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1.
Psychiatry Res ; 297: 113736, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33486272

RESUMO

Suicide risk assessment is a subjective process and remains a clinical challenge in psychiatry. We aimed to examine physicians' characteristics that influence management of acutely suicidal patients. In a cross-sectional design, we performed an anonymous internet survey of psychiatry residents and attendings from four academic centers. Gender, years of experience, practice setting, prior patient suicide, and personal exposure to suicide were characterized. Participants were presented with three clinical vignettes and asked to rate suicide risk and clinical disposition. The relationship between responses to the vignettes and physician characteristics were examined with generalized linear models. Fifty-four residents and 49 attendings completed the survey. Four (7%) residents and 24 (49%) attendings had patients die by suicide, whereas 32 (59%) and 36 (74%), respectively, knew somebody outside their practice who died by suicide. Among residents, lower rating of acute suicide risk was associated with prior exposure to non-patient suicide. Less hospitalization chosen by attendings was associated with greater perceived difficulty of suicide risk assessment. In the combined resident and attending sample, less proneness to hospitalize was associated with number of previous patients die by suicide and with outpatient practice. Our results suggest that previous exposure to suicide is associated with more risk-averse management.

2.
Psychiatry Res Neuroimaging ; : 111216, 2020 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-33129637

RESUMO

We aimed to identify brain structural changes in cortical and subcortical regions linked to recent suicidal behavior. We performed secondary analyses of structural MRI data of two independent studies, namely the Establishing Moderators/Biosignatures of Antidepressant Response - Clinical Care (EMBARC) study and a Little Rock study on acute suicidal behavior. Study 1 (EMBARC, N = 187), compared individuals with remote suicide attempts (Remote-SA), individuals with lifetime suicide ideation but no attempts (Lifetime-SI only), and depressed individuals without lifetime suicide ideation or attempts (non-suicidal depressed). Study 2 (Little Rock data, N = 34) included patients recently hospitalized for suicide ideation or attempt constituted by: patients who recently attempted suicide (Recent-SA), individuals with remote suicide attempts (Remote-SA), and Lifetime-SI only. Study 3 combined the EMBARC and Little Rock datasets including Recent-SA, Remote-SA, Lifetime-SI only and non-suicidal depressed individuals. In Study 1 and Study 2, no significant differences were observed between groups. In Study 3, significantly lower middle temporal gyrus thickness, insular surface area, and thalamic volume and higher volume in the nucleus accumbens were observed in Recent-SA. This pattern of structural abnormalities may underlie pain and emotion dysregulation, which have been linked to the transition from suicidal thoughts to action.

3.
Eur Neuropsychopharmacol ; 40: 4-16, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33004229

RESUMO

Effective suicide prevention is hindered by a limited understanding of the natural progression and neurobiology of the suicidal process. Our objective was to characterize the duration of the suicidal process and its relation to possible determinants: time judgment and cognitive impulsivity. In four groups of adults of both sexes including recent suicide attempters (n = 57), suicidal ideators (n = 131), non-suicidal depressed controls (n = 51) and healthy controls (n = 48) we examined time estimation and production, impulsivity and other cognitive variables. Duration of the suicidal process was recorded in suicide attempters. The suicide process duration, suicide contemplation and action intervals, had a bimodal distribution, ∼40% of attempters took less than 5 min from decision to attempt. Time slowing correlated negatively with the suicidal action interval (time from the decision to kill oneself to suicide attempt) (p = .003). Individuals with suicide contemplation interval shorter than three hours showed increased time slowing, measured as shorter time production at 35 s (p = .011) and 43 s (p = .036). Delay discounting for rewards correlated with time estimation at 25 min (p = .02) and 90 s (p = .01). Time slowing correlated positively with suicidal ideation severity, independently of depression severity (p < .001). Perception of time slowing may influence both the intensity and the duration of the suicidal process. Time slowing may initially be triggered by intense psychological pain, then worsen the perception of inescapability in suicidal patients.

4.
SN Compr Clin Med ; : 1-5, 2020 Sep 26.
Artigo em Inglês | MEDLINE | ID: mdl-33015547

RESUMO

The COVID-19 pandemic is associated with different types of stressors: fear of infection, financial burden, and social isolation. Additionally, COVID-19 infection seems to increase the risk for neuropsychiatric symptoms including psychosis. We present a case of a 52-year-old male with no previous psychiatric history who developed severe paranoia leading to a suicide attempt. He was successfully treated with a combination of milieu treatment, pharmacotherapy, and electroconvulsive therapy. We add to the nascent literature that COVID-19, as other coronaviruses, can increase the risk for severe psychosis and suicidal behavior.

5.
J Alzheimers Dis ; 77(4): 1483-1493, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32925060

RESUMO

BACKGROUND: Apathy, a profound loss of motivation, initiation, and goal directed cognition, is a common comorbidity of Alzheimer's disease (AD). The presence of apathy is associated with rapid progression of AD, long-term impairment, disability, and higher mortality. Pharmacological treatments of apathy are limited. OBJECTIVE: The primary objective was to evaluate the efficacy of repetitive transcranial magnetic stimulation (rTMS) for apathy in AD. METHODS: A randomized, double-blind, parallel-arm, sham-controlled pilot study was conducted in subjects with AD and apathy (N = 20). Subjects were randomized to rTMS or sham treatment (5 days/week) for four weeks. Primary outcome, apathy evaluation scale-clinician version (AES-C), and secondary outcome measures, modified-Mini Mental State Examination (3MS), instrumental activities of daily living (IADL), and clinical global impression (CGI), were assessed at baseline and four weeks. Follow-up visits were conducted at 8 and 12 weeks to test the durability of effects of intervention. RESULTS: Mean age was 77.3 (±7.2) years, 80% were Caucasians and 10% were females. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment (-10.1 (-15.9 to -4.3); t (16) â€Š= -3.69; p = 0.002) at 4 weeks. There was also significantly greater improvement in 3MS (6.9 (1.7 to 12.0); t (15) â€Š= 2.85; p = 0.012), IADL (3.4 (1.0 to 5.9); χ21 = 7.72; p = 0.006), CGI-S (1.4 (0.5 to 2.3), t (16) â€Š= 3.29; p = 0.005), and CGI-I (-2.56 (-3.5 to -1.6), t (17) â€Š= -5.72; p < 0.001) for rTMS compared to the sham at 4 weeks. The effects of rTMS were durable at 12 weeks. CONCLUSION: rTMS may be safely used in subjects with AD and may improve apathy, function, and some aspects of cognition.

7.
Int J Psychiatry Med ; 55(6): 387-396, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32216493

RESUMO

OBJECTIVE: Chronic pain is frequently comorbid with opioid abuse and severe depression, a combination that greatly compounds suicide risk. In addition to the therapeutic value of buprenorphine in addiction and analgesia, growing evidence suggests potential use as an antidepressant. Data supporting buprenorphine antisuicidal properties are scarce. We aim to contribute to the discussion of buprenorphine antisuicidal potential in patients with significant psychiatric and medical comorbidity. METHODS: We performed a chart review of suicidal adult depressed patients with comorbid chronic pain and opioid use disorder who received off-label buprenorphine in outpatient and inpatient settings in a university hospital between 2013 and 2016. RESULTS: Four of the patients had an early positive response. However, only three continue to adhere to treatment for six months or longer. CONCLUSIONS: More severe opioid use disorder seems to more negatively influence clinical outcome, independently of cluster b personality traits. Identification of patients who could benefit from buprenorphine will require further studies.

8.
Eur Arch Psychiatry Clin Neurosci ; 270(5): 619-631, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30903270

RESUMO

Low social integration is commonly described in acutely suicidal individuals. Neural mechanisms underlying low social integration are poorly understood in depressed and suicidal patients. We sought to characterize the neural response to low social integration in acutely suicidal patients. Adult depressed patients within 3 days of a suicide attempt (n = 10), depressed patients with suicidal ideation (n = 9), non-suicidal depressed patients (n = 15), and healthy controls (N = 18) were administered the Cyberball Game while undergoing functional magnetic resonance imaging. We used complementary functional connectivity and region of interest data analysis approaches. There were no group differences in functional connectivity within neural network involving the pain matrix, nor in insula neural activity or the insula during either social inclusion. Superior anterior insula activity exhibited an inverted U-shaped curve across the suicide risk spectrum during social inclusion. Superior insula activity during social inclusion correlated with depression severity and psychological pain. Dorsal anterior cingulate cortex activity during social exclusion correlated with physical pain severity. Neural responses in the anterior insula significantly correlated with depression severity and with psychological pain during social inclusion, whereas dACC activity significantly correlated with physical pain during social exclusion. Recent suicidal behavior seems associated with a distinct neural response to social exclusion independently of presence of depression or suicidal thoughts.

9.
Artigo em Inglês | MEDLINE | ID: mdl-31326514

RESUMO

INTRODUCTION: One of the main challenges in suicide prevention is the limited understanding of the biological mechanisms underlying suicide. Recent findings suggest impairments in pain processing in acutely suicidal patients. However, little is known about the biological factors that may drive these discrete physiological abnormalities. In this study, we examined plasma peptides involved in analgesic and inflammatory responses and physical pain threshold in acutely suicidal patients. METHODS: Thirty-seven depressed patients of both sexes hospitalized for severe suicidal ideation or a recent suicide attempt were characterized clinically including history of suicidal ideation and behavior. Psychological and physical pain, and pressure pain threshold was also measured. Plasma levels of ß-endorphin, neurotensin, agouti-related protein (AgRP), C-reactive protein (CRP), adrenocorticotropic hormone (ACTH), and brain-derived neurotrophic factor (BDNF) were run in Milliplex multiplex assays. RESULTS: The number of lifetime suicide attempts was positively correlated with ß-endorphin (r = 0.702; p = 0.007), and neurotensin (r = 0.728, p = 0.007) plasma levels. Higher pain threshold was measured in the suicide attempt group as compared to the suicidal ideation group. Pain threshold was strongly and negatively associated with CRP plasma levels (r = -0.548; p < 0.001). In patients reporting chronic pain, lower AgRP levels and lower pain threshold were observed (t = 4.472; p = 0.001). CONCLUSION: Our results suggest that abnormalities in the opioid and neurotensin systems may underlie the increase in pain threshold found in suicide attempters, and possibly risk for suicidal behavior. Targeting pain circuits and systems may provide therapeutic mechanisms for suicide prevention.


Assuntos
Transtorno Depressivo/fisiopatologia , Neurotensina/sangue , Limiar da Dor/fisiologia , Ideação Suicida , Tentativa de Suicídio , beta-Endorfina/sangue , Adolescente , Adulto , Transtorno Depressivo/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-30391308

RESUMO

OBJECTIVE: Psychological pain lies at the heart of human experience. However, it may also be abnormally intense and/or prolonged in pathological states, with negative outcomes. A simple and reliable measure of psychological pain for clinical use would be useful. In this study, we present a preliminary validation of a simple visual analog scale jointly measuring psychological and physical pain. METHODS: Two samples of adult (non elderly) depressed patients and healthy controls were independently recruited in two locations in Canada and the USA (N = 46/48 and 200/20, respectively). Six dimensions were successively scored on a paper visual analog scale measuring current, mean and worst pain over the last 15 days, for physical then psychological pain. RESULTS: All physical and psychological pain dimensions discriminated depressed from non-depressed subjects. Among depressed patients, psychological pain scores were higher than physical pain scores for a given period of assessment. Moreover, correlations between dimensions from the same pain category (physical or psychological) were higher than between different pain categories. Psychological pain was mainly correlated with depression and hopelessness scales while physical pain was mainly correlated with anxiety scales. Secondary analyses showed that psychological (and some physical) pain measures were correlated with suicidal ideas in one location, but no difference in pain scores was found between patients with vs. without a history of suicidal acts in both samples. Childhood trauma positively correlated with several pain dimensions. CONCLUSION: The PPP-VAS appears to be a valid tool in terms of discriminative capacities and convergent-divergent validities. Validation in different samples, including adolescents and elderly, and in various psychiatric and medical conditions will have to be conducted, in addition to the assessment of concurrent and predictive validities, and the confirmation of sensitivity to change. The role of psychological pain in the suicidal process needs to be further elucidated.


Assuntos
Transtorno Depressivo Maior/diagnóstico , Medição da Dor/métodos , Dor/diagnóstico , Escala Visual Analógica , Adulto , Feminino , Humanos , Masculino , Dados Preliminares , Ideação Suicida
11.
Drug Alcohol Depend ; 192: 215-222, 2018 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-30268937

RESUMO

BACKGROUND: Comorbidity of drug use disorders (DUD) with other psychopathology is associated with worse functional and treatment outcomes than DUD alone. The present study sought to identify altered functional neural circuitry underlying DUD comorbidity with other psychiatric disorders, and model the relationship of these alterations to childhood trauma (Childhood Trauma Questionnaire) and negative self-beliefs (Beck Depression Inventory). METHODS: A sample of adult men and women (mean = 36.8 years) with childhood maltreatment histories (n = 81) was allocated into the following groups based on psychiatric diagnoses and drug use history: no current or past psychiatric disorders (trauma control sample, n = 20), DUD only (n = 22), psychopathology only (n = 20), and DUD comorbid with other psychiatric illness (DCoP, n = 25). RESULTS: Multiple regression of seed-based resting-state fMRI, controlling for age and sex, identified a functional connection between the right rostral anterior cingulate cortex (rACC) and left temporoparietal junction (TPJ) that was significantly increased in DCoP females, relative to the other clinical and control groups. Within the DCoP female sample, mediation analysis demonstrated that strength of connectivity between the subgenual cingulate cortex and both the right anterior insula and rostral lateral prefrontal cortex significantly mediated the relationship between increasing physical abuse and self-criticism with age as a moderator. CONCLUSIONS: This study related sex-dependent alterations in functional organization of the prefrontal cortex with DCoP that are, in turn, related to magnitude of negative self-beliefs to childhood trauma exposure. Additionally, DCoP-selective alterations in rACC connectivity suggest that the neural correlates of DCoP do not represent linear additive contributions from two independent disorders.


Assuntos
Maus-Tratos Infantis/diagnóstico , Maus-Tratos Infantis/psicologia , Córtex Pré-Frontal/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias/diagnóstico por imagem , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Criança , Estudos de Coortes , Comorbidade , Feminino , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Vias Neurais/diagnóstico por imagem , Escalas de Graduação Psiquiátrica , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Inquéritos e Questionários
12.
J Clin Psychiatry ; 79(4)2018 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-29995357

RESUMO

OBJECTIVE: A major target in suicide prevention is interrupting the progression from suicidal thoughts to action. Use of complex algorithms in large samples has identified individuals at very high risk for suicide. We tested the ability of data-driven pattern classification analysis of brain functional connectivity to differentiate recent suicide attempters from patients with suicidal ideation. METHODS: We performed a cross-sectional study using resting-state functional magnetic resonance imaging in depressed inpatients and outpatients of both sexes recruited from a university hospital between March 2014 and June 2016: recent suicide Attempters within 3 days of an attempt (n = 10), Suicidal Ideators (n = 9), Depressed Non-Suicidal Controls (n = 17), and Healthy Controls (n = 18). All depressed patients fulfilled DSM-IV-TR criteria for major depressive episode and either major depressive disorder, bipolar disorder, or depression not otherwise specified. A subset of suicide attempters (n = 7) were rescanned within 7 days. We used a support vector machine data-driven neural pattern classification analysis of resting-state functional connectivity to characterize recent suicide attempters and then tested the classifier's specificity. RESULTS: A binary classifier trained to discriminate patterns of resting-state functional connectivity robustly differentiated Suicide Attempters from Suicidal Ideators (mean accuracy = 0.788, signed rank test: P = .002; null hypothesis: area under the curve = 0.5), with distinct functional connectivity between the default mode and the limbic, salience, and central executive networks. The classifier did not discriminate stable Suicide Attempters from Suicidal Ideators (mean accuracy = 0.58, P = .33) or presence from absence of lifetime suicidal behavior (mean accuracy = 0.543, P = .348) and was not improved by modeling clinical variables (mean accuracy = 0.736, P = .002). CONCLUSIONS: Measures of intrinsic brain organization may have practical value as objective measures of suicide risk and its underlying mechanisms. Further incorporation of serum or cognitive markers and use of a prospective study design are needed to validate and refine the clinical relevance of this candidate biomarker of suicide risk.


Assuntos
Transtorno Bipolar/fisiopatologia , Encéfalo/fisiopatologia , Transtorno Depressivo Maior/fisiopatologia , Ideação Suicida , Tentativa de Suicídio , Adulto , Estudos de Casos e Controles , Estudos Transversais , Feminino , Neuroimagem Funcional , Humanos , Imagem por Ressonância Magnética , Masculino , Adulto Jovem
13.
J Psychopharmacol ; 32(4): 482-488, 2018 04.
Artigo em Inglês | MEDLINE | ID: mdl-29552947

RESUMO

BACKGROUND: Increased inflammation is linked to suicide risk. However, it is unclear whether increased inflammation drives suicidal crises or is a trait associated with lifetime suicidal behavior. Limited data exist on the sources of increased inflammation observed in suicidal patients and on its downstream effects. AIMS: To examine factors associated with inflammation and with suicidal ideation severity in acutely suicidal depressed patients. METHODS: Fifty-two adult depressed patients of both sexes hospitalized for severe suicidal ideation were characterized for suicidality, depression, anxiety, medical comorbidity, psychological and physical pain, impulsivity, verbal fluency, C-reactive protein (CRP) and interleukin (IL) 6. Two generalized linear models were performed with either CRP or suicidal ideation severity as dependent variables. RESULTS: CRP levels were positively associated with age, body mass index (BMI), IL6, current physical pain and number of lifetime suicide attempts. Suicidal ideation severity was not significantly correlated with either CRP or IL6. Suicidal ideation severity was positively associated with female sex, presence of an anxiety disorder, current physical pain, number of lifetime suicide attempts and with delay discounting for medium and large losses. CONCLUSIONS: Increased inflammation is not associated with acute suicidal risk, but seems to represent a trait associated with lifetime suicidal behavior.


Assuntos
Transtorno Depressivo/psicologia , Inflamação/psicologia , Tentativa de Suicídio/psicologia , Adolescente , Adulto , Transtornos de Ansiedade/psicologia , Desvalorização pelo Atraso/fisiologia , Depressão , Feminino , Humanos , Comportamento Impulsivo/fisiologia , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Ideação Suicida , Adulto Jovem
14.
Psychiatry Res ; 261: 312-318, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-29331848

RESUMO

Apathy is a common and disabling behavioral concomitant of many neurodegenerative conditions. The presence of apathy with Mild Cognitive Impairment (MCI) is linked with heightened rates of conversion to Alzheimer's disease. Improving apathy may slow the neurodegenerative process. The objective was to establish the efficacy of repetitive transcranial magnetic stimulation (rTMS) in improving apathy in older adults with MCI. An 8-week, double-blind, randomized, sham-controlled cross-over study was conducted in nine subjects (66 ± 9 years) with apathy and MCI. Subjects were randomized to rTMS or sham treatment (5 days/week) for 2 weeks following which they underwent a 4-week treatment-free period. Subjects then crossed-over to receive the other treatment for 2 weeks. The primary (apathy (AES-C)) and secondary (cognition (3MS & MMSE), executive function (TMT-A & TMT-B), and clinical global impression (CGI)) outcomes were assessed at baseline, 2, 6, and 8 weeks. After adjusting for baseline, there was a significantly greater improvement in the AES-C with rTMS compared to sham treatment at 2 weeks. There was significantly greater improvement in 3MS, MMSE, TMT-A, and CGI-I with rTMS compared to the sham treatment. This study establishes that rTMS is efficacious in improving apathy in subjects with MCI.


Assuntos
Apatia , Disfunção Cognitiva/terapia , Estimulação Magnética Transcraniana/métodos , Idoso , Doença de Alzheimer/psicologia , Cognição , Disfunção Cognitiva/psicologia , Estudos Cross-Over , Método Duplo-Cego , Função Executiva , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Resultado do Tratamento
15.
Psychiatry Res ; 258: 365-373, 2017 12.
Artigo em Inglês | MEDLINE | ID: mdl-28888697

RESUMO

Suicidal behavior is frequently triggered by social crises, such as familial, romantic, social or work-related conflict. A variety of cognitive and social functioning impairments has been associated with suicidal thoughts and acts. One of the precipitating and perpetuating factors of social conflict is the desire for retribution after a perceived offense, even at one's own detriment. We utilized the Ultimatum Game-a behavioral economic task which examines the behavioral response to perceived unfairness-in order to characterize the response to unfairness across the acute suicide risk spectrum. We examined five groups of adult individuals of both genders (n = 204): High- and Low-Lethality recent Suicide Attempters, Suicidal Ideators, Non-Suicidal Depressed Patients; and Healthy Controls. We also measured demographic and clinical variables. Even though all depressed groups showed similar rejection rates in the Ultimatum Game, there was a higher likelihood of rejecting offers in the low stakes condition in all acutely suicidal groups compared with healthy controls. Stake size, offer, education, and gender of the proposer were significantly associated with rejection rates. Acutely suicidal patients may be more vulnerable to adverse interpersonal interactions. Further characterization of social behavior may provide targets for secondary and tertiary prevention for high-risk individuals.


Assuntos
Comportamento Social , Justiça Social , Ideação Suicida , Tentativa de Suicídio/psicologia , Adulto , Estudos de Casos e Controles , Depressão/psicologia , Feminino , Humanos , Relações Interpessoais , Masculino , Tentativa de Suicídio/prevenção & controle
16.
Behav Brain Res ; 332: 136-144, 2017 08 14.
Artigo em Inglês | MEDLINE | ID: mdl-28551067

RESUMO

Reciprocity is central to human relationships and is strongly influenced by multiple factors including the nature of social exchanges and their attendant emotional reactions. Despite recent advances in the field, the neural processes involved in this modulation of reciprocal behavior by ongoing social interaction are poorly understood. We hypothesized that activity within a discrete set of neural networks including a putative moral cognitive neural network is associated with reciprocity behavior. Nineteen healthy adults underwent functional magnetic resonance imaging scanning while playing the trustee role in the Trust Game. Personality traits and moral development were assessed. Independent component analysis was used to identify task-related functional brain networks and assess their relationship to behavior. The saliency network (insula and anterior cingulate) was positively correlated with reciprocity behavior. A consistent array of brain regions supports the engagement of emotional, self-referential and planning processes during social reciprocity behavior.


Assuntos
Altruísmo , Encéfalo/fisiologia , Relações Interpessoais , Confiança , Adolescente , Adulto , Encéfalo/diagnóstico por imagem , Mapeamento Encefálico , Feminino , Jogos Experimentais , Humanos , Imagem por Ressonância Magnética , Masculino , Princípios Morais , Testes Neuropsicológicos , Personalidade , Testes de Personalidade , Análise de Regressão , Inquéritos e Questionários , Confiança/psicologia , Adulto Jovem
17.
South Med J ; 110(4): 235-238, 2017 04.
Artigo em Inglês | MEDLINE | ID: mdl-28376517

RESUMO

OBJECTIVE: Evidence reveals a link between poor physical health and suicide. The physical health of rural, adult psychiatric outpatients with a history of suicide was examined. METHODS: The medical records of 192 patients seen at a tertiary-level academic medical center were examined for demographics, psychiatric and medical history, and self-reported measures of depression, anxiety, childhood trauma, and health status. RESULTS: The 48 subjects who endorsed a history of suicide attempts evidenced more medical conditions than those who had not made a suicide attempt (t = 2.91, P = 0.005). CONCLUSIONS: The results support the hypothesis of increased health risks in patients with a history of suicide attempts and highlight the need for targeted health interventions.


Assuntos
Nível de Saúde , Transtornos Mentais/complicações , Pacientes Ambulatoriais/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Adulto , Ansiedade/complicações , Ansiedade/psicologia , Depressão/complicações , Depressão/psicologia , Feminino , Humanos , Masculino , Transtornos Mentais/psicologia , Pacientes Ambulatoriais/psicologia , Fatores de Risco , População Rural/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Estados Unidos/epidemiologia
19.
20.
J Psychiatr Res ; 79: 28-33, 2016 08.
Artigo em Inglês | MEDLINE | ID: mdl-27135541

RESUMO

OBJECTIVES: To examine the relationship of inflammation and suicidal behavior in hospitalized adult psychiatric patients. METHOD: We retrospectively examined serum high sensitivity C-reactive protein (hsCRP) levels in inpatients at a tertiary-level university hospital (N = 184). The inpatients comprised three cohorts: 1) patients admitted following a suicide attempt, 2) patients with suicidal ideation, and 3) inpatient psychiatric controls. Additionally, we gathered demographic data, clinical data, smoking status, white blood cell count, and fasting lipid panel. RESULTS: As CRP level increased, the probability of patients belonging to the suicide attempt group increased as compared to both the probabilities of being in inpatient psychiatric control and or suicide ideation groups [OR = 2.09, CI = (1.29, 3.38) and OR = 1.75, CI = (1.15, 2.66) respectively]. We also observed a significant effect of depression in that depressed patients were more likely to have a suicide attempt when compared to patients with no depression or with mania [OR = 10.38, CI = (1.97, 54.70)]. CONCLUSIONS: There seems to be an inflammation gradient, measured by CRP levels, from recent suicide attempters, suicidal ideators and psychiatric controls. We replicated the association between a pro-inflammatory state and suicidal behavior in a sample of "real world" severely ill psychiatric inpatients.


Assuntos
Proteína C-Reativa/metabolismo , Pacientes Internados , Ideação Suicida , Tentativa de Suicídio , Adulto , Biomarcadores/sangue , Depressão/sangue , Depressão/complicações , Depressão/imunologia , Feminino , Humanos , Masculino , Estudos Retrospectivos , Estresse Psicológico/sangue , Estresse Psicológico/complicações , Estresse Psicológico/imunologia
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