good adherence, those who were nonadherent had lower mean scores on the Global Assessment of Functioning (41.4 compared with 47.2), more often received compulsory treatment (52 percent compared with 22 percent), more often had impaired insight into their illness at admission (63 percent compared with 24 percent) and discharge (41 percent compared with 13 percent), and had more days of inpatient treatment in the year after discharge from the index episode (mean of 44.8 days compared with 20.6 days). Adherence was significantly better among patients in regular contact with their psychiatrist and among younger patients. Nonadherent patients who gained insight during treatment had significantly fewer days of inpatient treatment during the next year than those whose insight was still low at discharge (mean of 19.2 days compared with 73.2 days). CONCLUSIONS: Nonadherence is an important contributor to the need for inpatient treatment and is associated with a less favorable course of treatment. The best predictor of further inpatient treatment is insight into illness at discharge.     

Belief in an afterlife, spiritual well-being and end-of-life despair in patients with advanced cancer

Despite the plethora of research linking spirituality, religiosity and psychological well-being among people living with medical illnesses, the role of afterlife beliefs on psychological functioning has been virtually ignored. The present investigation assessed afterlife beliefs, spiritual well-being and psychological functioning at the end of life among 276 terminally ill cancer patients. Results indicated that belief in an afterlife was associated with lower levels of end-of-life despair (desire for death, hopelessness and suicidal ideation) but was not associated with levels of depression or anxiety. Further analyses indicated that when spirituality levels were controlled for, the effect of afterlife beliefs disappeared. The authors concluded that spirituality has a much more powerful effect on psychological functioning than beliefs held about an afterlife. Treatment implications are discussed.     

Serum lipid levels and suicidality among male patients with schizoaffective disorder

Suicidal behavior in schizoaffective disorder is a serious problem and suicide risk during lifetime ranges between 5%-10%. Neurobiology of suicidal behavior has not been studied sufficiently, and a high number of studies are oriented toward lipid investigation. The aim of our study was to investigate whether there were differences in the level of lipids (cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides) in hospitalized suicidal (n=20) and non-suicidal (n=20) patients with schizoaffective disorder. The study also included male healthy control subjects (n=20). Hamilton Depression Rating Scale (HDRS-17), and Positive and Negative Syndrome Scale (PANSS) were used to confirm the level of psychopathology in patients with schizoaffective disorder. Severity of suicidality was measured by Scale for Suicide Ideation (SSI) at time of admission. Results of the study indicated significantly lower concentrations of cholesterol (p<0.001), LDL-cholesterol (p<0.01) and HDL-cholesterol (p<0.01). There were no differences in the number of previous hospitalization and previous suicide attempts between suicidal and non-suicidal patients (p>0.05). Duration of the illness was significantly (p<0.05) shorter in suicidal patients. Suicidal patients also had a significantly higher score on HDRS-17 (p<0.001) and PANSS (p<0.01) compared to non-suicidal patients.     

Clinical differences between cocaine-induced psychotic disorder and psychotic symptoms in cocaine-dependent patients

The aim of this study is to compare the clinical characteristics of three groups of patients in treatment for cocaine dependence: patients without any psychotic symptoms (NS), patients with transient psychotic symptoms (PS) and patients with cocaine-induced psychotic disorder (CIPD). An observational and retrospective study of 150 cocaine-dependent patients undergoing treatment in the Drug Unit of the Psychiatry Department of University Hospital Vall d?Hebron in Barcelona (Spain) using these three groups, NS, PS and CIPD, was performed. All patients were evaluated with the PRISM interview. ANOVA, χ² tests and multivariate multinomial regression analysis were used to perform statistical analyses. Seven patients with a primary psychotic disorder were discharged. Forty-six patients (32.1%) did not report any psychotic symptoms. Ninety-seven patients (67.9%) presented with a history of any cocaine-induced psychotic symptom and were considered as the cocaine-induced psychotic (CIP) group. Among them, 39 (27.3%) were included in the PS group and 58 (40.6%) were included in the CIPD group. A history of imprisonment was found significantly more frequently in the PS group than in the NS group. The distribution of age at onset of dependence, lifetime cannabis abuse or dependence and imprisonment were significantly different between the NS and CIPD groups. We conclude that in cocaine-dependent patients, clinicians should be advised about the risk of development of psychotic symptoms. The presence of some psychotic symptoms could increase the potential risks of disturbing behaviours.     

The analysis of negative life events, hopelessness and coping strategies among psychotic patients

Some theories explaining the background of suicidal attempts emphasise the role of depression, while others emphasise the role of hopelessness in the case of different psychological states, like psychosis. According to researches negative emotions, namely hopelessness predicts suicidal intentions more precisely than depression itself. In our study we measured the suicidal risk of our psychotic patients with hopelessness, depression and life event scales. Our results have implied that suicidal psychotic patient groups showed significantly more serious level of depression and hopelessness and had more negative life events than the non-suicidal group. Indeed, a sub-group could also be distinguished among suicidal psychotic patients in which the level of hopelessness predicts suicidal risk and not depression.     

Psychopathology and personality traits in psychotic patients and their first-degree relatives

Personality dimensions have been associated with symptoms dimensions in schizophrenic patients (SP). In this paper we study the relationships between symptoms of functional psychoses and personality dimensions in SP and their first-degree relatives (SR), in other psychotic patients (PP) and their first-degree relatives (PR), and in healthy controls in order to evaluate the possible clinical dimensionality of these disorders. Twenty-nine SP, 29 SR, 18 PP, 18 PR and 188 controls were assessed using the temperament and character inventory (TCI-R). Current symptoms were evaluated with positive and negative syndrome scale (PANSS) using the five-factor model described previously (positive [PF], negative [NF], disorganized [DF], excitement [EF] and anxiety/depression [ADF]). Our TCI-R results showed that patients had different personality dimensions from the control group, but in relatives, these scores were not different from controls. With regard to symptomatology, we highlight the relations observed between harm avoidance (HA) and PANSS NF, and between self-transcendence (ST) and PANSS PF. From a personality traits-genetic factors point of view, schizophrenia and other psychosis may be initially differentiated by temperamental traits such as HA. The so-called characterial traits like ST would be associated with the appearance of psychotic symptoms.     

Stress response symptoms in relatives of acutely admitted psychotic patients: A pilot study

Objective: The aim of this study is to identify specific stress response symptoms in relatives of acutely admitted psychotic patients, and to compare these responses with those of relatives of chronic inpatients. Method: Twenty-five relatives of acutely hospitalized, psychotic patients and 21 relatives of chronic inpatients were assessed within days of the acute patient's admission and 6 weeks later. The Impact Event Scale assessed intrusion and avoidance; items from the General Health Questionnaire (GHQ) and the Spielberger State Anxiety Inventory (STAI) assessed arousal. Results: At the first assessment, relatives of the acutely admitted psychotic patients reported higher intensity of intrusive symptoms, and more often a high arousal level compared to the relatives of chronic inpatients. Six weeks later, relatives of acutely admitted psychotic patients revealed both higher intensity and higher number of intrusive and avoidance symptoms, and higher level of arousal symptoms. Seven relatives of acutely admitted psychotic patients and no relatives of the chronic inpatients reported moderate to high level of intrusion, avoidance and arousal at both assessments. Conclusion: Relatives of acutely admitted psychotic patients revealed strong acute and persistent stress responses, similar to those described in subjects exposed to severe or life threatening illness. Even relatives of the chronic inpatients revealed stress-specific symptoms, but at a lower level. Specific stress response symptoms may impair the relatives' well-being, care-giving abilities, and their co-operation with the mental health system. Our results suggest that stress response symptoms in relatives should be given more attention.     

Impetuous suicidality with zolpidem use: a case report and minireview

Zolpidem is a clinically effective hypnotic medication for treating chronic insomnia. In the last decade, there has been increasing documentation of altered consciousness and behavioral changes following zolpidem administration. This report presents a case of a probable zolpidem induced suicide attempt and highlights similar studies of suicidal thoughts and behaviors of other patients that have taken the drug. We examine zolpidem and other treatments for insomnia, including the FDA approved hypnotics and frequently prescribed off-label medications, in terms of prescribing practices and adverse effects, especially altered consciousness and risk of suicide. Parallels are identified between the untoward activating side effects of zolpidem and its off-label use for patients in persistent vegetative states. We hypothesize that similar to the proposed mechanism in which the wakefulness promoted by zolpidem in vegetative patients is mediated by disruption of GABAergic tone in neurodormant brain regions, there may occur in patients with parasomnias interference of GABA activity in brain regions that maintain a high level of inhibitory regulation. Dosing recommendations are offered together with the FDA Safety Announcement addressing dose reductions for women due to possible carry-over effects the morning after ingesting zolpidem.     

Epilepsy and Religious Experiences: Voodoo Possession

Summary: Epileptic seizures have a historical association with religion, primarily through the concept of spirit possession. Five cases where epileptic seizures were initially attributed to Voodoo spirit possession are presented. The attribution is discussed within the context of the Voodoo belief system.     

Auditory event-related potentials in patients with psychotic illness: A 5-year follow-up

The auditory processing is diversely impaired in patients with the first-episode psychosis. During acute phase we previously reported reduced amplitudes in attention-dependent auditory evoked electrical brain potentials but not in those of early automatic components. Here seven first-episode patients at the disease onset and 5 years later were studied and compared to control subjects. At follow-up, also the unattended auditory stimuli elicited reduced amplitudes both in primary sensory component (N100, p = .043) and in automatic deviance detection (N200, p = .013) as compared to acute phase. Patients' psychopathology had improved, however they still showed alterations in components detecting automatic stimulus classification which may convey persisting tendency for misinterpretation in auditory perception.     

Cognitive insight and psychotic disorder: the impact of active delusions

While several studies have determined the Beck Cognitive Insight Scale (BCIS; [Beck, A.T., Baruch, E., Balter, J.M., Steer, R.A., Warman, D.M., 2004. A new instrument for measuring insight: The Beck Cognitive Insight Scale. Schizophr. Res. 68, 319–329] is a useful measure of cognitive insight, a number of questions have remained unanswered. While individuals with psychotic disorders have been shown to have impaired cognitive insight compared to a psychiatric comparison group, it has remained unclear how the cognitive insight of individuals with psychotic disorders compares to healthy individuals. Further, as previous studies have classified participants based on diagnostic classification, it has remained unknown if individuals with delusions and individuals with psychotic disorders without active delusions score differently on this measure. To examine these questions, we assessed the cognitive insight of healthy individuals and individuals with psychotic disorders, both with and without active delusions. Results indicated that individuals with psychotic disorders had impaired cognitive insight relative to healthy controls (p = .005), though individuals with active delusions and individuals with psychotic disorders without delusions had impairments in different domains. Individuals with delusions were overly confident in their own judgment relative to healthy controls and those without delusions (p = .011), though their self-reflectiveness was the same as normal controls. Individuals without delusions reported low self-reflectiveness relative to healthy controls and individuals with delusions (p = .004), though they were not overconfident in their judgment. These results are discussed in terms of existing research on cognitive insight, decision making, and psychosis.     

Relationship of Myers Briggs type indicator personality characteristics to suicidality in affective disorder patients

The current study characterized the Myers Briggs Type Indicator (MBTI) personality profiles of 64 suicidal and 30 non-suicidal psychiatric inpatients with affective disorder diagnoses. The MBTI divides individuals categorically into eight personality preferences (Extroverted and Introverted, Sensing and Intuitive, Thinking and Feeling, and Judging and Perceiving). Compared to the group of non-suicidal affective disorder patients, suicidal affective disorder patients were significantly more Introverted and Perceiving using ANCOVA analyses, and significantly more Introverted alone using Chi Square analyses.