scholarly journals Remission of Suicidal Ideation in Emotionally Unstable Personality Disorder with Flupenthixol

2022 ◽  
Vol 2022 ◽  
pp. 1-3
Author(s):  
Daniel J. Chivers ◽  
Mohammed Shaffiullah
Keyword(s):  
Suicidal Ideation ◽  
Personality Disorder ◽  
Older Patients ◽  
Suicide Attempts ◽  
Later Life ◽  
Age Group ◽  
Pharmacological Treatments ◽  
Current Guidance ◽  
Emotionally Unstable Personality Disorder

There are currently no licensed pharmacological treatments for Emotionally Unstable Personality Disorder. This case report describes a 50-year-old male who two years previously had been brought to the attention of psychiatric services following an overdose with intention to end his life. He was subsequently diagnosed with Emotionally Unstable Personality Disorder (EUPD) and, following further suicide attempts and trials of mainstream pharmacological treatments, responded to flupenthixol IM 20 mg fortnightly, experiencing complete remission from his suicidal ideation. Clinicians should be aware of EUPD presenting in later life and should consider the role of typical antipsychotics, including flupenthixol, in the treatment of suicidal ideation in patients with EUPD. Age-specific guidance on EUPD management would be of use to clinicians, especially in the management of older patients, as current guidance is based on findings within a narrow age group.

Progression from interpersonal problems to suicidal ideation and suicidal behavior in borderline personality disorder

2020 ◽  
Author(s):  
Timothy Allen ◽  
Michael Hallquist ◽  
Aidan G.C. Wright ◽  
Alexandre Dombrovski
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Negative Affect ◽  
Structural Equation ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Equation Modeling ◽  
Interpersonal Dysfunction ◽  
Suicidal Crisis

Importance: Clinicians treating borderline personality disorder (BPD) are often faced with the difficult challenge of assessing when, and for whom, risk for suicide is greatest. Addressing this dilemma requires longitudinal, prospective data from high-risk samples with an elevated base rate of suicide attempts.Objective: To test whether dispositional characteristics modulate the pathway from interpersonal dysfunction to suicide in BPD. Design: This longitudinal, observational study was conducted between 1990 and 2020. Data were analyzed between April and July 2020. Participants were assessed annually for up to 30 years (mean number of follow-ups = 7.82). Setting: Participants were recruited from inpatient, outpatient, and community referral sources.Participants: 458 individuals (Mean age = 28.59, 77% female) diagnosed with BPD.Main Outcomes and Measures: Presence or absence of a suicide attempt within one year of each follow-up assessment. Multilevel structural equation modeling was used to 1) examine longitudinal, within-person transitions from interpersonal dysfunction to suicidal ideation to suicide attempts (i.e., the [I]nterpersonal-[I]deation-[A]ttempt pathway); and 2) evaluate whether two maladaptive personality dimensions, negative affect and disinhibition, moderated these transitions.Results: At the within-person level, there was support for the I-I-A pathway: suicidal ideation accounted for the association between interpersonal dysfunction and suicide attempts. Personality further moderated each component of the I-I-A pathway: negative affect was associated with a stronger coupling between interpersonal dysfunction and ideation; and disinhibition was associated with a stronger coupling between ideation and attempts. Conclusions and Relevance: The escalation from interpersonal difficulties to a suicidal crisis in BPD involves two psychologically distinct process. An internalizing process links interpersonal dysfunction to suicidal ideation and is facilitated by trait negative. An additional externalizing process links suicidal ideation to suicide attempts, and is facilitated by trait disinhibition. Assessment of these intra- and interindividual risk factors may inform clinical decisions about when, and for whom, crisis intervention is necessary.

scholarly journals Off-licence use of clozapine in patients with emotionally unstable personality disorder: a case series analysis

BJPsych Open ◽  
2021 ◽  
Vol 7 (S1) ◽  
pp. S116-S116
Author(s):  
Declan Hyland ◽  
Alex Walmsley ◽  
Victoria Simpson
Keyword(s):  
Side Effects ◽  
Personality Disorder ◽  
Suicide Attempts ◽  
Symptom Control ◽  
Case Series ◽  
Community Support ◽  
Retrospective Case ◽  
Psychotherapeutic Treatment ◽  
Self Harm ◽  
Emotionally Unstable Personality Disorder

ObjectiveThis retrospective case series followed emotionally unstable personality disorder (EUPD) patients following initiation of clozapine on an off-licence basis, aiming to examine tolerance by determining side effect prevalence and treatment cessation frequency, as well as examining efficacy, by investigating number of hospital re-admissions and symptom control.Case reportThis case series captured the experiences of 11 EUPD patients under the care of Mersey Care NHS Foundation Trust, all of whom had, at some time in the past five years, been initiated on clozapine. All patients were white British females, with a median age of 31. The median daily dose of clozapine was 300 mg. Most patients had significant psychiatric comorbidities, as well as illicit substance and / or alcohol misuse.Whilst prescribed clozapine, patients were only admitted to hospital once on average and this was commonly for clozapine re-titration. Whilst in hospital, rates of self-harm were low, but ligaturing and suicide attempts showed higher prevalence. Patients still demonstrated self-harming behaviour out of hospital leading to A and E presentations. In the community, contacts with the police were minimal, with only two patients undergoing Section 136 assessments or arrests.All patients reported side effects from clozapine - usually hypersalivation, over-sedation and constipation. All 11 patients experienced sinus tachycardia. Eight patients temporarily ceased taking clozapine at some point. In three patients, discontinuation of clozapine was as a result of intolerable side effects. Three patients experienced neutropenia, which subsequently resolved. Only two patients had a body mass index within healthy range.DiscussionDespite patients reporting clozapine to provide symptomatic benefit for their EUPD, and improved their engagement with mental health services, prevalence of self-harm and of A and E presentations remained high, indicating the importance of community support and concomitant psychotherapeutic treatment. Patients with more robust community support showed greater adherence to clozapine.High prevalence of side effects and obesity in these patients, in addition to risk of developing neutropenia, highlights the importance of rigorous monitoring after initiating clozapine. It is reassuring that, despite development of neutropenia in some patients, this recovered quickly, and clozapine treatment could resume.ConclusionClozapine may be an effective pharmacological treatment for enabling EUPD patients to engage more therapeutically with services. Clozapine may be of greater benefit to those with more stable, less chaotic lives. Although diminished, patients still show self-harming behaviour and need for A and E admissions and re-hospitalisation. Side effects of clozapine are common and regular monitoring is required.

scholarly journals Mediating role of borderline personality disorder traits in the effects of childhood maltreatment on suicidal behaviour among mood disorder patients

2017 ◽  
Vol 44 ◽  
pp. 53-60 ◽  
Author(s):  
K.I. Aaltonen ◽  
T. Rosenström ◽  
I. Baryshnikov ◽  
B. Karpov ◽  
T. Melartin ◽  
...  
Keyword(s):  
Borderline Personality Disorder ◽  
Suicidal Ideation ◽  
Personality Disorder ◽  
Childhood Maltreatment ◽  
Suicidal Behaviour ◽  
Suicide Attempts ◽  
Borderline Personality ◽  
Mediation Effect ◽  
Mediation Analyses ◽  
Borderline Personality Disorder Traits

AbstractBackground:Substantial evidence supports an association between childhood maltreatment and suicidal behaviour. However, few studies have examined factors mediating this relationship among patients with unipolar or bipolar mood disorders.Methods:Depressive disorder and bipolar disorder (ICD-10-DCR) patients (n = 287) from the Helsinki University Psychiatric Consortium (HUPC) Study were surveyed on self-reported childhood experiences, current depressive symptoms, borderline personality disorder traits, and lifetime suicidal behaviour. Psychiatric records served to complement the information on suicide attempts. We examined by formal mediation analyses whether (1) the effect of childhood maltreatment on suicidal behaviour is mediated through borderline personality disorder traits and (2) the mediation effect differs between lifetime suicidal ideation and lifetime suicide attempts.Results:The impact of childhood maltreatment in multivariate models on either lifetime suicidal ideation or lifetime suicide attempts showed comparable total effects. In formal mediation analyses, borderline personality disorder traits mediated all of the total effect of childhood maltreatment on lifetime suicide attempts, but only one fifth of the total effect on lifetime suicidal ideation. The mediation effect was stronger for lifetime suicide attempts than for lifetime suicidal ideation (P = 0.002) and independent of current depressive symptoms.Conclusions:The mechanisms of the effect of childhood maltreatment on suicidal ideation versus suicide attempts may diverge among psychiatric patients with mood disorders. Borderline personality disorder traits may contribute to these mechanisms, although the influence appears considerably stronger for suicide attempts than for suicidal ideation.

Evaluation of Suicidal Behaviour in a General Psychiatric Consultation

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
C. Silva ◽  
I. Gil ◽  
M.A. Mateus ◽  
Ó. Nogueiro
Keyword(s):  
Suicidal Ideation ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Age Group ◽  
Psychiatric Consultation ◽  
Process Data ◽  
Systematic Screening ◽  
High Prevalence ◽  
History Of ◽  
Religious Aspects

Several studies have been conducted to establish a profile of the suicidal/parasuicidal patient. Also several factors have been identified as possibly influencing the suicidal rates, including the religious practices.Objectives:Characterize the profile of suicidal behavior in a sample of patients followed in a general psychiatric consultation.Methods:It was done an analytical observational study of a random sample of 100 patients followed in a general psychiatric consultation. A survey was conducted with the collection of socio-economic, religious aspects and clinical data, and it was consulted the patient"s clinical process. Data analysis was done in Excel 2003.Results:The sample was consisted mostly by women (74%), being the most representative age group between 40 and 50 years (27%), mostly married (61%), 24% had 2 children and 65% lived in the rural area. The clinical diagnosis (ICD-9) was in 46% of cases, neurotic depression. 52% consider themselves religious not practitioners, being 90% catholics. History of suicide attempts/parasuicide occurred in 32% of patients, in the form of drug intoxication (31%) or with another method (11%). Most of the individuals said to have already thought about suicide at least once in their lifetime (74%). Only 8% had current suicidal ideation. Family history of suicide occurred in 27%, particularly in first degree family members, mainly by drowning (7%) and hanging (7%).Conclusions:Our results suggest that exists a high prevalence of suicidal behavior in this patients. For that reason, it should be done a systematic screening for suicidal ideation in this risk population.

scholarly journals PTSD and Suicidal Behaviors Amongst L'Aquila 2009 Earthquake Young Survivors

2021 ◽  
Vol 9 ◽  
Author(s):  
Claudia Carmassi ◽  
Carlo Antonio Bertelloni ◽  
Valerio Dell'Oste ◽  
Chiara Luperini ◽  
Donatella Marazziti ◽  
...  
Keyword(s):  
Suicidal Ideation ◽  
Suicide Attempts ◽  
Self Report ◽  
Ptsd Symptoms ◽  
Suicidal Behaviors ◽  
Post Traumatic Stress ◽  
Partial Group ◽  
Group 2 ◽  
Group 1

Background: Post-traumatic stress disorder (PTSD) is one of the most frequent and severe psychiatric consequences of natural disasters, frequently associated with suicidality. The aim of this study was at examining the possible relationships between suicidal behaviors and full-blown or partial PTSD, in a sample of young earthquake survivors. The second aim was at investigating the specific role of PTSD symptoms on suicidality.Methods: A total of 475 young adults who survived the L'Aquila 2009 earthquake, one of the most severe Italian disasters of the last decades, were recruited and assessed after 21 months from the catastrophe. Participants were evaluated by two questionnaires assessing subthreshold psychopathology, the Trauma and Loss Spectrum Self-Report (TALS-SR) to investigate both full and partial PTSD, and two specific Mood Spectrum Self-Report (MOODS-SR) sub-domains exploring suicidality, namely suicidal ideation and suicide attempts.Results: The ensuing findings showed that suicidal ideation and suicide attempts were present, respectively, in 40 (8.4%) and 11 (2.3%) survivors. Rates of suicidal ideation were significantly more elevated in full-blown PTSD subjects (group 1), as compared with those suffering from partial (group 2) or no PTSD (group 3). Interestingly, group 2 subjects showed significantly more suicidal ideation than healthy individuals, and less than those of group 1, while the frequency of suicide attempts was similar across the three groups. Suicidal ideation was associated with higher scores in the following TALS-SR domains: grief-reactions, re-experiencing, avoidance and numbing, maladaptive coping, and personal characteristics/risk factor.Conclusions: The results of the present study support and extend previous findings on the role of PTSD symptoms in suicidality after a severe earthquake. However, as compared with available literature, they also highlight the significant impact of sub-threshold PTSD manifestations in increasing the suicide risk in survivors of a mass disaster.

The Protective Role of Parental Involvement in Adolescent Suicide

Crisis ◽  
2002 ◽  
Vol 23 (1) ◽  
pp. 17-22 ◽  
Author(s):  
Eirini Flouri ◽  
Ann Buchanan
Keyword(s):  
Suicidal Ideation ◽  
Parental Involvement ◽  
Academic Motivation ◽  
Adolescent Suicide ◽  
Suicide Attempts ◽  
Protective Role ◽  
Illegal Drug ◽  
Suicide Attempters ◽  
Family Disruption

Summary: This study of 2722 adolescents aged 14-18 years explored whether parental involvement can protect against adolescent suicide attempts. Compared to their counterparts suicide attempters were more likely to have been in trouble with the police, to report lower levels of parental interest and academic motivation, and to report suicidal ideation and using alcohol or an illegal drug when they feel stressed. They were also less likely to reside with both parents. The association between parental involvement and suicidal behaviour was not stronger for sons than for daughters or for adolescents who had experienced family disruption than for those who grew up in two-parent families.

scholarly journals Variables de riesgo y protección relacionadas con la tentativa de suicidio

2019 ◽  
Vol 23 (3) ◽  
pp. 221
Author(s):  
David Sánchez-Teruel ◽  
José Antonio Muela-Martínez ◽  
Ana García-León
Keyword(s):  
Suicidal Ideation ◽  
Suicide Attempts ◽  
Public Health Problem ◽  
Suicidal Attempt ◽  
Important Public Health Problem ◽  
Psychological Variables ◽  
Completed Suicide ◽  
Increased Risk ◽  
Predictive Behavior

Abstract: Risk and protection variables related to suicidal attempt. Suicide is an important public health problem, being the suicidal attempt the most predictive behavior of completed suicide. The aim of this study was to detect if there are differences in psychosocial and emotional variables in people with and without suicidal ideation and attempt. The sample consisted of 166 participants (86.36% women), aged between 20 and 77 years (M= 36, SD= 14.12) with and without suicide attempts, which was in turn divided into three groups through the Scale of Suicidal Ideation. The results show that there are important differences between the three groups in the psychological variables measured. We discuss the role of psychosocial variables, which are at the base of the increased risk or protection towards the ideation or suicidal attempt, to promote public suicide prevention policies more focused on those clinical subpopulations with specific risk profiles.Resumen: El suicidio es un importante problema de salud pública, siendo la tentativa de suicidio la conducta más predictiva del suicidio consumado. Mediante el presente estudio se pretende detectar si existen diferencias en variables psicosociales y emocionales en personas con y sin ideación y tentativa suicida.  La muestra estuvo constituida por 166 participantes (86.36 % mujeres), con edades comprendidas entre los 20 y 77 años (M= 36; DT= 14.12) con y sin tentativas suicidas, que fue a su vez dividida en tres grupos a través de la Escala de Ideación Suicida. Los resultados muestran que existen importantes diferencias entre los tres grupos en las variables psicológicas medidas. Se discute el papel de las variables psicosociales, que están en la base del incremento del riesgo o protección hacia la ideación o tentativa suicida, para propiciar políticas públicas de prevención del suicidio más centradas en aquellas subpoblaciones clínicas con perfiles de riesgo concretos.

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