A Case of Violent Suicide Attempt in a Context of Myxedema Psychosis following Radioiodine Treatment in a Patient with Graves’ Disease

Introduction. Hypothyroidism has been associated with mood disorders but some cases of acute psychosis have also been reported. However, less attention has been paid to suicidal behavior in these patients. Case Report. We report a case of suicide attempt by self-stabbing in a 43-year-old woman without past psychiatric history, four months after radioiodine therapy for Graves’ disease. On clinical examination remarkable signs of myxedema were found and blood investigations showed hypothyroidism with an extremely high thyroid stimulating hormone (TSH) level (152 mUI/L; reference range 0.20-5.10). The patient presented delirium symptoms at the time of self-stabbing, which was associated with persecutory delusions and auditory harm command hallucinations. A rapid physical and psychiatric improvement was observed after the initiation of an oral thyroid replacement therapy without relapse after early discontinuation of the antipsychotic treatment. Discussion. The most distinctive feature of our case is that the violent suicide attempt could be attributed to the myxedema psychosis. Suicide may result from several factors, including psychosocial stressors, psychiatric symptoms, and hormonal disturbance. This unique presentation should remind clinicians to systematically consider ordering additional tests in patients with atypical psychiatric presentation, even when serious behavioral disorders (such as violent suicide attempts) are present and may result in premature transfer to psychiatric units.

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Graves’ Hyperthyroidism-Induced Psychosis Treated With Aripiprazole—A Case Report

Journal of Pharmacy Practice ◽

10.1177/0897190012451934 ◽

2012 ◽

Vol 26 (1) ◽

pp. 59-61 ◽

Cited By ~ 4

Author(s):

Livia R. Macedo ◽

Jehan Marino ◽

Brady Bradshaw ◽

Joseph Henry

Keyword(s):

Atrial Fibrillation ◽

Psychiatric Symptoms ◽

Thyroid Stimulating Hormone ◽

Graves Disease ◽

Long Term Effects ◽

Free T4 ◽

History Of ◽

Antithyroid Peroxidase Antibody ◽

First Time

Graves’ disease is an autoimmune syndrome with symptoms such as tachycardia, atrial fibrillation, and psychiatric symptoms. Limited evidence exists for the treatment of Graves’ hyperthyroidism-induced psychosis with atypical antipsychotics. A 47-year-old female with a psychiatric history of bipolar disorder presented for the first time to the psychiatric hospital. She was agitated and grossly psychotic with delusions. Electrocardiogram showed atrial fibrillation and tachycardia. Drug screen urinalysis was negative. Endocrine workup resulted in a diagnosis of Graves’ disease (thyroid-stimulating hormone [TSH]: 0.005 μIU/mL, triiodothyronine [T3]: 537 ng/dL, thyroxine [T4]: 24 mcg/dL, free T4: 4.5 ng/dL, positive antithyroid peroxidase antibody, and antinuclear antibody). Aripiprazole 10 mg daily was initiated and titrated to 15 mg daily on day 4. On day 16, her suspicious behavior, judgment, and insight improved. Other medications given included aspirin 325 mg daily, metoprolol 25 mg twice daily, titrated to 12.5 mg twice daily, and methimazole 30 mg daily, titrated to 20 mg twice daily, and discontinued on day 29. The patient received radioiodine I-131 treatment 1 week later. We report the first known case on the use of aripriprazole to treat Graves’ hyperthyroidism-induced psychosis. Further studies examining the long-term effects and appropriate dose and duration of aripiprazole in this patient population are needed.

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Clinical-evolutive particularities and the main rehabilitation difficulties in a patient with schizophrenia who suffered from a TSCI by falling from height (affirmative suicidal attempt)- a case report

Balneo Research Journal ◽

10.12680/balneo.2020.396 ◽

2020 ◽

pp. 533-535

Author(s):

Mihaela OPREA (MANDU) ◽

Elena CONSTANTIN ◽

Cristinel Dumitru BADIU ◽

Alina BAJENARU ◽

Alexandru STAVRICA ◽

...

Keyword(s):

Suicide Attempt ◽

Multidisciplinary Team ◽

Suicide Attempts ◽

Psychiatric Symptoms ◽

Motor Deficit ◽

Complex Process ◽

Cord Injury ◽

Severe Motor ◽

Literature Highlight ◽

Psychiatric Manifestations

Introduction. Schizophrenia is a surprisingly common chronic psychiatric illness in the general population affecting 1 in 100 people worldwide. Although the symptoms widely differ from one case to another, schizophrenia is quite difficult to recognize because the patient can behave normally and appropriately in different social situations. Studies in the literature highlight that the majority of the patients with SCI and pre-existing schizophrenia have suffered accidents as a result of voluntary height adjustments. Also, 37.5% of the suicide attempts with SCI are caused by schizophrenia and depression. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. At the same time, the risk of suicide in patients with schizophrenia after suffering from SCI is higher than those with SCI without schizophrenia. Therefore, the recovery of the patients with SCI and schizophrenia is a complex process which requires the control of the psychiatric symptoms. A multidisciplinary team is required for such a purpose. Material and method. Having the patient's consent and approval of the Ethics Committee of “Bagdasar-Arseni” Clinical Emergency Hospital, N.O. 3159/30.01.2020, the paper presents the case of a 23-year-old female patient with AIS/ Frankel B flaccid paraplegia after TVML after falling from height (affirmative through window-suicide attempt) operated on, in a polytraumatic context. The patient is known with schizophrenia and she was being monitored by a psychiatrist at the time of the accident, but she voluntarily discontinued treatment during that period. The patient was clinically and functionally evaluated, according to the standardized protocols implemented in our clinic, through the assessment scales (ASIA, FIM, FAC, QoL, Ashworth and Penn) and also paraclinically, in order to evaluate her biological reserve and her bearing availability of the recovery program. Results and discussions. The patient presented a slowly favorable evolution (slowed down by her severe motor deficit, but also by her psychiatric symptoms such as affective ability with depressive, negative behavior, depersonalization). Conclusions. The main difficulties encountered in the recovery of these patients are the psychiatric manifestations. Therefore, the recovery of patients with SCI and schizophrenia is a complex process that first requires the control of psychiatric symptoms. A multidisciplinary team is required for such a purpose. Keywords: Schizophrenia, spinal cord injury, multidisciplinary, suicide attempt, rehabilitation,

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Risk Factors for Medically Serious Suicide Attempts

Journal of the American Psychoanalytic Association ◽

10.1177/0003065112442240 ◽

2012 ◽

Vol 60 (3) ◽

pp. 555-576 ◽

Cited By ~ 11

Author(s):

J. Christopher Fowler ◽

Mark J. Hilsenroth ◽

Michael Groat ◽

Spencer Biel ◽

Christina Biedermann ◽

...

Keyword(s):

Risk Factors ◽

Suicide Attempt ◽

Suicide Risk ◽

Suicide Attempts ◽

Psychiatric Symptoms ◽

Baseline Risk ◽

High Risk Behaviors ◽

Reality Testing ◽

Life Threatening ◽

History Of

This study explored a psychodynamic model for suicide risk by examining risk factors for medically serious suicide attempts, including assessments of affect flooding, negative self-schema / fragmentation, and impaired reality testing, closely approximating Maltsberger’s psycho-dynamic formulation of suicide crisis. Baseline risk factors including age, gender, psychiatric symptoms, high-risk behaviors, and the Implicit Risk for Suicide Index (IRSI) were used to detect medically serious suicide attempts monitored for up to a year after the assessment. Twenty-five psychiatric inpatients who made life-threatening suicide attempts after assessment were compared to 25 inpatients and 25 psychotherapy outpatients who made no suicide attempts during follow-up. Statistical analysis revealed that a history of at least one suicide attempt and elevated IRSI scores accounted for 60 percent of the variance in detecting medically serious suicide attempts. Elevated IRSI accurately identified suicide attempt status above and beyond past suicide attempts and other empirically validated risk factors. Results are discussed in light of psychodynamic formulations of suicide risk.

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Serious Suicide Attempts in a State Corrrectional System and Strategies to Prevent Suicide

The Journal of Psychiatry & Law ◽

10.1177/009318530503300204 ◽

2005 ◽

Vol 33 (2) ◽

pp. 227-247 ◽

Cited By ~ 16

Author(s):

Anasseril E. Daniel ◽

Jennifer Fleming

Keyword(s):

Suicide Attempts ◽

Psychiatric Symptoms ◽

Single Cells ◽

Psychosocial Stressors ◽

Prevention Policy ◽

Maximum Security ◽

Multiple Strategies ◽

White Males ◽

Services Delivery ◽

Suicide Completers

The characteristics of offenders who attempt suicide in prisons indicate that they are mostly white males, likely to be property offenders, serving less than ten years, suffer from depression and personality disorders, experience significant psychosocial stressors, often have a cellmate and use predominantly cutting and slashing. A significant percentage use lethal methods such as attempted hanging and overdose. Those who use lethal methods tend to be genuine in their intent and have many features common to those who commit suicide. Comparison of those who used lethal methods with a cohort of inmates who committed suicide indicated no significant differences in gender, race, age, crime type, diagnosis, and prior or current psychiatric care. However, the suicide completers tended to have more psychiatric symptoms such as delusions, hallucinations, impulsivity and guilt feelings, as well as experience of conflicts, ridicule and/or rape immediately preceding the self harm acts. Furthermore, more completers experienced new convictions, medical conditions, psychosocial stressors, and had shown prior suicidal behaviors. They were likely to be held in maximum security prisons and in single cells. While hanging dominated the completed suicides, medication overdose was more common among the lethal attempters. The authors discuss multiple strategies to deal with the identified group of suicide attempters in order to prevent subsequent serious attempts or suicides. They include comprehensive mental health (MH) services delivery, implementation of a suicide prevention policy, timely inpatient and involuntary treatment, watch take procedure for psychotropic medications, noncompliance management, suicide watch, therapy, use of liquid medications, elimination of Benzodiazepines and timely action by MH, correctional and medical staff.

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Attachment Organization in Suicide Prevention Research

Crisis ◽

10.1027/0227-5910/a000231 ◽

2014 ◽

Vol 35 (1) ◽

pp. 60-66 ◽

Cited By ~ 10

Author(s):

Amanda Venta ◽

Carla Sharp

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Interpersonal Relationships ◽

Suicide Ideation ◽

Suicide Attempts ◽

Critical Role ◽

Self Report ◽

Future Research ◽

Self Harm

Background: Identifying risk factors for suicide-related thoughts and behaviors (SRTB) is essential among adolescents in whom SRTB remain a leading cause of death. Although many risk factors have already been identified, influential theories now suggest that the domain of interpersonal relationships may play a critical role in the emergence of SRTB. Because attachment has long been seen as the foundation of interpersonal functioning, we suggest that attachment insecurity warrants attention as a risk factor for SRTB. Aims: This study sought to explore relations between attachment organization and suicidal ideation, suicide attempts, and self-harm in an inpatient adolescent sample, controlling for demographic and psychopathological covariates. Method: We recruited 194 adolescents from an inpatient unit and assigned them to one of four attachment groups (secure, preoccupied, dismissing, or disorganized attachment). Interview and self-report measures were used to create four variables reflecting the presence or absence of suicidal ideation in the last year, single lifetime suicide attempt, multiple lifetime suicide attempts, and lifetime self-harm. Results: Chi-square and regression analyses did not reveal significant relations between attachment organization and SRTB, although findings did confirm previously established relations between psychopathology and SRTB, such that internalizing disorder was associated with increased self-harm, suicide ideation, and suicide attempt and externalizing disorder was associated with increased self-harm. Conclusion: The severity of this sample and methodological differences from previous studies may explain the nonsignificant findings. Nonsignificant findings may indicate that the relation between attachment organization and SRTB is moderated by other factors that should be explored in future research.

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Suicide Attempts Among Depressed Inpatients with Depressive Disorder in a Malaysian Sample

Crisis ◽

10.1027/0227-5910/a000088 ◽

2011 ◽

Vol 32 (5) ◽

pp. 283-287 ◽

Cited By ~ 14

Author(s):

L. F. Chan ◽

T. Maniam ◽

A. S. Shamsul

Keyword(s):

Risk Factors ◽

Suicidal Ideation ◽

Suicide Attempt ◽

Depressive Disorder ◽

Suicide Attempts ◽

Psychosocial Risk Factors ◽

Psychosocial Risk ◽

Life Event ◽

Axis I ◽

A Current

Background: Depressed inpatients constitute a high-risk population for suicide attempts. Aims: To describe the interactions of clinical and psychosocial risk factors influencing suicide attempts among a Malaysian sample of depressed inpatients. Methods: Seventy-five subjects were diagnosed with a depressive disorder according to the Structured Clinical Interview for DSM-IV Axis I Disorders-Clinical Version (SCID-CV). Data on suicide attempts, suicidal ideation (Scale for Suicidal Ideation, SSI), depression severity (Beck’s Depression Inventory, BDI), recent life-event changes (Social Readjustment Rating Scale, SRRS), sociodemographic and other relevant clinical factors were collected. Results: A third of the subjects presented after a current suicide attempt. Significant factors for a current suicide attempt were race, religion, recent life-event changes, suicidal ideation, and alcohol use disorder. Independent predictive risk factors for a current suicide attempt were Chinese race, recent marital separation, major mortgage or loans, and being newly diagnosed with depression. Any recent change in personal habits was shown to be a protective factor against current suicide attempt. Age and gender were nonsignificant factors. Conclusions: The findings are generally consistent with existing studies and highlight the role of psychosocial risk factors.

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Interactive Effects of Acute Suicidal Affective Disturbance and Pain Persistence on Suicide Attempt Frequency and Lethality

Crisis ◽

10.1027/0227-5910/a000588 ◽

2019 ◽

Vol 40 (6) ◽

pp. 413-421 ◽

Cited By ~ 2

Author(s):

Megan L. Rogers ◽

Thomas E. Joiner

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Pain Perception ◽

Suicide Attempts ◽

Pain Tolerance ◽

Self Report ◽

Interactive Effects ◽

Physical Pain ◽

Affective Disturbance ◽

The Relationship

Abstract. Background: Acute suicidal affective disturbance (ASAD) has been proposed as a suicide-specific entity that confers risk for imminent suicidal behavior. Preliminary evidence suggests that ASAD is associated with suicidal behavior beyond a number of factors; however, no study to date has examined potential moderating variables. Aims: The present study tested the hypotheses that physical pain persistence would moderate the relationship between ASAD and (1) lifetime suicide attempts and (2) attempt lethality. Method: Students ( N = 167) with a history of suicidality completed self-report measures assessing the lifetime worst-point ASAD episode and the presence of a lifetime suicide attempt, a clinical interview about attempt lethality, and a physical pain tolerance task. Results: Physical pain persistence was a significant moderator of the association between ASAD and lifetime suicide attempts ( B = 0.00001, SE = 0.000004, p = .032), such that the relationship between ASAD and suicide attempts strengthened at increasing levels of pain persistence. The interaction between ASAD and pain persistence in relation to attempt lethality was nonsignificant ( B = 0.000004, SE = 0.00001, p = .765). Limitations: This study included a cross-sectional/retrospective analysis of worst-point ASAD symptoms, current physical pain perception, and lifetime suicide attempts. Conclusion: ASAD may confer risk for suicidal behavior most strongly at higher levels of pain persistence, whereas ASAD and pain perception do not influence attempt lethality.

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The Role of Past Suicidal Behavior on Current Suicidality: A Retrospective Study in the Israeli Military

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18020649 ◽

2021 ◽

Vol 18 (2) ◽

pp. 649

Author(s):

Leah Shelef ◽

Jessica M Rabbany ◽

Peter M Gutierrez ◽

Ron Kedem ◽

Ariel Ben Yehuda ◽

...

Keyword(s):

Suicide Attempt ◽

Suicidal Behavior ◽

Military Service ◽

Suicide Ideation ◽

Rating Scale ◽

Suicide Attempts ◽

Significant Risk ◽

Significant Risk Factor ◽

Severity Rating ◽

Significant Difference

Past suicide attempts are a significant risk factor for future suicidality. Therefore, the present military-based study examined the past suicidal behavior of soldiers who recently made a severe suicide attempt. Our sample consisted of 65 active-duty soldiers (61.5% males), between the ages of 18 and 28 years old (M = 20.4, SD ± 1.3). The inclusion criterion was a recent severe suicide attempt, requiring at least a 24 h hospitalization. This sample was divided into two groups, according to previous suicidal behavior, namely whether their first suicide attempt was before or after enlistment (n = 25; 38.5% and n = 40; 61.5%, respectively). We then examined the lethality and intent of the recent event in regard to this division. Four measures were used to assess the subjects’ suicidal characteristics: the Columbia Suicide Severity Rating Scale, the Self-Harm Behavior Questionnaire, the Suicidal Behaviors Questionnaire-Revised, and the Beck Scale for Suicide Ideation. No significant difference in the severity of the suicide attempts (either actual or potential severity) were found between those who had suicide attempts before enlistment and those who had their first attempt in the service. As a matter of fact, most of the suicide attempts that occurred for the first time during military service had used a violent method (58.3%, n = 21). Finally, using multivariate analyses, we found that current thoughts and behavior, rather than past suicidality, was the strongest predictor for the lethality of suicide attempts.

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Healthcare Utilization Due to Suicide Attempts among Homeless Youth in New York State

American Journal of Epidemiology ◽

10.1093/aje/kwab037 ◽

2021 ◽

Author(s):

Rie Sakai-Bizmark ◽

Hiraku Kumamaru ◽

Dennys Estevez ◽

Emily H Marr ◽

Edith Haghnazarian ◽

...

Keyword(s):

Emergency Department ◽

New York ◽

Length Of Stay ◽

Suicide Attempt ◽

Healthcare Utilization ◽

Regression Models ◽

Homeless Youth ◽

Suicide Attempts ◽

New York State ◽

Individual Characteristics

Abstract Suicide remains the leading cause of death among homeless youth. We assessed differences in healthcare utilization between homeless and non-homeless youth presenting to the emergency department or hospital after a suicide attempt. New York Statewide Inpatient and Emergency Department Databases (2009–2014) were used to identify homeless and non-homeless youth ages 10 to 17 who utilized healthcare services following a suicide attempt. To evaluate associations with homelessness, we used logistic regression models for mortality, use of violent means, intensive care unit utilization, log-transformed linear regression models for hospitalization cost, and negative binomial regression models for length of stay. All models were adjusted by individual characteristics with a hospital random effect and year fixed effect. We identified 18,026 suicide attempts with healthcare utilization rates of 347.2 (95% Confidence Interval [CI]: 317.5, 377.0) and 67.3 (95%CI: 66.3, 68.3) per 100,000 person-years for homeless and non-homeless youth, respectively. Length of stay for homeless youth was statistically longer than non-homeless youth (Incidence Rate Ratio 1.53; 95%CI: 1.32, 1.77). All homeless youth who visited the emergency department after a suicide attempt were subsequently hospitalized. This could suggest a higher acuity upon presentation among homeless youth compared with non-homeless youth. Interventions tailored to homeless youth should be developed.

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Psychological, Structural, Social and Economic Determinants of Suicide Attempt: Risk Assessment and Decision Making Strategies

OMEGA - Journal of Death and Dying ◽

10.1177/00302228211003462 ◽

2021 ◽

pp. 003022282110034

Author(s):

Azam Farmani ◽

Mojtaba Rahimianbougar ◽

Yousef Mohammadi ◽

Hossein Faramarzi ◽

Siamak Khodarahimi ◽

...

Keyword(s):

Risk Assessment ◽

Suicide Attempt ◽

Suicide Attempts ◽

Psychological Services ◽

Cross Sectional ◽

Economic Determinants ◽

History Of ◽

Cross Sectional Design ◽

High Level ◽

Risk Assessment And Management

The aim of this research was to conduct a risk assessment and management of psychological, structural, social and economic determinants (PSSED) in a suicide attempt. The sample consisted of 353 individuals who had a recorded history of suicidal attempt; and 20 professional individuals by purposive sampling method within a descriptive cross-sectional design. Worksheets for RAM and AHP were used for data collection in this study. The rate of suicide attempt was 7.21 per 100,000 population in this study. Analysis showed that depression and mental disorders; personality disorders; family problems; socio-cultural and economic problems; lack of awareness; and low level of education have a high level of risk for suicide attempts. Psychiatric and psychological services; awareness and knowledge of life skills; medical services to dysfunctional families; development of community-based planning for PSSED of suicide; and employment and entrepreneurship services may lower suicide attempt risk.

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