Intramuscular ketamine in depression, suicidal thoughts and anxiety: A report on two cases

2017 ◽  
Vol 41 (S1) ◽  
pp. S420-S420
Author(s):  
M. Cigognini ◽  
R. Moreno
Keyword(s):  
Side Effects ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Bipolar Depression ◽  
Vital Signs ◽  
Hospital Setting ◽  
Medical Monitoring ◽  
Promising Alternative ◽  
Treatment Of Depression ◽  
Competing Interest

IntroductionSeveral studies have shown that ketamine, an antagonist of NMDA receptors, represents a promising alternative in the treatment of depression. The therapeutic use of ketamine, commonly used at a dose of 0.5 mg/kg, and in a single application IV has been short and requires monitoring in a hospital setting. IM use has been shown to be effective in treating depression and suicide risk, and have low side effect profile.MethodsTwo patients diagnosed with bipolar depression and suicide risk were submitted to ketamine IM application (0.75 mg/kg), receiving one application of ketamine IM every two days, totaling 4 applications. Patients were under medical monitoring for 2 hours after injection verifying vital signs and potential side effects. Responses were measured using BDI, BAI and BSI.AimTo evaluate response of ketamine IM injections on depressive, suicidal and anxious symptoms.SummaryCase 1: female, 20 years old, single with three recent suicide attempts, symptomatic for two months. Started lithium 450 mg daily. Side effects of ketamine were nausea, drowsiness and paresthesia. Case 2: female, 24 years old, single with symptoms lasting for six years. Started aripiprazole 5–10 mg and 25 mg lamotrigine concomitantly. Side effects of dry mouth, dizziness and dissociation.ConclusionsThe use of ketamine IM showed reduction of 75.5%–83.3%–85.7% (case 1) and 71.4%–77.2%–60.8% (case 2) in BDI, BAI and BSI, respectively as well as safety and tolerability in use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Characteristics of suicide attempters with a high lethality means

2017 ◽  
Vol 41 (S1) ◽  
pp. s889-s889
Author(s):  
C.T. Lee ◽  
S.Y. Lee ◽  
K.U. Lee ◽  
H.K. Lee ◽  
Y.S. Kweon
Keyword(s):  
Clinical Judgment ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Demographic Variables ◽  
Suicide Attempters ◽  
Exact Test ◽  
Factors Associated ◽  
History Of ◽  
Competing Interest ◽  
Lethal Means

IntroductionSuicide attempts with higher lethality increase the likelihood of suicide completion. Accumulating knowledge on risk factors contributing to higher suicide lethality may help clinicians to allocate their limited resources to more endangered people.ObjectivesTo explore the factors associated with higher lethality in suicide attempts.MethodsAll suicide attempters, who visited the emergency department of Uijeongbu St. Mary's hospital from January 2014 to December 2015, were reviewed retrospectively. We compared between the high vs. the low lethality group, of which had been recorded based on clinical judgment using t-test or Chi2/Fisher's exact test with two-sided P-value of 0.05.ResultsAmong the 753 suicide attempters, the assessed lethality was recorded in 736 cases. Low and highly lethal attempters were 426 (57.9%) and 310 (42.1%), respectively. For demographic variables, the high lethality attempters were significantly more likely to be older (48.3 vs. 44.78; P = 0.009), unemployed (61.0% vs. 56.5%; P = 0.042, without religion (90.9% vs. 84.9%; P = 0.017). For clinical variables, the high lethality attempters were significantly more likely have hopelessness (67.7% vs. 58.2%; P = 0.013) and a history of schizophrenia (4.5% vs. 1.4%; P = 0.023, while they did display any difference for mood disorders. The low lethality suicide attempts were more frequent in patients with comorbid personality disorders (9.2% vs. 4.9%; P = 0.031).ConclusionsThese results are in line with literatures reporting higher suicide risk in people, who are old, unemployed, not having a religion, psychotic and hopeless. These may have been moderated by committing a higher lethal means of suicide at least in part and warrants additional investigations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychiatric comorbidity and suicide risk in patients with psoriasis

2016 ◽  
Vol 33 (S1) ◽  
pp. S395-S396 ◽  
Author(s):  
M. Pompili ◽  
M. Innamorati ◽  
D. Erbuto ◽  
A. Costanzo
Keyword(s):  
Suicidal Ideation ◽  
Suicide Risk ◽  
Psychiatric Comorbidity ◽  
Rating Scale ◽  
Suicide Attempts ◽  
The Other ◽  
Depression And Anxiety ◽  
Melanoma Patients ◽  
Competing Interest ◽  
Hamilton Rating Scale

IntroductionPsoriasis has a significant impact on the mental and emotional functioning.ObjectiveIt has been reported that the risk of psychiatric comorbidity increases with the severity of the disorder, and the most frequent associations appear to be those with depression and anxiety.AimsTo analyze the association between psoriasis, mental disorders and suicidal ideation in a sample of patients affected by psoriasis. To investigate the differences between psoriasis patients and patients with other dermatologic diseases.MethodsParticipants were 242 consecutive patients (142 women and 100 men), 112 patients with psoriasis (46.3%), 77 with melanoma (31.8%) and 53 with allergy (21.0%). All patients were administered a structured sociodemographic interview and the following measures: the Hamilton Rating Scale for Depression (HAM-D) and the Hamilton Rating Scale for Anxiety (HAM-A). We also assessed current and previous suicidal ideation and previous suicide attempts.ResultsPatients with psoriasis (compared to other groups of patients) more frequently had a comorbid mood disorder (16.1% vs 3.9% and 0.0%, respectively for patients with melanoma and patients with allergy; χ22 = 14.98; P < 0.001), past suicidal ideation (33.9% vs 15.6% and 18.9%, respectively for patients with melanoma and patients with allergy; χ22 = 2.05; P < 0.01) and attempts (6.3% vs 0.0% and 0.0%, for the other groups of patients; χ22 = 8.37; P < 0.05). Patients with psoriasis reported higher HAM-D scores than melanoma patients.ConclusionsThe clinical evaluation of patients with psoriasis should include the assessment of psychiatric comorbidities and the routinely assessment of suicide risk.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Sociodemographic and clinical profile in elderly suicide victims: 34 autopsy case studies

2017 ◽  
Vol 41 (S1) ◽  
pp. s887-s887
Author(s):  
S. Ellouze ◽  
I. Baati ◽  
W. Ben Amar ◽  
D. Trigui ◽  
W. Abbes ◽  
...  
Keyword(s):  
Public Health ◽  
Health Problem ◽  
Suicide Risk ◽  
Public Health Problem ◽  
The Elderly ◽  
University Hospital ◽  
Major Public Health Problem ◽  
Treatment Of Depression ◽  
Competing Interest ◽  
Elderly Suicide

IntroductionThe elderly suicide is a major public health problem that is gaining more and more ground, given the aging population problem. This has rarely been the subject of forensic studies in Tunisia.ObjectivesTo identify the sociodemographic and clinical characteristics of elderly suicide victims over 60 years and to determine what factors might increase suicide risk in this population.MethodsWe conducted a retrospective study on suicide victims aged 60 and over, autopsied in forensic medicine department of the Habib Bourguiba university hospital in Sfax (Tunisia), on a 10-year period (January 2006–December 2015).ResultsWe identified 34 cases with an average age of 66 years. The sex ratio was 2.77. Suicide victims were alone in 38.2% of cases. They were inactive professionally in 32.4% of cases. Almost half of them (44.1%) had a psychiatric history, 40% of depressed pace, 26.7% of bipolar disorder and 13.3% of schizophrenia.Three main factors were identified as precipitating the passage to suicidal act: family conflicts (26.5%), financial difficulties (11.8%) and loss of autonomy (5.9%).Suicide methods were hanging (50%), immolation and drug intoxication (11.8%), hit by train and poisoning (8.8%), jumping from height (5.9%) and drowning (2.9%). In 55.8% of cases, suicide took place at home.ConclusionElderly suicide seems to be a huge but largely preventable public health problem. Its prevention is essentially based on the identification of risk situations and the detection and treatment of depression: major suicide risk factor in this population.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Unconventional side effects of antidepressants: Focus on emotional blunting

2017 ◽  
Vol 41 (S1) ◽  
pp. S751-S751
Author(s):  
V. Falaschi ◽  
S. Baroni ◽  
F. Mucci ◽  
H. Akiskal ◽  
D. Marazziti
Keyword(s):  
Side Effects ◽  
Selective Serotonin Reuptake Inhibitors ◽  
Term Treatment ◽  
Special Focus ◽  
Sexual Side Effects ◽  
Treatment Of Depression ◽  
Long Term Treatment ◽  
Competing Interest ◽  
Loving Relationship

ObjectivesThe aim of this study was to investigate the unconventional side-effects of selective serotonin reuptake inhibitors (SSRIs) and tricyclics (TCAs) antidepressants during long-term treatment of depression, with a special focus on emotional blunting and, in particular, on the possible changes of some features of loving relationships.MethodsTwo hundred outpatients (130 women and 70 men, mean age ± SD: 43.4 ± 11.1 years) were enrolled. They were suffering from mild or moderate depression, according to DSM–5 criteria, treated with one antidepressant for at least six months and involved in a long-term loving relationship. A specifically designed test, the so-called “sex, attachment, love” (SALT) questionnaire was built to assess the possible changes of the loving relationship.ResultsThe results showed differences between the two genders, in particular women taking TCAs reported more sexual side effects than men, whereas men taking SSRIs complained a reduction of the feelings of love and attachment towards the partner.ConclusionsAntidepressants seem to have a dimorphic effect on some elements of loving relationships, however these results need to be further explored.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Self-Image and Risk of Suicide in Eating Disorders

2017 ◽  
Vol 41 (S1) ◽  
pp. S281-S281
Author(s):  
A. Birgegård ◽  
M. Andersen
Keyword(s):  
Eating Disorders ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
High Specificity ◽  
Lower Sensitivity ◽  
Longitudinal Models ◽  
Self Image ◽  
Competing Interest ◽  
Separate Regression ◽  
Variance Explained

IntroductionSuicide risk is increased in eating disorders (ED), and detection is key to prevention. Self-image as operationalized in the structural analysis of social behavior (SASB) model has been shown to be associated with symptoms, treatment dropout, and outcome. SASB is a circumplex organizing self-directed behaviors along affiliation (love vs. hate) and autonomy (set free vs. control) dimensions. In a recent study, SASB related to health care-detected suicide attempts in ED. Methodology in that study ensured high specificity but risked lower sensitivity in suicide variables, and with such a high-threat outcome, research is needed on additional variables related to risk.Objectives and aimsWe aimed to study associations between SASB self-image and clinician- and self-rated suicidality at presentation and predicted over 12 months in ED patients.MethodsAdult patients (n = 551) from a Swedish clinical database included 19% anorexia, 32% bulimia, 7% binge ED, and 42% other ED. We ran separate regression models for these diagnostic groups using SASB questionnaire data, also controlling for general psychiatric and ED symptoms, and in longitudinal models including baseline of each outcome.ResultsSASB alone was associated with suicidality at presentation (9–67% variance explained) and predictively over 12 months (7–29%), and in the majority of models explained additional variance beyond baseline and clinical variables. Both affiliation and autonomy related to dependent variables in diagnosis-specific patterns.ConclusionsThe findings have implications for both theory and detection tools for suicide risk, as well as suggesting intervention targets to mitigate risk in treatment based on the well-validated SASB theory.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Electroconvulsive therapy: Brief versus ultrabrief pulse right unilateral electroconvulsive therapy

2016 ◽  
Vol 33 (S1) ◽  
pp. S618-S618
Author(s):  
M.R. Raposo ◽  
M.L. Medina ◽  
A.L. González ◽  
I. Martínez ◽  
A. Gil ◽  
...  
Keyword(s):  
Side Effects ◽  
Electroconvulsive Therapy ◽  
Meta Analysis ◽  
Electrode Placement ◽  
Current Evidence ◽  
List Type ◽  
Treatment Of Depression ◽  
The Subject ◽  
Competing Interest ◽  
Cognitive Side Effects

IntroductionElectroconvulsive therapy (ECT) is an effective depression treatment, but it has potential cognitive side effects. Bitemporal ECT has been traditionally used, but in recent decades, right unilateral (RUL) electrode placement has been proposed to decrease the cognitive side effects of ECT. Ultrabrief pulse (UBP) right unilateral (RUL) ECT is an increasingly used treatment option that can potentially combine efficacy with lesser cognitive side effects.ObjectivesTo evaluate whether ultrabrief pulse (UBP) right unilateral (RUL) electroconvulsive therapy (ECT) is as effective as brief pulse (BP) RUL ECT in addition to cause lesser cognitive side effects.Material and methodsA search is performed in the available scientific literature on systematic review and meta-analysis of the subject under study, through the database PubMed.Results– Current evidence supports the efficacy of right unilateral (RUL) electroconvulsive therapy (ECT) given with an ultrabrief pulse width in the treatment of depression;– ultrabrief pulse RUL ECT leads to lesser cognitive side effects than traditional forms of ECT;– ultrabrief pulse RUL ECT may be slightly less effective than traditional forms of ECT.ConclusionsBP compared with UBP RUL ECT was slightly more efficacious in treating depression and required fewer treatment sessions, but led to greater cognitive side effects. The decision of whether to use BP or UBP RUL ECT should be made on an individual patient basis and should be based on a careful weighing of the relative priorities of efficacy versus minimization of cognitive impairment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Profile Socio-Demographic and Clinical of Suicide Victims in Brusque County, Santa Catarina, Brazil, Between 2012 and 2015

2017 ◽  
Vol 41 (S1) ◽  
pp. S291-S291
Author(s):  
M. Cigognini
Keyword(s):  
Suicide Risk ◽  
Average Rate ◽  
The State ◽  
Prevention Strategies ◽  
Santa Catarina ◽  
The Third ◽  
Police Investigations ◽  
Treatment Of Depression ◽  
Causes Of Mortality ◽  
Competing Interest

IntroductionAmong the main causes of mortality in the world stands out approximately 1 million deaths due to suicide. In Brazil, this is the third cause of death due to external factors, being 5.3 the average rate per 100,000 inhabitants. The state of Santa Catarina ranks second in the national ranking with an index of 8.6. According to WHO, it is necessary to detect probable suicide risk factors once information can prevent deaths.AimIdentify socio-demographic and clinical profile of suicide victims in Brusque County, State of Santa Catarina, Brazil, between 2012 and 2015.MethodsObservational, descriptive and quantitative study, with analysis of 60 police investigations with suicide records, occurred from January 2012 to December 2015, in Brusque County.ResultsThe suicide was 15.29 per 100,000 inhabitants. The victims had an average age of 46.51, and ±2.12 (SD). Among them, 67.5% suffered from depression and 88% received pharmacological treatment. Regarding marital status, 59% were married or living in a stable union. Men accounted for 78% of the sample. Death by hanging occurred in 65% of cases and 22% previous attempts were recorded, and in 15%, it was mentioned suicidal intent. Among the reasons for the act, it was highlighted family member's death. Given the underreporting, such data may be even more significant.ConclusionsThe observed rates were significantly higher than the state and national rates. Prevention strategies can be focused on early diagnosis and treatment of depression in middle-aged men, and who had recent loss of a family member.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Dermal reactivity and resilience in a sample of depressed patients

2016 ◽  
Vol 33 (S1) ◽  
pp. S598-S598
Author(s):  
I. Coppola ◽  
E. Gattoni ◽  
C. Gramaglia ◽  
S. Di Marco ◽  
C. Delicato ◽  
...  
Keyword(s):  
Depressive Disorders ◽  
Attempted Suicide ◽  
Suicide Attempts ◽  
Bipolar Depression ◽  
Response To Treatment ◽  
Depressed Patients ◽  
Resilience Scale ◽  
History Of ◽  
Competing Interest ◽  
The Impact

BackgroundMental disorders are considered a risk factor for suicide: for example, the lifetime risk of suicide is estimated to be 4%–8% in people with mood disorders. The literature suggests that a history of suicide attempts is significantly related to electrodermal hyporeactivity and that patients with violent suicide attempters exhibit faster habituation of the electrodermal response to repeated neutral tones than patients with non-violent attempts. The impact of depressive symptoms on suicidal ideation may be moderated by resilience. Resilience refers to the ability to maintain o regain mental health despite experiencing adversity. In bipolar and depressive disorders, resilience may influence severity of episodes, frequency of relapse and response to treatment.AimThe objective of our study was to assess the possible correlation among attempted suicide, resilience and dermal reactivity in a sample of depressed patients.MethodsWe recruited patients with depressive disorders and bipolar depression; data about socio-demographic, clinical features, severity of attempted suicide and suicidal risk were gathered. Patients filled in the Resilience Scale for Adult (RSA). Moreover, for each patient we performed the Edor test in order to assess dermal reactivity.ResultsData collection is still ongoing. We expect to find lower levels of resilience in those patients who are hyporeactive and attempted suicide. Moreover, we hypothesize that suicide attempts in the group of hyporeactive patients would be characterized by planning and greater severity. Clinical implications will be discussed.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Comparative analysis of suicidality in two Bulgarian regions

2017 ◽  
Vol 41 (S1) ◽  
pp. S403-S403
Author(s):  
K. Stoychev ◽  
V. Nakov ◽  
D. Dekov ◽  
M. Baltov ◽  
R. Dinolova-Hodzhadzhikova ◽  
...  
Keyword(s):  
Suicidal Behavior ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Population Aging ◽  
Psychotic Symptoms ◽  
Prevention Interventions ◽  
Health Related ◽  
Competing Interest ◽  
Methods Of Suicide ◽  
Old Females

IntroductionSuicidality is still an understudied problem in Bulgaria especially on a subnational (regional) level.ObjectivesTo collect data on suicidality in two major regions of Bulgaria with a population over 250,000 each (Plovdiv and Pleven) for a six years period (2009–2015).AimsTo analyze demographic, health-related and other characteristics associated with suicidal behavior as well as motives and methods of suicide.MethodsData were extracted from relevant documentation (medical records, public health reports, etc.) and statistically processed upon collection.ResultsMajority of suicide victims were males between 45 and 64 years while most suicide attempts occurred among 18–29 years old females.Leading method of suicide was hanging, followed by jumping from high places and use of firearm.Prevailing suicidal motives were psychotic symptoms, serious somatic illnesses and family problems. Depression accounted for 25% of all suicide cases and in another 25% motivation could not be identified because of insufficient data.The proportion of unemployed among suicide committers was not significantly higher than that of employed and retired.ConclusionsSevere mental disorders are a major trigger of suicidal behavior.Personal relationships should be targeted by suicide prevention interventions.Somatic illnesses are increasingly important suicide risk factor driven by the ongoing process of population aging.Frontline healthcare professionals should be trained to explore underlying suicidal motives and actively probe for depression in each case of suicidal behavior.Unemployment related suicide risk is most likely mediated through an adaptation crisis mechanism induced by the abrupt change of social status.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Is prior suicide attempt a reliable indicator of short-term suicide risk amongst patients admitted to an acute suicide inpatient intervention unit in India?

2017 ◽  
Vol 41 (S1) ◽  
pp. s889-s889
Author(s):  
S. Mishra
Keyword(s):  
High Risk ◽  
Suicide Attempt ◽  
Suicide Risk ◽  
Suicide Attempts ◽  
Recent Attempt ◽  
Short Term ◽  
Competing Interest ◽  
Indian Men ◽  
Traditional Pattern ◽  
Suicidal Patients

IntroductionTraditionally past suicide attempt is considered a strong reliable factor in predicting an immediate or short-term suicide risk. Considering the complex interplay of different variables associated with suicide, the absence of past attempts may not prove to be of lesser risk for a consequent attempt.AimTo compare sociodemographic and clinical correlates within high-risk suicidal patients who have made a recent suicide attempt in the presence versus absence of past suicide attempts.MethodsRetrospective review of patient's records admitted to intensive care unit, applied suicide intervention and supportive treatment (ASIST) between 1st January 2015 and 31st May 2016 was conducted. Data was extracted for all consecutive admissions to ASIST, of adults (16 to 60 years) male patients with high risk for suicide.ResultsOut of 109 at risk inpatients, 31% were recent attempters without past attempts and 13.5% were recent and past attempters. Rest included past attempters without recent attempt and non-attempters. Except for poor coping skills, which were significantly higher (Chi2= 13.97; P = 0.001) in the group consisting recent and past attempters, all other relevant sociodemographic and illness related correlates were comparable across these groups.ConclusionSuicide risk may be associated with multiple factors. Apart from past attempts, a faulty coping style can be associated with risk for further attempts. Other correlates like age, marital status, employment and illness profile did not follow the traditional pattern in our study which makes them equally important while addressing suicide risk in Indian men.Disclosure of interestThe author has not supplied his/her declaration of competing interest.

Sign in / Sign up

Export Citation Format

Share Document