Personality and psychopathological profiles in individuals exposed to mobbing.

Increasingly, mental health and medical professionals have been asked to assess claims of psychological harm arising from harassment at the workplace, or "mobbing." This study assessed the personality and psychopathological profiles of 146 individuals exposed to mobbing using validity, clinical, and content scales of the Minnesota Multiphasic Personality Inventory 2. Profiles and factor analyses were obtained. Two major dimensions emerged among those exposed to mobbing: (a) depressed mood, difficulty in making decisions, change-related anguish, and passive-aggressive traits (b) somatic symptoms, and need for attention and affection. This cross-sectional pilot study provides evidence that personality profiles of mobbing victims and psychological damage resulting from mobbing may be evaluated using standardized assessments, though a longitudinal study is needed to delineate cause-and-effect relationships.

Body uneasiness and suicide risk in a non-clinical sample of university students.

Attitudes and feelings towards the body may be a source of pleasure and well-being; on the other hand, bodily dissatisfaction may lead to suffering, depression and even suicide. The study population consisted of 500 university students (190 males, 310 females); mean age of participants was 21.62 (SD = 2.70). Participants were assessed by means of the Body Uneasiness Test (BUT), the Reason for Living Inventory (RFL), and the Zung Self Depression Scale (SDS). Data underline a linear relationship between uneasiness linked to body image and possible suicide risk. Such evidence suggests that body uneasiness can be a source of psychological pain and in serious cases expose the individuals to an increased suicide risk. Yet, depression was the strongest correlate of increased suicide risk.

Health-related quality of life in myotonic dystrophy type 1 and its relationship with cognitive and emotional functioning.

OBJECTIVE: To evaluate the health-related quality of life in myotonic dystrophy type 1 and its relationships with clinical, genetic, neuropsychological and emotional factors. DESIGN: Case-control study of a continuous series of patients with myotonic dystrophy type 1. PATIENTS AND METHODS: Twenty patients, and 20 age-, sex- and education-matched healthy controls underwent the MOS 36-Item Short-Form Health Survey (SF-36), an extensive neuropsychological battery and emotional functioning tests. RESULTS: Patients' SF-36 mean scores were lower than those of controls in all dimensions. The neuropsychological study showed a significant impairment in visuospatial and verbal abstract reasoning (p=0.001), visuospatial memory (p=0.002) and attentive functions (p=0.03) in patients with myotonic dystrophy type 1. The emotional assessment showed significantly high scores in anxiety (p=0.002) and depression (p=0.001), which occurred in approximately 50% of patients. Both physical and mental SF-36 areas were inversely correlated with age, duration and grade of disease, depression and anxiety and positively correlated with attentive control. SF-36 areas were not correlated with cytosine thymine guanidine expansion. CONCLUSION: Health-related quality of life is severely impaired in myotonic dystrophy type 1 and it is negatively influenced by severity and duration of disease as well as by specific cognitive deficits and changes in emotional functioning. Therapeutic intervention in this field could contribute to ameliorate health-related quality of life in myotonic dystrophy type 1.

Suicide and attempted suicide in eating disorders, obesity and weight-image concern.

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Meta-analyses have shown that individuals suffering from anorexia nervosa and bulimia nervosa commit suicide more often than their counterparts in the general population; also a few studies have suggested that suicide is the major cause of death among patients with anorexia nervosa, refuting the assumption that inanition generally threatens the life of these patients. Data concerning suicide in bulimia nervosa, on the other hand, are still scarce but suicide attempts are easily found among cohorts of patients with bulimia nervosa, which constitutes a risk factor for completed suicide. Suicidality in obesity and individuals with disturbed weight status has been reported. Both in the case of bulimia nervosa and obesity more long-term follow-up studies need to be completed before the risk of suicide for such disorders may be compared with that for anorexia nervosa.

Emergency staff reactions to suicidal and self-harming patients.

Staff in the emergency departments of hospitals are reported as being negative or ambivalent toward suicidal or self-harming individuals. According to the literature, these patients are subjected to stigmatization and lack of empathy. This phenomenon has been linked to a decreased quality of care offered to these individuals and to missing an important opportunity to prevent further suicidal behavior or repetition of deliberate self-harm. Also, protocols, proper guidelines and education for the emergency staff call for a revision and an implementation. In this paper, evidence suggesting staff attitudes toward suicidal and self-harming patients is reviewed. An overview of related issues such as clinical judgment, the use of scales and nurses' role is also included in this report.

Childhood suicide: a major issue in pediatric health care.

Although prevention of youth suicide is a major aim in most countries, it often is not taken into account that younger children also are capable of killing themselves. Evidence suggests that the suicide rate among children has increased dramatically and that risk factors for suicide must be evaluated when dealing with children in primary and secondary care. Adverse life events in combination with other factors, such as depression, may lead to suicide. This article aims at stimulating further discussion among those involved in pediatric health care. Epidemiological data, an overview of risk factors, and the authors' reflections on the topic are provided.

Toward a new prevention of suicide in schizophrenia.

Suicide is the primary cause of death among schizophrenic patients; follow-up studies suggested that 10-13% of schizophrenic patients die by suicide. Preventive measures based on early recognition of risk factors and the establishment of drug treatment protocols are no doubt of great help but have not resulted in a significant reduction of the number of suicides among these patients. Schizophrenia is a chronic disorder affecting all aspects of the individual's life. Prevention should therefore be addressed to various areas. This paper overviews studies dealing with major fields of interest in the prevention of suicide among patients with schizophrenia. The authors focus on the role of pharmacological treatment, psychosocial interventions and psychotherapy, the struggle against stigmatization and the role of GPs. Prevention of suicide among inpatients with schizophrenia is also analysed. It is concluded that those integrated strategies already in use and the implementation of less known interventions should constitute a more effective prevention of self-inflicted deaths among these patients.

A case of social phobia and avoidant personality disorder with erectile dysfunction successfully treated with venlafaxine and add-on reboxetine.

A 25-year-old man with DSM-IV-TR Axis I social phobia and Axis II avoidant personality disorder and erectile dysfunction, presenting with depression, anxiety and insomnia, responded partially to extended release oral venlafaxine (75 mg/die for 6 weeks), but developed side effects and worsening symptoms when dose was increased to 150 mg/die; he responded to a combination of 75 mg/die venlafaxine and 4 mg/die reboxetine and improved on most of his symptoms.

Suicide in schizophrenia. What are we going to do about it?

Suicide is the single major cause of death among patients with schizophrenia. Follow-up studies have estimated that 10-13% of these patients die by suicide. Various studies have identified risk factors for suicide in schizophrenic patients which are of great value for prediction and prevention of self-inflicted death. Despite great efforts, both on the side of drug treatment and psychosocial strategies, the number of suicides among schizophrenic patients has remained unchanged. We focus on a number of issues that are of paramount importance for the understanding and prevention of suicide in these patients, pointing to the need of supporting programs addressed to families and to establish a valid doctor-patient relationship with these patients both during consultation with psychiatrists or general practitioners and with medical staff during inpatient treatment.

Suicidality in DSM IV cluster B personality disorders. An overview.

Personality disorders are a considerable risk factor for suicidal behavior. In psychological autopsy studies, individuals with personality disorders are frequently found among suicide victims. Suicidal attempts (which are a major risk factor for completed suicide) are also an important issue among affected patients. We performed careful MedLine, Excerpta Medica, PsycLit and PsycINFO searches from 1980 to 2004. Search terms were "suicide", "personality disorders", "mortality", "follow-up". We identified studies dealing with suicide and the following areas of interest: borderline personality disorder, narcissistic personality disorder, antisocial personality disorder, comorbidity (especially with affective disorder and substance abuse disorder) and risk factors for suicide in personality disorders. Despite the fact that comorbidity with DSM-IV Axis I disorders often impairs a correct judgment of suicidality in personality disorders, this overview showed that some personality disorders have a stronger link to suicide and that identifiable risk factors may be used for the development of preventive measures. Given the fact that personality disorders have high prevalence in the general population, prediction and prevention of suicide among these individuals is a problem of public health.

[Suicide and attempted suicide in anorexia nervosa and bulimia nervosa]. / Suicidio e tentato suicidio nell'anoressia nervosa e nella bulimia nervosa.

Suicide in anorexia nervosa and bulimia nervosa is a major cause of death. Risk factors for suicide and attempted suicide (which in many cases results in successful suicide) in anorexia nervosa include: purging type, chronic disease, and during treatment, obsessive symptoms and drug abuse, major depression, and for anorexia nervosa low body mass index (BMI) at presentation. In anorexia nervosa suicide has been considered the first cause of death and attempted suicide is a serious threat to these individuals. Data concerning suicide in bulimia nervosa has still scarce whereas attempted suicides are easily found in clinical histories of patients. No doubt suicidal behavior is underestimated amongst patients with anorexia nervosa and bulimia nervosa. An effort to reconcile with subject of suicide and a better evaluation of these patients' psychopathology should improve suicide prevention strategies amongst these individuals.

[Neuropsychological and behavioural assessment in Alzheimer's disease]. / Valutazione neuropsicologica e comportamentale nel morbo di Alzheimer.

To assess the onset and subsequent course of cognitive, behavioural and neuropsychiatric symptoms of Alzheimer's dementia (AD) we considered the clinical course of these groups of symptoms in 100 patients with NINCDS-ADRDA AD, > 65 years from onset to exitus during the phases t0 (early), t1 (state), t2 (neurological) and t3 (medical). Memory, depressive (40%), anxious (30%), sexual (15%) disturbances are frequent during t0. During t1, memory disturbances worsen in 90% of patients, and attention deficit (46%) and difficulty in abstract thinking appear. During t2, eating disorders (80%), stereotypy (38%), and delusions (23%) appear; anxiety and attention deficit (74%) worsen. During t3, eating disorders (95%) and delusions (46%) increase; higher brain functions can no more be assessed through neuropsychological tests. We showed progressive deterioration of cognitive function and behaviour, and abrupt onset and rapid progress of neuropsychiatric and medical disturbances during AD.

Suicide and awareness of illness in schizophrenia: an overview.

Suicide is the first cause of premature death in patients with schizophrenia. Numerous studies have identified risk factors for suicide among these patients. This study reviews available literature focusing on awareness of illness in patients with schizophrenia. Insight, or awareness of illness, has been considered a risk factor for suicide in schizophrenic patients. In assessing insight, many issues have to be taken into account, because a high degree of insight is not desirable in some conditions.

Hopelessness and suicide risk emerge in psychiatric nurses suffering from burnout and using specific defense mechanisms.

Burnout in psychiatric nurses is a phenomenon of great concern. We conducted an investigation of 120 nurses working in the psychiatric, general medicine/rehabilitation, and critical care/surgery wards to explore the correlations of level of burnout and defense mechanisms with hopelessness. The nurses were administered the Maslach Burnout Inventory, Gleser and Ihilevich's Defense Mechanisms Inventory, and Beck's Hopelessness Scale. The results indicate that burnout and some of the defense mechanisms predicted the level of hopelessness -- a predictor of suicide risk.

Suicide in borderline personality disorder: a meta-analysis.

Suicide is the major cause of death among patients with borderline personality disorder; however, the literature on completed suicides in such disorder is inconclusive, as suicide rates vary greatly among cohorts of patients. We searched MedLine, Excerpta Medica and PsycLit from 1980 to 2005 to identify papers dealing with suicide in borderline personality disorder. We also searched the World Health Statistics Annual to ascertain the suicide rate in the age groups for specific years and country. We selected eight studies comprising 1179 patients with a diagnosis of borderline personality disorder. Of these patients, 94 committed suicide. Results obtained for each study were processed together to calculate the mean figure for each year of suicides for 100,000 individuals suffering from borderline personality disorder. Our meta-analysis shows that suicide among patients with borderline personality disorder is more frequent when compared with the general population. All study analyses reported that patients with borderline personality disorder committed suicide more often than their counterparts in the general population. Suicide seems more alarming in the first phases of follow-up than during chronic phases of illness.

Suicide in the epilepsies: a meta-analytic investigation of 29 cohorts.

OBJECTIVES: Suicide in epilepsy is a major cause of death and is very often underestimated. We conducted a meta-analysis to compare data reported in representative studies of suicide in epilepsy with data for the general population. METHODS: We searched the Index Medicus until 2005 through MedLine. We also searched the World Health Statistics Annual to ascertain the suicide rates in the age groups indicated in the studies on epileptic patients for specific years and country. RESULTS: We selected 29 studies comprising 50,814 patients, 187 of whom committed suicide. Results obtained for each study were processed together to calculate the mean number of suicides per 100,000 individuals suffering from epilepsy for each year. CONCLUSIONS: Our meta-analysis shows that suicide in patients with epilepsy is more frequent than in the general population. Nevertheless, a number of cohorts of epileptic patients had a suicide rate lower than that of the general population. Possible explanations for this heterogeneous trend and risk factors are discussed.

Where schizophrenic patients commit suicide: a review of suicide among inpatients and former inpatients.

OBJECTIVE: To review the literature on suicide of inpatients with schizophrenia, to identify suicide risk factors as well as typical patterns of behavior and to suggest a rationale and strategies for future interventions. METHOD: A computerized MedLine, Excerpta Medica and PsycLit search supplemented by an examination of cross-references and reviews. RESULTS: Up to half the suicides among patients with schizophrenia occur during inpatient admission. Inpatient suicides were found among those of a young age group who were predominantly single, childless and socially isolated. The vast majority experienced an illness characterized by long duration and prolonged psychiatric hospitalizations or multiple admissions and discharges. Up to 50% of the suicides occurred in the first few weeks and months following discharge from the hospital. The paranoid subtype of schizophrenia, where positive symptoms prevail and negative symptoms are few, is associated with a suicide risk that is three times greater than that associated with nonparanoid subtypes and eight times greater than the risk associated with the deficit subtype. CONCLUSIONS: Treatment of suicide is a major problem among inpatients with schizophrenia. Evidence suggests that suicide is generally carried-out by patients who have been recently discharged or by those who manage to get away from the hospital. Strategies aimed at preventing this phenomenon have been introduced to the medical personnel, but suicide in these patients does not seem to have been reduced. We emphasize the need to establish guidelines for the prevention of suicide in hospitalized patients with schizophrenia.