The use of stimulants in depression: Results from a self-controlled register study

Objective: To investigate the effectiveness of stimulants in patients with depression, by using naturalistic outcome measures, such as psychiatric admissions, psychiatric bed-days and incidents of intentional self-harm or suicide attempts. Methods: Via linkage of the Danish nationwide health registers, we identified all patients with a diagnosis of depression initiating stimulants, including methylphenidate, modafinil, amphetamine, dexamphetamine or lisdexamphetamine, from 1995 to 2012. We used a mirror-image model to test whether redemption of a stimulant prescription was associated with a reduction in psychiatric admissions, inpatient days and incidents of intentional self-harm or suicide attempts. Specifically, the number of these outcomes in the 2 years leading up to redemption of a stimulant prescription was compared to the two subsequent years. Similar outcomes were used in a reverse mirror-image model to investigate the effect of stimulant termination. Results: A total of 3354, 935 and 105 patients diagnosed with depression redeemed prescriptions for methylphenidate, modafinil or amphetamine/dexamphetamine/lisdexamphetamine, respectively. Initiation of methylphenidate was not associated with a significant change in psychiatric admissions (mean: −0.02 admissions, p = 0.11) or inpatient days (mean: 0.13 days, p = 0.74). Similar findings were made for modafinil and the amphetamines. In addition, no clinically relevant change in psychiatric admissions or inpatient days was found after termination of a stimulant. After initiation of methylphenidate, the incidents of self-harm or suicide attempts were reduced by 54%, from 68 to 31 events ( p = 0.004). No significant change in incidents of self-harm or suicide attempts were found for modafinil or the amphetamines. Conclusion: This nationwide study, using naturalistic outcomes, does not support the use of stimulants in patients with depression. However, the use of methylphenidate was associated with a 54% reduction in incidents of self-harm or suicide attempts, indicating that methylphenidate may potentially be useful in patients with depression with suicidal- or self-harming behaviour. However, further studies are needed, before any firm conclusions can be made.

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Real-World Effectiveness of Clozapine for Borderline Personality Disorder: Results From a 2-Year Mirror-Image Study

Journal of Personality Disorders ◽

10.1521/pedi_2017_31_328 ◽

2018 ◽

Vol 32 (6) ◽

pp. 823-837 ◽

Cited By ~ 6

Author(s):

Christopher Rohde ◽

Christoffer Polcwiartek ◽

Christoph U. Correll ◽

Jimmi Nielsen

Keyword(s):

Borderline Personality Disorder ◽

Personality Disorder ◽

Borderline Personality ◽

Mirror Image ◽

Image Study ◽

Psychiatric Admissions ◽

Number Of Patients ◽

Second Generation Antipsychotics ◽

Self Harm ◽

Bed Days

While some second-generation antipsychotics have shown efficacy on patients with borderline personality disorder (BPD), limited data exist regarding the effect of clozapine. Thus, we aimed to investigate the effects of clozapine on naturalistic outcomes in BPD patients with a 2-year mirror-image model. Among 25,916 patients with BPD, 1,107 redeemed ≥ 1 clozapine prescription. Of these, 18,188 were “specific” BPD patients, and 102 redeemed ≥ 1 clozapine prescription. During a mean observation period of 598.51 days, in all BPD patients, clozapine was associated with a significant reduction in psychiatric admissions from 2.52 (95‥ CI [2.31, 2.78]) to 2.00 (95‥ CI [1.77, 2.23]) admissions (p < .001) and a significant reduction in psychiatric bed-days from 190.08 (95‥ CI [176.84, 203.33]) to 65.95 (95‥ CI [58.27, 73.66]) bed-days (p < .001). Similar findings were found for “specific” BPD patients. The number of patients with intentional self-harm or overdose decreased significantly from 189 to 114 individuals (p < .001) after clozapine initiation. Randomized trials evaluating the risk- benefit ratio of clozapine in patients with severe BPD are warranted.

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Real-world effectiveness of mood stabilizers on self-harm and suicide attempts in patients with bipolar disorder: a 2-year mirror-image study

Journal of Affective Disorders Reports ◽

10.1016/j.jadr.2020.100064 ◽

2020 ◽

pp. 100064

Author(s):

Oskar Hougaard Jefsen ◽

Søren Dinesen Østergaard ◽

Jimmi Nielsen ◽

Christopher Rohde

Keyword(s):

Bipolar Disorder ◽

Real World ◽

Suicide Attempts ◽

Mirror Image ◽

Mood Stabilizers ◽

Image Study ◽

Self Harm

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Adolescents’ self-mutilation - Relationship with dependent behaviour

Swiss Journal of Psychology ◽

10.1024/1421-0185.62.4.241 ◽

2003 ◽

Vol 62 (4) ◽

pp. 241-249 ◽

Cited By ~ 8

Author(s):

M. Bolognini ◽

B. Plancherel ◽

J. Laget ◽

P. Stéphan ◽

O. Halfon

Keyword(s):

Suicide Attempts ◽

Clinical Sample ◽

Control Sample ◽

Clinical Population ◽

Control Group ◽

Clinical Group ◽

Self Mutilation ◽

Self Harm ◽

Partial Overlap ◽

The Relationship

The aim of this study, which was carried out in the French-speacking part of Switzerland, was to examine the relationship between suicide attempts and self-mutilation by adolescents and young adults. The population, aged 14-25 years (N = 308), included a clinical sample of dependent subjects (drug abuse and eating disorders) compared to a control sample. On the basis of the Mini Neuropsychiatric Interview ( Sheehan et al., 1998 ), DSM-IV criteria were used for the inclusion of the clinical population. The results concerning the occurrence of suicide attempts as well as on self-mutilation confirm most of the hypotheses postulated: suicidal attempts and self-mutilation were more common in the clinical group compared to the control group, and there was a correlation between suicide attempts and self-mutilation. However, there was only a partial overlap, attesting that suicide and self-harm might correspond to two different types of behaviour.

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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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Identifying Suicide Typologies Among Trauma-Exposed Veterans

Crisis ◽

10.1027/0227-5910/a000637 ◽

2020 ◽

Vol 41 (4) ◽

pp. 288-295 ◽

Cited By ~ 1

Author(s):

Nadia Bounoua ◽

Jasmeet P. Hayes ◽

Naomi Sadeh

Keyword(s):

Latent Profile Analysis ◽

Suicide Attempts ◽

Clinical Symptoms ◽

Profile Analysis ◽

Risky Behaviors ◽

Self Report ◽

Cross Sectional ◽

Research Priority ◽

Self Harm ◽

And Behaviors

Abstract. Background: Suicide among veterans has increased in recent years, making the identification of those at greatest risk for self-injurious behavior a high research priority. Aims: We investigated whether affective impulsivity and risky behaviors distinguished typologies of self-injurious thoughts and behaviors in a sample of trauma-exposed veterans. Method: A total of 95 trauma-exposed veterans (ages 21–55; 87% men) completed self-report measures of self-injurious thoughts and behaviors, impulsivity, and clinical symptoms. Results: A latent profile analysis produced three classes that differed in suicidal ideation, suicide attempts and nonsuicidal self-injury (NSSI): A low class that reported little to no self-injurious thoughts or behaviors; a self-injurious thoughts (ST) class that endorsed high levels of ideation but no self-harm behaviors; and a self-injurious thoughts and behaviors (STaB) class that reported ideation, suicide attempts and NSSI. Membership in the STaB class was associated with greater affective impulsivity, disinhibition, and distress/arousal than the other two classes. Limitations: Limitations include an overrepresentation of males in our sample, the cross-sectional nature of the data, and reliance on self-report measures. Conclusion: Findings point to affective impulsivity and risky behaviors as important characteristics of veterans who engage in self-injurious behaviors.

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Self-harm and suicidality among three subgroups of male sex offenders: results from an Australian prisoner cohort

Health & Justice ◽

10.1186/s40352-021-00146-6 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Mathew Gullotta ◽

David Greenberg ◽

Olayan Albalawi ◽

Armita Adily ◽

Azar Karminia ◽

...

Keyword(s):

Sex Offenders ◽

Sex Offender ◽

Suicide Attempts ◽

Sexual Offending ◽

Violent Offenders ◽

Health Condition ◽

Self Report ◽

Psychiatric Medication ◽

Self Harm ◽

Self Report Data

Abstract Objective Prisoners complete suicide and self-harm more frequently than members of the community. Sex offenders have been found to be at greater risk of engaging in these behaviours. This study examines the characteristics, prevalence, and predictors of self-harm and suicide attempts among: sex offenders that only victimise children (ChildSOs); adults (AdultSOs); or both (age-crossover polymorphous; PolySOs). Methods Data from three waves (1996, 2001, 2009) of the New South Wales (NSW) Inmate Health Survey was linked to the State’s re-offending database to identify men with histories of sexual offending. The health surveys captured self-report data on self-harm and suicidality. Results Non-sexual violent offenders (15%) and AdultSOs (14%) had the highest rate of self-harm, significantly more than ChildSOs (11%), non-sexual non-violent offenders (10%), and PolySOs (0%). Several factors significantly predicted self-harm at the bivariate level for both ChildSOs and AdultSOs, with unique predictors for each group. At the multivariate level, manic-depression trended towards significance for ChildSOs and any mental health condition remained a significant predictor for AdultSOs who self-harmed relative to AdultSOs who had not (aOR = 11.989, 95%CI [1.14, 126.66]). Approximately 23% of AdultSOs, 22% of PolySOs, and 19% of ChildSOs reported a suicide attempt throughout their lifetime, whereas only 15% of non-sexual non-violent offenders reported an attempt. At the bivariate level, few factors were significant for ChildSOs while several factors were significant for AdultSOs. At the multivariate level, a diagnosis of depression and treatment with psychiatric medication trended towards being significant predictors of suicide attempts for ChildSOs. In contrast, treatment with psychiatric medication (aOR = 25.732, 95%CI [1.91, 347.19])] remained a significant predictor for AdultSOs who attempted suicide relative to AdultSOs who had not, as well as historical psychiatric hospitalisation (aOR = 6.818, 95%CI [1.04, 44.82]) and self-harm (aOR = 5.825, 95%CI [1.31, 25.99]). Conclusion Sex offenders are at significantly higher risk of attempting and completing suicide relative to non-sexual non-violent offenders and warrant special attention. The prevalence rates and predictors of self-harm and suicidality suggest differences between sex offender subgroups may exist. These hold implications for the criminal justice and public health systems for addressing needs and identifying those most at risk of self-harm and suicide.

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Postcard intervention for repeat self-harm: randomised controlled trial

The British Journal of Psychiatry ◽

10.1192/bjp.bp.109.075754 ◽

2010 ◽

Vol 197 (1) ◽

pp. 55-60 ◽

Cited By ~ 69

Author(s):

Annette L. Beautrais ◽

Sheree J. Gibb ◽

Alan Faulkner ◽

David M. Fergusson ◽

Roger T. Mulder

Keyword(s):

Emergency Department ◽

New Zealand ◽

Randomised Controlled Trial ◽

Outcome Measures ◽

Suicidal Behaviour ◽

Controlled Trial ◽

Elevated Risk ◽

Emergency Department Presentation ◽

Self Harm ◽

Randomised Controlled

BackgroundSelf-harm and suicidal behaviour are common reasons for emergency department presentation. Those who present with self-harm have an elevated risk of further suicidal behaviour and death.AimsTo examine whether a postcard intervention reduces self-harm re-presentations in individuals presenting to the emergency department.MethodRandomised controlled trial conducted in Christchurch, New Zealand. The intervention consisted of six postcards mailed during the 12 months following an index emergency department attendance for self-harm. Outcome measures were the proportion of participants re-presenting with self-harm and the number of re-presentations for self-harm in the 12 months following the initial presentation.ResultsAfter adjustment for prior self-harm, there were no significant differences between the control and intervention groups in the proportion of participants re-presenting with self-harm or in the total number of re-presentations for self-harm.ConclusionsThe postcard intervention did not reduce further self-harm. Together with previous results this finding suggests that the postcard intervention may be effective only for selected subgroups.

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Socio-Demographic, Clinical Profile, Life Stress Events and Psychiatric Comorbidities in Patients with First Attempt Suicide

Journal of Psychiatry and Behavioral Sciences ◽

10.33582/2637-8027/1037 ◽

2020 ◽

Vol 3 (1) ◽

Author(s):

Karthik Selvaraj ◽

◽

Pranjali Bansal ◽

Akshay Singh ◽

Sushma Viswanathan ◽

...

Keyword(s):

Life Stress ◽

Rating Scale ◽

Suicide Attempts ◽

Stressful Events ◽

Clinical Profile ◽

Family Type ◽

P Value ◽

Suicide Intent ◽

Self Harm ◽

Severity Of Depression

Background: Contemporary literature focuses on various socio-demographic, clinical profile and psychiatric comorbitidies in patients with first attempt suicide. Aim: 1. To study the socio-demographic factors and the clinical profile of subjects with the first attempt suicide. 2. To assess the severity of depression and severity of stress due to various stressful events in patients with first attempt suicide. 3. To assess the severity of the suicide intent in patients with first attempt suicide. 4. To study the association between socio demographic profile of the patients with severity of depression, severity of suicide intent and severity of stress. Materials and Methods: Hundred fifteen patients were assessed using Hamilton rating scale for depression, becks suicide intent scale, Holmes-Rahe life stress inventory, MINI international neuropsychiatric interview. The data was analysed using the statistical software SPSS version 20. Results: The sample of 115 patients showed mean age to be 29 years, majority of them being males (58%). With most common mode of attempting suicide to be drug overdose and most of the patients had adjustment issues due to various domestic household issues and financial stressors. The severity of depression was mild and suicide intent were low (67%). In our study chi square finding association between various socio demographic variables and severity of depression found to be highly significant. It was strongest among gender at p value 0.009, occupation in which depression was found mostly among employed patients and housewives at p value 0.001. Results also found depression more common among participants with urban background at p value 0.03 and family type being nuclear at p value 0.05. Conclusion: Promoting healthy coping mechanism and reduction in stress is required to reduce self-harm. As is evident from the study, modifying the interpersonal relationship problems in the family might help in preventing many of suicide attempts/intentional self-harm and therefore important to address their various life events that might be stressful for them forcing them to take this step. In a country like India, where formal mental health resources are limited and are attached to a stigma, it is important to provide adequate information also among people hailing from lower economic status.

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Some Experiments on Artificially Roughened Lucy Ashton Geosims

Journal of Ship Research ◽

10.5957/jsr.1980.24.3.170 ◽

1980 ◽

Vol 24 (03) ◽

pp. 170-180

Author(s):

A.J. Smits ◽

N. Matheson ◽

P.N. Joubert

Keyword(s):

Pipe Flow ◽

Wave Drag ◽

Mirror Image ◽

Turbulent Pipe Flow ◽

Viscous Resistance ◽

Local Parameter ◽

Image Model ◽

Outer Flow ◽

Total Drag ◽

Towing Tank

A mirror-image model of the Lucy Ashton was covered with two different "mesh-type" roughnesses and tested in a wind tunnel. Total drag and velocity profile measurements are presented. Total drag results are also given for a normal Lucy Ashton model with the same roughness mesh tested in a towing tank. The influence of roughness on the wave drag component was found to be small, implying that the "interdependence" of wavemaking and viscous resistance is small. The importance of considering roughness as a local parameter is demonstrated, and the roughness function results agree well with the fully developed turbulent pipe flow results of Perry and Abell, even though the ship boundary-layer outer flow did not follow any recognized wake function.

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