伴人格障碍自杀未遂者临床特点研究

为探讨伴人格障碍自杀未遂的临床特点，对１０８名自杀未遂急诊入院的患按ＣＣＭＤ—２—Ｒ进行人格障碍的诊断，分为伴人格障碍组和不伴人格障碍组，得到社会人口学资料和临床资料并进行自杀意图量表及自杀企图冲动性和致死性的测定，将有关项目作对比分析。结果，有４０（３７．０４％）名自杀未遂伴发人格障碍。与不伴人格障碍自杀未遂比较，伴人格障碍自杀未遂有较多的既往自杀未遂史和精神科治疗史，自杀意图和自杀企图致死性较低，冲动性较高。提示，对伴人格障碍自杀未遂应给予特别对待和积极治疗。     

冲动性与非冲动性自杀未遂的比较

目的 自杀未遂是我国重要的公共卫生问题,但缺乏针对性的、有效的干预措施。本研究通过比较冲动性与非冲动性自杀未遂的特征,为制定相应的预防措施奠定基础。方法 对4所市县级综合医院的306例病情较重的自杀未遂病人用自制调查表进行调查。按其自杀前考虑自杀时间的长短人为地分为冲动性(≤2小时,164例)和非冲动性(>2小时,142例)两组,并对两组进行比较。结果 两组在许多方面有显著差异。用非条件Logistic回归分析控制不同因素之间的相互影响后,发现在自杀未遂者中,自杀前2周抑郁程度越轻、自杀意图强度越低,有急性(≤1月)负性生活事件、自杀前1个月生命质量越高、居住在乡村、越年轻越易发生冲动性自杀行为;而性别和其他因素与冲动性自杀行为的发生无关。结论 冲动性与非冲动性自杀未遂的特征明显不同,对这两种不同的自杀未遂人群是否应采取不同的预防及干预措施是目前迫切需要解决的问题。     

中国农村严重自杀未遂危险因素的配对病例对照研究(英文)

背景中国农村的自杀率是城市自杀率的2~3倍,但造成城乡自杀率之巨大差异的原因并不清楚。目的评估国内农村严重自杀未遂者的特征及危险因素。方法精神科医生采用结构式问卷对山东郓城县人民医院急诊室收治的297例严重自杀未遂者(至少在医院6小时者)及其陪伴的家属分别进行访谈。该问卷内容详尽,完成问卷需要2~3h。对照组选取同一居住地中年龄、性别与自杀未遂组相匹配的、既往无自杀未遂史的居民及其同住家庭成员,分别进行同样的结构式访谈。使用Cox回归模型来识别自杀未遂的危险因素。结果 297例自杀未遂者中,74%为女性,78%是农民,平均(标准差)年龄为33.2(14.6),平均受教育年限为4.8(3.1)年,80%为口服农药自杀,57%的自杀未遂者报告在采取自杀行动之前考虑自杀只有或不足5分钟,76%的自杀意图量表中计划分量表得分不足50分(0~100分),11%有过自杀未遂史,只有38%存在符合DSM-IV诊断标准的精神障碍。在控制性别、年龄、居住地以及之前的自杀未遂史(在配对分析中控制该变量)后,通过多因素分析,自杀未遂的危险因素包括:受教育水平低、与有过自杀行为的人交往、之前1年中至少有4次负性生活事件、之前1个月中生活质量低且家庭不够和睦、之前2周内的抑郁症状得分高以及冲动性和攻击性高(最后一项仅在小样本中进行评估)。结论我国农村严重自杀未遂者多数不符合精神障碍的诊断标准,冲动性和攻击性高、自杀意图并不强烈,多采用口服农药的方式。这些特点与高收入发达国家的特点不同,因而需要采取不同的方法来预防自杀行为。这些方法应更多的关注如何降低获取农药的便利性,并教育冲动性个体如何自我调整情绪和行为,而不是过度地关注精神障碍的识别和治疗。     

天水市农村女性自杀未遂者危险因素研究

目的:探讨甘肃天水市农村自杀未遂女性的自杀危险因素。方法:对天水市3个县区23个乡镇自杀未遂报告系统2007年6月至2009年1月报告的年龄≥14岁的自杀未遂女性150人(自杀未遂组)及由同一报告者提供的近1年内无自杀行为、年龄、居住地相匹配的正常女性150人(正常对照组)分别采用自编《伤害幸存者研究问卷》和《正常对照者研究问卷》进行自由访谈及问卷调查;分析自杀行为的危险因素。结果:自杀未遂组在文盲、人均年收入低、现患精神障碍、有人格障碍、对自杀接受性高、自杀意念强、既往有自杀未遂史、近1个月有过失眠、近1个月因心理问题难以工作、近1年有生活事件、急/慢性应激高、生命质量低、冲动性及攻击性高、家庭亲密性及家庭适应性低、社会支持差的发生率上明显高于正常对照组(χ~2=5.051~71.082,P0.05或P0.001);自杀行为特征为冲动性、服农药、家庭纠纷或为解脱痛苦。Logistic回归分析显示年龄40岁、文盲、现患精神障碍、对自杀接受性高、近1月因心理问题难以工作、近1年有生活事件、急性应激高、攻击性高、家庭亲密性低进入方程。结论:服药是天水市农村女性最常见的自杀方式;年龄40岁、文盲、现患精神障碍、对自杀接受性高、近1月因心理问题难以工作、近1年有生活事件、急性应激高、攻击性高、家庭亲密性低是天水农村女性自杀行为的危险因素。     

精神分裂症冲动性与自杀未遂的关联分析

目的 探讨精神分裂症患者冲动性与自杀未遂之间的关系。方法 本研究通过回顾调查河北省第六人民医院2018年1月～12月住院精神分裂症患者,应用自制一般情况调查表,收集患者的社会人口学资料。通过冲动行为风险评估表评估患者冲动性和自杀风险评估量表评估患者自杀未遂史。结果 住院精神分裂症患者冲动性检出率为35.7%。单因素分析显示：精神分裂症患者冲动性与吸烟、男性、住院次数、自杀未遂史有关。多因素Logistic回归分析显示：多次住院（0R=1.069,P=0.038）、男性（0R=1.579,P=0.005）、自杀未遂史（0R=2.272,P<0.001）为独立危险因素。结论 精神分裂症患者自杀未遂与冲动性密切相关,多次住院、男性精神分裂症患者冲动风险更高。     

冲动性和攻击性对大学生自杀未遂行为的影响

目的 了解冲动性及攻击性对大学生自杀未遂行为的影响.方法 采用<自杀态度与心理健康状况问卷(大学版-Ⅳ)>对重庆市随机抽取的11所大学的12000名大学生进行调查.比较有无自杀未遂大学生中文版Barratt冲动行为量表与Buss和Perry攻击问卷的评估结果,分析冲动性及攻击性人格对大学生发生自杀行为的影响.结果 收集有效问卷9808份,大学生自杀未遂的报告率为1.7%(169/9808).自杀未遂组的冲动行为量表中的非计划性、行动冲动性和认知冲动性及总分均高于无自杀未遂组(P<0.001).自杀未遂组Buss和Perry攻击问卷的总分及身体攻击、言语攻击、愤怒、敌意、指向自我的攻击等各因子分均高于无自杀未遂组(P<0.01).多因素条件logistic回归分析显示,与自杀未遂最密切有关的独立危险因素排列为:攻击性总分高(OR=20.81,95%CI:12.36～35.03,P<0.01),行动冲动性分高(OR=4.32,95%CI:2.33～8.01,P<0.01).冲动性总分高(OR=3.37,95%CI:1.65～8.42,P<0.01),非计划性分值高(OR=3.12,95%CI:1.75～5.56,P<0.01),自杀意念强(OR=2.54,95%CI:1.75～3.70,P<0.01),已发生过性行为(3.12,95%CI:1.75～5.56,P<0.01),女性(OR=2.15,95%CI:1.48～3.14,P<0.01),指向自我的攻击分值高(OR=1.89,95%CI:1.24～2.88,P<0.01).结论 有自杀未遂的大学生更多体现出冲动性及攻击性人格,对大学生冲动性自杀行为应采取不一样的干预方案.     

农村地区有、无精神障碍自杀未遂者及其自杀特征的比较

目的　比较农村地区有、无精神障碍自杀未遂者的特征。方法　以 1998年 8月至 2 0 0 0年 8月四所县 (市 )级综合医院急诊室中自杀未遂者 (共 5 78例 )为研究对象 ,有 32 6例完成自制问卷调查 ;其中 12 9例 ( 39 6 % )符合美国精神障碍诊断与统计手册第 4版中精神障碍的诊断标准 (有精神障碍组 ) ,197例 ( 6 0 4 % )无精神障碍 ,比较两组的特征。结果　 ( 1)两组社会人口学各变量的差异均无显著性 (P >0 0 5 ) ;有精神障碍组既往有自杀未遂史的比例 ( 2 7 9% )高于无精神障碍组 ( 8 2 % ) ,而口服农药 ( 75 2 % )和冲动性自杀的比例 ( 2 7 3% )低于无精神障碍组 (分别为 88 3%和 6 9 4 % ) ;( 2 )有精神障碍组的自杀意图强、慢性负性生活事件 (对心理影响≥ 1年 )多 ,急性应激强度小 (均P <0 0 0 1)。结论　有、无精神障碍自杀未遂者及自杀特征明显不同 ,对两种自杀人群应采取不同的干预措施。     

有自杀企图史的抑郁症住院患者临床特征研究

目的 研究有自杀企图史的抑郁症住院患者临床特点及相关危险因素。方法 回顾性 连续纳入 2013 年 12 月至 2016 年 11 月于首都医科大学附属北京安定医院抑郁症治疗中心住院的 472 例 抑郁症重度发作患者，根据有无自杀企图史将所有患者分为有自杀企图史组与无自杀企图史组。对有 自杀企图史和无自杀企图史患者的人口学资料、疾病特征、治疗药物、实验室检查指标等进行单因素和 多因素分析，对有自杀企图史的影响因素进行多元 Logistic 回归分析。结果 有自杀企图史组 120 例， 无自杀企图史组 352 例。与无自杀企图史组比较，有自杀企图史组女性多［68.33%（82/120）比 57.39% （202/352），χ2 =4.48，P＜ 0.05］、发病年龄早［34.00（24.25，44.00）岁比 38.00（27.00，49.00）岁；Z=-2.01， P＜ 0.05］、病程长［6.50（1.00，15.00）年比 3.00（0.58，10.00）年；Z=-3.07，P＜ 0.01］、发作次数多［2.00 （2.00，3.75）次比 2.00（1.00，3.00）次；Z=-3.01，P＜ 0.01）］。多元 Logistic 回归分析结果显示，女性（OR=1.64， 95%CI：1.05～2.56，P＜ 0.05）和病程长（OR=1.04，95%CI：1.01～1.07，P＜ 0.05）是患者有自杀企图史的 危险因素。结论 有自杀企图史的抑郁症患者有其相应的临床特点，如女性、病程长、发作次数多等， 对相关因素进行分析研究，有助于临床中对自杀风险进行预防及针对性治疗。     

精神分裂症急性期伴自杀行为患者的临床分析

目的 探讨精神分裂症急性期伴自杀行为患者的临床特征.方法 对64例精神分裂症急性期伴自杀行为患者进行分析,并与564例精神分裂症急性期无自杀行为患者的临床资料进行对照分析.结果 2组在性别、婚姻状况方面无显著性差异;在文化程度、居住地、病前有无生活事件方面有显著性差异.在临床症状方面,研究组的幻觉、思维障碍、抑郁症状明显高于对照组,而冲动行为、情感平淡、意志减退2组则无显著性差异.发生自杀未遂者以服用精神科药物居多,发生地点多于家中,多数患者自杀前有表示过其自杀意图.结论 精神分裂症患者急性期伴自杀行为的危险因素为幻觉、思维障碍、抑郁症状、病前生活事件等.多与患者沟通及时发现其自杀意图,严格控制药物来源为有效地预防其自杀的措施之一.     

精神分裂症自杀未遂与冲动性、社会人口学因素 关联分析

目的 探讨精神分裂症患者自杀未遂与冲动性、社会人口学因素之间的关系。方法 本 研究设计为横断面研究，调查河北省第六人民医院 2018 年 1 月 1 日至 12 月 31 日的 913 例住院精神分裂 症患者，自制一般情况调查表，记录患者的社会人口学资料、疾病特征。通过自杀风险评估量表中“自 杀未遂史”确定患者是否有过自杀未遂，通过冲动行为风险评估表评估患者是否有冲动性，采用单因素 和多因素 Logistic 回归分析对患者的自杀未遂影响因素进行分析。结果 住院精神分裂症患者终生自 杀未遂检出率为12.5%。单因素Logistic回归分析显示，冲动性（OR=2.226，P=0.001）、多次住院（0R=1.103， P=0.012）、吸烟（OR=1.603，P=0.039）为精神分裂症患者出现自杀未遂的相关因素（P＜ 0.05）。多因素 Logistic 回归分析结果显示，冲动性（0R=2.197，P＜ 0.001）与精神分裂症自杀未遂具有相关性，社会人口 学因素中女性（OR=2.459，P=0.001）、吸烟（OR=2.630，P=0.001）、多次住院（OR=1.091，P=0.030）与自杀未 遂有关（P＜ 0.05）。结论 冲动性、女性、多次住院、吸烟的精神分裂症患者自杀风险更高。     

Suicide attempts and personality disorder

OBJECTIVE: The purpose of the present study was to compare clinical characteristics of suicide attempters with or without personality disorders. METHOD: A systematic sample (n = 114) of patients from consecutive cases of attempted suicide referred to general hospitals in Helsinki was interviewed and diagnosed according to DSM-III-R. Forty-six subjects with DSM-III-R personality disorders were identified and divided into clusters A (n = 4), B (n = 34) and C (n = 8). These subjects were compared with 65 suicide attempters without personality disorders in terms of clinical characteristics and treatment received. RESULTS: Suicide attempters with personality disorders more often had a history of previous suicide attempts and lifetime psychiatric treatment than comparison subjects. However, suicide attempts did not differ in terms of suicide intent, hopelessness, lethality or impulsiveness between subjects with or without personality disorders. CONCLUSION: Although suicidal behaviour is a more persistent feature among those with personality disorders, their clinical characteristics at the time of a suicide attempt may not differ from those without personality disorders.     

A comparison of the medical lethality of suicide attempts in bipolar and major depressive disorders

Objectives:  Among mood disorders, bipolar disorder (BPD) is often noted to involve the highest rates of suicide attempts and possibly of completion. This study sought to determine whether suicide attempters with BPD exhibit suicide attempts with higher lethality than attempters with major depressive disorder (MDD) and to explore differences in clinical features associated with suicidal acts.
Methods:  Mood disordered suicide attempters were interviewed about Axis I and II diagnoses, lifetime history of suicide attempts, suicidal intent, suicidal ideation, the medical lethality of their most severe suicide attempt, severity of depression, hopelessness, lifetime aggression, and impulsivity.
Results:  The maximum lethality of suicidal acts tended to be higher among BPD attempters compared with those with MDD. However, there were no differences in the number of suicide attempts, intent to die or suicidal ideation. Suicide attempters with BPD reported higher levels of aggression and impulsivity but less hopelessness compared with MDD attempters. These differences could not be explained by Cluster B personality disorder comorbidity. Of note, within the BPD group, but not the MDD group, males reported suicidal acts with higher lethality. Multivariate analyses suggested that risk for more lethal suicide attempts is associated with BPD and male sex and that bipolar males appear to be especially vulnerable to these behaviors.
Conclusions:  Males with BPD make more lethal suicide attempts than females with BPD, an effect not observed among the MDD sample. Our findings suggest that higher rates of suicidal behavior in BPD may be due to a specific effect of BPD on males, leading to more dangerous suicidal behaviors. This effect, together with the larger proportion of males in the BPD group compared with the MDD group may lead to higher rates of reported attempted and completed suicide.     

Alexithymia and suicidal behavior

A number of factors including hopelessness have been identified as amplifying suicide risk. Alexithymia has recently been investigated as a predictor of suicidal behavior. The prevalence of the personality trait alexithymia in suicide attempters as well as other predictors of suicidal behavior were investigated in this study. One hundred suicide attempters were compared to 60 healthy controls on the measures of hopelessness, alexithymia, depression and suicidal ideation. First-timers and repetitive suicide attempters, males and females, married and unmarried suicide attempters were compared to each other in the suicide attempter group. The correlations of hopelessness, depression and alexithymia with suicidal intent and suicide lethality were investigated. The suicide attempter group did not display significantly higher scores on the alexithymia measure, compared to healthy controls. Alexithymia neither seemed to be a prevalent personality trait in suicide attempters nor a sensitive predictor of suicidality. The subscales of Toronto Alexithymia Scale measuring difficulty in identification and expression of feelings also did not reveal a significant difference between the two groups. Suicide attempters were more depressive, more hopeless and displayed greater suicidal ideation than healthy controls. Severity of depression was a stronger predictor of suicidal intent than hopelessness in the suicide attempter group. The lethality of the suicide attempt did not correlate with any of the psychometric measures. These findings propose that difficulty in the identification and articulation of feelings does not comprise a risk factor for suicidal behavior.     

Are suicide attempters who self-mutilate a unique population?

OBJECTIVE: Individuals who mutilate themselves are at greater risk for suicidal behavior. Clinically, however, there is a perception that the suicide attempts of self-mutilators are motivated by the desire for attention rather than by a genuine wish to die. The purpose of this study was to determine differences between suicide attempters with and without a history of self-mutilation. METHOD: The authors examined demographic characteristics, psychopathology, objective and perceived lethality of suicide attempts, and perceptions of their suicidal behavior in 30 suicide attempters with cluster B personality disorders who had a history of self-mutilation and a matched group of 23 suicide attempters with cluster B personality disorders who had no history of self-mutilation. RESULTS: The two groups did not differ in the objective lethality of their attempts, but their perceptions of the attempts differed. Self-mutilators perceived their suicide attempts as less lethal, with a greater likelihood of rescue and with less certainty of death. In addition, suicide attempters with a history of self-mutilation had significantly higher levels of depression, hopelessness, aggression, anxiety, impulsivity, and suicide ideation. They exhibited more behaviors consistent with borderline personality disorder and were more likely to have a history of childhood abuse. Self-mutilators had more persistent suicide ideation, and their pattern for suicide was similar to their pattern for self-mutilation, which was characterized by chronic urges to injure themselves. CONCLUSIONS: Suicide attempters with cluster B personality disorders who have a history of self-mutilation tend to be more depressed, anxious, and impulsive, and they also tend to underestimate the lethality of their suicide attempts. Therefore, clinicians may be unintentionally misled in assessing the suicide risk of self-mutilators as less serious than it is.     

Beyond the mental pain: A case-control study on the contribution of schizoid personality disorder symptoms to medically serious suicide attempts

BackgroundClinical and research findings have highlighted the role of interpersonal factors in suicidal behavior with high levels of intent and lethality. Schizoid personality disorder (SPD) is at the extreme end of interpersonal difficulties. Thus, we aimed to understand the contribution of SPD symptoms to suicide behavior and specifically to more lethal suicide attempts.MethodFour groups were investigated (N = 338): medically serious suicide attempters, medically non-serious suicide attempters, psychiatric and healthy controls. SPD symptoms, mental pain variants, and clinical characteristics were assessed.ResultsOverall, attempters were characterized by higher levels of most SPD symptoms. Solitary lifestyle and emotional detachment were higher among medically serious suicide attempters relative to less-serious attempters. Emotional detachment doubled the risk for high lethality, beyond mental pain variables.ConclusionsSPD symptoms of interpersonal difficulties and low levels of emotional expressions are important risk factors for more severe suicidal behavior. Implications for identification of at-risk groups for suicide are discussed.     

Hopelessness,impulsiveness and intent among suicide attempters with major depression,alcohol dependence,or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.     

Attempted suicide in those with personality disorders

Summary From a sample of 499 patients admitted to hospitals for suicide attempts, a subsample of 182 suicide attempters who described histories of illicit activities or who were diagnosed with DSM-II antisocial, drug or alcohol personality disorders were compared with another sample of 109 suicide attempters diagnosed as having depressive disorders. The former group of unsocialized attempters obtained similar depression inventory scores as the diagnosed depressive attempters. However, the index attempts of the unsocialized group were made with less suicidal intent than those of the diagnosed depressive patients, and they made more prior suicide attempts than the diagnosed depressive patients.     

Clinical Features Associated with Suicide Attempts versus Suicide Gestures in an Inpatient Sample

The objective of this study was to test whether suicide attempters and suicide gesturers can be clinically differentiated. A total of 150 subjects who had attempted suicide at least once, had made a suicide gesture, had suicidal ideation, and/or had engaged in non-suicidal self-injury were recruited from the inpatient service of the Jiménez Díaz Foundation (Madrid, Spain). A multinomial regression analysis was conducted. Histrionic and antisocial personality disorders were risk factors specific to suicide gestures. Narcissistic personality disorder was specifically associated with suicide attempts. Borderline personality disorder was associated with both suicide gestures and attempts. A high level of impulsiveness was a risk factor specific to suicide attempts. Conclusion: Suicide attempters and suicide gesturers are two distinct, although partially overlapping, populations.     

Characteristics of first suicide attempts in single versus multiple suicide attempters with bipolar disorder

Although suicidality remains highly prevalent among patients with bipolar disorder, little research exists examining the characteristics of successive attempts among individuals who make and survive a first suicide attempt. We compared bipolar subjects with a history of one suicide attempt to those with multiple attempts and assessed demographic characteristics, family histories, psychopathology, and clinical dimensions of suicidal behavior. Fifty-two DSM-IV bipolar patients (age 21 to 74 years) with a history of at least one suicide attempt were consecutively evaluated in the Bipolar Disorders Research Clinic of the New York Presbyterian Hospital. Circumstances surrounding each lifetime suicide attempt were assessed by direct interviews, questionnaires, and chart reviews along with family psychiatric histories, substance abuse histories, current psychopathology, and features of impulsivity and aggression. Multiple suicide attempts occurred in approximately two thirds of the study group. Single attempters were significantly more likely than multiple attempters to show high seriousness of intent at their first attempt (OR = 0.65, 95% CI = 0.43 to 0.99), and tended to be less likely than multiple attempters to exhibit mixed states at their first attempt (OR = 0.54, 95% CI = 0.28 to 1.01). Seriousness of intent was consistent across the first and second attempts (r =.48, P <.01) and second and third attempts (r =.74, P <.05). Single and multiple attempters differed in no other clinical or demographic characteristics studied. We conclude that multiple suicide attempts are common among bipolar patients. Those who survive an initial suicide attempt involving high seriousness of intent appear less likely than those with low intent to make subsequent attempts. Consequently, single attempters may represent a group more closely resembling those who complete suicide on a first attempt, in terms of the risk for death associated with their first attempt. However, multiple suicide attempts among bipolar patients are not necessarily associated with a higher risk for lethality in first suicide attempt survivors.     

Alexithymia in suicide attempters

Taiminen TJ, Saarijärvi S, Helenius H, Keskinen A, Korpilahti T. Alexithymia in suicide attempters. Acta Psychiatr Scand 1996: 93: 195–198. © Munksgaard 1996. Alexithymia seems to share some common features with psychological constriction, a phenomenon described in suicidal individuals. Fifty suicide attempters were interviewed within 24 h after arrival at a hospital, and measures of lethality of the attempt, suicidal intent, depression and alexithymia were carried out with structured instruments. Almost all the attempters were depressive, and about half of them were also alexithymic. However, alexithymia was not more prevalent in this population than in non-suicidal depressive patients. Depression and alexithymia correlated significantly with each other, but there was no correlation between alexithymia and lethality of the suicide attempt or suicidal intent. The authors conclude that alexithymia in suicide attempters seems to be associated with depression, but not with suicidality per se. Therefore, measurement of alexithymia may not yield extra information in suicide risk assessment.