Pharmacological and somatic treatment effects on suicide in adults: A systematic review and meta-analysis.

BACKGROUND: Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. METHODS: A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. RESULTS: In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. CONCLUSION: Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.

Pharmacological and Somatic Treatment Effects on Suicide in Adults: A Systematic Review and Meta-Analysis.

Background: Suicide is a public health crisis. We conducted a systematic review and meta-analysis of the effects of psychopharmacologic and somatic therapies on suicide risk. Methods: A systematic search of MEDLINE for studies evaluating the effects of pharmacologic (excluding antidepressants) or somatic interventions on suicide risk was conducted. Studies were included if they used a comparison group, reported on suicide death, assessed a psychopharmacological or somatic intervention, and included adults. Study quality was assessed using the Newcastle-Ottawa scale. Fifty-seven studies were included from 2940 reviewed citations. Results: In bipolar disorder, lithium was associated with a reduction in the odds of suicide compared to active controls (odds ratio [OR] = .58, p = .005; k = 12) and compared to placebo/no lithium (OR = .46, p = .009; k = 9). In mixed diagnostic samples, lithium was associated with a reduction in the odds of suicide compared to placebo/no lithium (OR = .27, p < .001; k = 12), but not compared to active controls (OR = .89, p = .468; k = 7). In psychotic disorders, clozapine was associated with a reduction in the odds of suicide (OR = .46, p = .007; k = 7). Associations between suicide death and electroconvulsive therapy (OR = .77, p = .053; k = 11), non-clozapine antipsychotics in bipolar disorder (OR = .73, p = .090; k = 6) and antipsychotics in psychotic disorders (OR = .39, p = .069; k = 6) were not significant. There was no consistent relationship between antiepileptic mood stabilizers and suicide. There were insufficient studies to meta-analyze associations of suicide risk with vagus nerve stimulation, transcranial magnetic stimulation, magnetic seizure therapy, or transcranial direct current stimulation. Conclusion: Lithium and clozapine have consistent data supporting protective effects against suicide in certain clinical contexts.Reprinted from Depress Anxiety 2022; 39:100-112, with permission from John Wiley and Sons. Copyright © 2022.

Glutamate Systems in DSM-5 Anxiety Disorders: Their Role and a Review of Glutamate and GABA Psychopharmacology.

Serotonin reuptake inhibitors and benzodiazepines are evidence-based pharmacological treatments for Anxiety Disorders targeting serotonin and GABAergic systems, respectively. Although clearly effective, these medications fail to improve anxiety symptoms in a significant proportion of patients. New insights into the glutamate system have directed attention toward drugs that modulate glutamate as potential alternative treatments for anxiety disorders. Here we summarize the current understanding of the potential role of glutamate neurotransmission in anxiety disorders and highlight specific glutamate receptors that are potential targets for novel anxiety disorder treatments. We also review clinical trials of medications targeting the glutamate system in DSM-5 anxiety disorders. Understanding the role of the glutamate system in the pathophysiology of anxiety disorder may aid in developing novel pharmacological agents that are effective in treating anxiety disorders.

Using likelihood ratios to detect invalid performance with performance validity measures.

Larrabee (2008) applied chained likelihood ratios to selected performance validity measures (PVMs) to identify non-valid performances on neuropsychological tests. He presented a method of combining different PVMs with different sensitivities and specificities into an overall probability of non-validity. We applied his methodology to a set of 11 PVMs using a sample of 255 subjects. The results of the study show that in various combinations of two or three PVMs, a high reliability of invalidity can be determined using the chained likelihood ratio method. This study advances the ability of clinicians to chain various PVMs together and calculate the probability that a set of data is invalid.

An adaptation of the MMPI-2 Meyers Index for the MMPI-2-RF.

Using an overall sample of 278 individuals who had taken the Minnesota Multiphasic Personality Inventory-Second Edition (MMPI-2) and who had clear diagnostic information available in their medical records, the Meyers Index (MI) for the MMPI-2 (Meyers, Millis, & Volkert, 2002 ) was calculated for each individual, and a new version of the MI created for the MMPI-2 Restructured Form (MMPI-2-RF) was calculated. The MI is a method of combining multiple MMPI-2 validity scales into a single weighted index to assess exaggerated self-report on the MMPI-2. The new index is intended to provide the same type of global assessment of validity but for the MMPI-2-RF (MI-r). The MI and the MI-r were compared at both individual and group levels and were found to correlate well (r = .87). Diagnostic groups of litigants and nonlitigants of traumatic brain injury, chronic pain, and posttraumatic stress disorder were also examined; and the performance of the MI and the MI-r were similar. Similarly, the pass and fail agreement rate for the two scales was 93%. The results indicate that the MI and MI-r perform very similarly and are good methods of assessing overall validity of MMPI-2 and MMPI-2-RF test performance.

Are Self-Ratings of Functional Difficulties Objective or Subjective?

In this study, we compared objective neuropsychological data using the Meyers Neuropsychological Battery (MNB; Meyers & Rohling, 2004 ) and self-report measures of emotional distress using the Symptom Checklist 90-Revised (SCL-90-R; Derogatis, 1994 ) with self-ratings of functional difficulties as measured by the Patient Competency Rating Scale (PCRS; Prigatano, 1986 ). The results showed a high correlation between the PCRS and scales on the SCL-90-R (r = .65), whereas correlation with the overall test battery mean of the MNB was quite small (r = .18). Our results indicate that self-report of cognitive difficulties is more related to current emotional distress than to objective measures. Therefore, any diagnostic considerations that rely on self-report need to be tempered by considerations of current emotional status. This has implications for diagnoses such as posttraumatic stress disorder and other diagnoses that rely on self-report as a source of diagnostic information.