Polyunsaturated fatty acids as predictors of future suicide attempt.

Polyunsaturated fatty acids (PUFAs) and cholesterol are lipids implicated in suicide risk. We prospectively studied plasma glycerophospholipid PUFAs and cholesterol as putative predictors of suicide attempts. In a multicenter cohort study, we enrolled 123 patients admitted to the emergency department (ED) for suicidal ideation or suicide attempt. Clinical assessments were performed, with follow-up telephone evaluations 6, 12, 18, and 24 months later. Blood samples were obtained in the ED and assayed for PUFAs. Using survival analysis, suicide events were not predicted by eicosapentaenoic acid (EPA, HR: -0.83, 95%CI: 0.39-1.76, p = 0.621) or docosahexaenoic acid (DHA, HR: -0.60, 95%CI: 0.19-1.86, p = 0.371). However, higher arachidonic acid (AA) was a trend for a protective factor (HR=0.30, 95%CI: 0.08-1.08, p = 0.065) in the entire trans-diagnostic sample. This protective effect was significant in all participants with a prior suicide attempt history (n = 85; HR=0.16, 95%CI: 0.04-0.67, p = 0.012), and in the subgroup of attempters with major depressive disorder (MDD; n = 55, HR=0.15, 95%CI:0.03-0.76, p = 0.002). Total LDL- and HDL-cholesterol did not predict subsequent suicide events. AA, but not DHA or EPA, positively correlated with baseline depression severity in MDD patients (r = 0.3, p = 0.006). Contrary to our hypothesis that low n-3 PUFA levels would create risk, we found that while higher AA was associated with greater depression severity at baseline, low AA unexpectedly predicted subsequent suicide attempts, the more so in higher-risk patients. Although surprising, this result agrees with a minority of reports concerning n-6 PUFAs and may represent complex interactions with sample characteristics.

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients.

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.

Interaction between prospective risk factors in the prediction of suicide risk.

BACKGROUND: To meet the goal of preventing suicide the most important thing is to know the risk factors of suicidal behavior and understand their interaction. AIMS: The current study aims to evaluate prospective predictors and the interaction between factors for suicide and suicide re-attempts in high-risk, suicidal patients during a 24 month prospective follow-up period. METHODS: A multicenter prospective cohort study was designed to compare data obtained from 324 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Participants were clinically evaluated at baseline and follow-up every 6 months to assess any unfavorable events (suicide or a suicide attempt). To estimate the rate of unfavorable events, the Kaplan-Meier method was used and Cox Proportional Hazards Regression Model was employed to examine predictors of suicide and suicide reattempt. RESULTS: The incidence of a new suicide attempt was 26,000 events/100,000 persons-years. The incidence of death by suicide was 1110 events/100,000 person-year. The most reliable predictors of unfavorable events were being women, previous suicide attempts, younger age, and childhood sexual abuse. Findings revealed an interaction between childhood sexual abuse and low psychosocial functioning that increased the risk of an unfavorable event. CONCLUSION: The risk of suicide re-attempts and suicide in the current 2-year follow-up was high. There was an interaction between low psychosocial functioning and childhood sexual abuse. This evidence should be taken into account for the evaluation and planning of preventive strategies.

Lethality of Previous Suicidal Behavior among Patients Hospitalized for Suicide Risk Predicts Lethality of Future Suicide Attempts.

OBJECTIVE: A suicide attempt is an established risk factor for subsequent suicide attempts and suicide. Nonetheless, the prediction of future suicidal behavior is poor. The lethality of previous suicidal behavior may be informative to better understand future suicide risk among patients hospitalized for suicidal thoughts and behavior. The current study examined whether the lethality of patients' index (most recent suicidal episode at hospitalization), first, and worst suicidal episode predicts the lethality of one's most lethal suicide attempt during a 2-year follow-up period. METHOD: A total of 98 patients hospitalized at an emergency department for high suicide risk (i.e., acute suicidal ideation or a suicide attempt) were included in the study. RESULTS: Results indicated that the lethality of the index suicidal episode predicted the lethality of the worst suicide attempt during a 2-year follow-up period. CONCLUSIONS: These findings extend a growing literature examining risk factors that influence the progression toward high lethality suicidal behavior.

Serotonin transporter gene polymorphism as a predictor of short-term risk of suicide reattempts.

OBJECTIVE: The serotonin-transporter-linked polymorphic region (5-HTTLPR) polymorphisms are associated with suicidal behavior; however, prospective studies are scarce. Herein we aim to determine if 5-HTTLPR polymorphisms predict risk of short-term suicide reattempt in a high-risk suicidal sample. We also explore possible mediators or moderators of this relationship. METHODS: A multicenter prospective cohort study was designed to compare data obtained form 136 patients admitted to the emergency department for current suicidal ideation or a recent suicide attempt. Subjects were clinically evaluated, genotyped, and monitored for a new suicide attempt for 6 months. RESULTS: At 6 months of follow up, 21% of the subjects had a new suicide attempt. The frequency of L-allele and L-carrier was higher in reattempters when compared with non-reattempters (55.8% vs. 35.4%, p =  0.01 and 76.9% vs. 54.2%, p = 0.04, respectively). Reattempters also differ from non-reattempters patients with respect to age, history of previous suicide attempts, and age of onset of suicidal behavior. The logistic regression model showed that L-carriers had an odds ratio of 2.8 (95% CI: 1.0-7.6) for reattempts when compared to SS genotype. The adjusted model indicates that this association is not mediated or moderated by impulsivity. CONCLUSION: The 5-HTTLPR polymorphisms predicted short-term risk of suicidal reattempt independently of age and sex. L-carriers have almost three times more risk of relapse when compared with SS carriers.

[Comparative analysis about hospitalization characteristics in the mental health unit of a general acute care hospital]. / Análisis comparativo sobre las características de las internaciones en una sala de Salud Mental en un hospital general de agudos.

INTRODUCTION: In Argentina, like in the rest of the world, deinstitutionalization policies have been implemented. In our country, the shortage of epidemiologic data regarding admissions in mental health is a limitation for the discussion about how this changes should be implemented and its effect. OBJECTIVES: Epidemiologic data of inpatients of the Mental Health Unit of the Teodoro Álvarez General Hospital between June 2012 and May 2013 has been analyzed in order to elaborate a comparative analysis with a previous study that took place in the same unit on the years 2004-2005. MATERIALS AND METHODS: This is naturalistic, descriptive and retrospective study about adult male inpatients admitted in the psychopathology ward of the Álvarez Hospital. Data was taken from the patient's medical history report. RESULTS: There were 51 hospitalizations during the study (versus 82 hospitalizations in the previous one). The average age was 34.4 years. The average patient hospitalization was 46.2 days (versus 45.4), 84% (vs 89.7%) of hospitalizations lasted less than 90 days, although there was an increase in hospitalization that lasted between 90 and 179 days (7.3% vs 13.7%). The most frequent reason for hospitalization was acute psychotic syndrome, 62.7% (versus 48.8%) of the patients had previous psychiatric hospitalizations. The most frequent diagnosis at discharge were: 38.4% schizophrenia and other psychotic disorders (vs 38.1%), 21.5% personality disorders (vs 25%), 17% mood disorders (vs 17.7%), 15.4% substance use related (vs 22.1%). CONCLUSION: There has been a considerable decrease (from 82 to 51) in the total number of hospitalizations and also a decrease in the BTR (bed turnover ratio) from 4.1 to 2.6 and an increase in hospitalizations with a duration superior to 90 days and inferior to 179 days.

[Posttraumatic stress disorder: Conceptualization and psychopharmacological treatment update]. / Trastorno por estrés postraumático: conceptualización y actualización en el tratamiento psicofarmacológico.

Posttraumatic stress disorder (PTSD) is characterized by four symptom complexes: the reexperience/intrusion of the traumatic event, a state of hyperarousal when exposed to traumatic events, emotional block and emotional/affective deregulation with negative cognitive and mood alterations. Its evolution tends to be chronic and its related with a significative morbidity, affecting the functionality of the individual in his interpresonal, social and employment areas. In 1980, the American Psychiatric Association includes PTSD in the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), and thereafter several research studies are developed to evaluate the effectiveness of drugs on its treatment. After reviewing its conceptualization, a critical review of published literature is made in order to provide an update on evidence-based pharmacotherapy of PTSD. Selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) are the drugs that have proven most effective, achieving the degree of recommendation for first line use.

[Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up]. / Pacientes hospitalizadas por ideación e intento de suicidio en un Hospital de Salud Mental: características clínico-demográficas y seguimiento a seis meses.

BACKGROUND: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. OBJECTIVE: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. METHODS: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. RESULTS: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. CONCLUSIONS: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.

Pacientes hospitalizadas por ideación e intento de suicidio en un Hospital de Salud Mental: características clínico-demográficas y seguimiento a seis meses / [Patients hospitalized for suicidal ideation and suicide attempt in a Mental Health Hospital: Clinicodemographical features and 6-month follow-up].

BACKGROUND: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. OBJECTIVE: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. METHODS: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. RESULTS: Baseline data show that of all patients who entered the Emergency Department, 27

did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41

) and schizophrenia (16

). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22

of patients had a new attempted suicide and 34

had a readmission in a 6-month period. CONCLUSIONS: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.