scholarly journals Repetition of deliberate self-harm and subsequent suicide risk: Long-term follow-up study of 11 583 patients

2004 ◽  
Vol 185 (1) ◽  
pp. 70-75 ◽  
Author(s):  
Daniel Louis Zahl ◽  
Keith Hawton
Keyword(s):  
Relative Risk ◽  
Suicide Risk ◽  
Single Episode ◽  
Deliberate Self Harm ◽  
Young Females ◽  
Follow Up Study ◽  
Increased Risk ◽  
Self Harm

BackgroundRepetition of deliberate self-harm (DSH) is a risk factor for suicide. Little information is available on the risk for specific groups of people who deliberately harm themselves repeatedly.AimsTo investigate the long-term risk of suicide associated with repetition of DSH by gender, age and frequency of repetition.MethodA mortality follow-up study to the year 2000 was conducted on 11583 people who presented to the general hospital in Oxford between 1978 and 1997. Repetition of DSH was determined from reported episodes prior to the index episode and episodes presenting to the same hospital during the follow-up period. Deaths were identified through national registers.ResultsThirty-nine percent of patients repeated the DSH. They were at greater relative risk of suicide than the single-episode DSH group (2.24; 95% CI 1.77–2.84). The relative risk of suicide in the repeated DSH group compared with the single-episode DSH group was greater in females (3.5; 95% C11.3–2.4) than males (1.8; 95% C1 2.3–5.3) and was inversely related to age (up to 54 years). Suicide risk increased further with multiple repeat episodes of DSH in females.ConclusionsRepetition of DSH is associated with an increased risk of suicide in males and females. Repetition may be a better indicator of risk in females, especially young females.

scholarly journals Deaths from all causes in a long-term follow-up study of 11583 deliberate self-harm patients

2006 ◽  
Vol 36 (3) ◽  
pp. 397-405 ◽  
Author(s):  
K. HAWTON ◽  
L. HARRISS ◽  
D. ZAHL
Keyword(s):  
Deliberate Self Harm ◽  
Risk Of Death ◽  
Follow Up Study ◽  
Increased Risk ◽  
Wide Range ◽  
Long Term Follow Up ◽  
Physical Disorders ◽  
Self Harm ◽  
Care Costs

Background. Deliberate self-harm (DSH) may be associated with increased risk of death from a variety of causes, not just suicide.Method. A follow-up study of 11583 DSH patients who presented to a general hospital over a 20-year period was conducted to examine risk of death from a range of causes during a follow-up period of between 3 and 23 years. Deaths were identified through national death registries. Expected numbers of deaths were calculated from national death statistics.Results. The number of deaths (1185, 10·2%) was 2·2 times the expected number, the excess being significantly greater in males than females. Suicides were 17 times more frequent than expected and undetermined causes of death and accidental poisonings 15 times more frequent. Significantly more than expected numbers of deaths from most natural causes were found, including respiratory disease, circulatory, neurological, endocrine, digestive, skin and musculoskeletal and connective tissue disorders, and symptoms, signs and ill-defined conditions. Deaths due to accidents other than poisoning were more frequent than expected in both genders and homicides more frequent in males.Conclusions. In addition to increased risk of suicide, DSH patients are at increased risk of dying from a wide range of other causes. Possible explanations include lifestyle factors, physical disorders contributing to initial risk of DSH, and social disadvantage. The findings are relevant to clinical management and evaluation of outcome and health-care costs associated with DSH.

scholarly journals Interleukin-1 Receptor Antagonist Synthesis by Peripheral Blood Mononuclear Cells

2000 ◽  
Vol 11 (11) ◽  
pp. 2114-2121
Author(s):  
VAIDYANATHAPURAM S. BALAKRISHNAN ◽  
CHRISTOPHER H. SCHMID ◽  
BERTRAND L. JABER ◽  
SVETLOZAR N. NATOV ◽  
ANDREW J. KING ◽  
...  
Keyword(s):  
Relative Risk ◽  
Receptor Antagonist ◽  
Clinical Outcomes ◽  
Peripheral Blood ◽  
Interleukin 1 ◽  
Peripheral Blood Mononuclear ◽  
Interleukin 1 Receptor Antagonist ◽  
Increased Risk

Abstract. Proinflammatory cytokines have been implicated in the short- and long-term morbidity experienced by hemodialysis (HD) patients. The present study, which is based on long-term follow-up of a cohort of 37 patients, relates peripheral blood mononuclear cell (PBMC) interleukin-1 receptor antagonist (IL-1Ra) synthesis (a reliable marker of IL-1β synthesis in HD patients) and plasma levels of an acute phase reactant, lipopolysaccharide binding protein (LBP), to clinical outcomes. In July 1993, predialysis blood samples from these patients were collected and IL-1Ra synthesis by PBMC and plasma LBP was measured. Hospital records were reviewed and patient follow-up data were obtained until December 1997 (54 mo) or death, whichever occurred earlier. The effect of age, diabetes, endotoxin- and IgG-stimulated IL-1Ra synthesis, and plasma LBP levels on mortality was assessed using the Cox proportional hazard regression model. Poisson regression was used to determine potential relationships between the number of outcome events and each continuous risk factor. Twenty-two patients (59%) died during the follow-up period. Mortality was unrelated to IL-1Ra synthesis but did increase with age (relative risk, 1.05/yr; P = 0.01) and diabetes (relative risk, 3.00/yr; P = 0.03). Cardiovascular event rates were higher among older individuals and in those with higher endotoxin-stimulated PBMC IL-1Ra synthesis. Cardiovascular events increased with plasma LBP levels in the range of 9,000 to 12,000 pg/ml but then seemed to decrease. In contrast, older age and low IgG-stimulated IL-1Ra synthesis were associated with an increased risk of infectious events. The results of this study demonstrate an interesting link between stimulus-dependent variability in IL-1Ra synthesis by PBMC and clinical outcomes among patients on chronic HD and provide interesting targets for therapeutic interventions in this vulnerable patient population.

scholarly journals A nationwide, population-based, long-term follow-up study of repeated self-harm in Taiwan

2012 ◽  
Vol 12 (1) ◽  
Author(s):  
Chi-Hsiang Chung ◽  
Ching-Huang Lai ◽  
Chi-Ming Chu ◽  
Lu Pai ◽  
Senyeong Kao ◽  
...  
Keyword(s):  
Population Based ◽  
Follow Up Study ◽  
Long Term Follow Up ◽  
Self Harm

Early predictors of deliberate self-harm among adolescents. A prospective follow-up study from age 3 to age 15

2006 ◽  
Vol 93 (1-3) ◽  
pp. 87-96 ◽  
Author(s):  
Andre Sourander ◽  
Minna Aromaa ◽  
Leena Pihlakoski ◽  
Antti Haavisto ◽  
Päivi Rautava ◽  
...  
Keyword(s):  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Early Predictors ◽  
Self Harm

Hostility, hopelessness and deliberate self-harm: a prospective follow-up study

1990 ◽  
Vol 81 (3) ◽  
pp. 280-283 ◽  
Author(s):  
A. D. Brittlebank ◽  
A. Cole ◽  
F. Hassanyeh ◽  
M. Kenny ◽  
D. Simpson ◽  
...  
Keyword(s):  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Self Harm

scholarly journals Kikuchi-Fujimoto disease: unusual presentation of rare disease

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Duy Vu ◽  
Srini Reddy ◽  
Lynn Day ◽  
Nail Aydin ◽  
Subhasis Misra
Keyword(s):  
Lupus Erythematosus ◽  
Unusual Presentation ◽  
Chronic Infections ◽  
Young Females ◽  
Inappropriate Treatment ◽  
Increased Risk ◽  
Long Term Follow Up ◽  
Autoimmune Processes

Kikuchi-Fujimoto disease (KFD) is a rare, benign disorder that typically follows a selflimiting natural course and was initially described in young females of Asian descent. Its clinical presentation may mimic lymphoproliferative disorders, connective tissue disorders, and chronic infections. This often leads to misdiagnosis and inappropriate treatment. The exact cause of this condition remains unknown although autoimmune processes and certain infectious agents have been associated with the disease. The diagnosis of KFD is made histopathologically. Treatment is supportive and long-term follow-up is recommended due to increased risk of future development of systemic lupus erythematosus. Here we are presenting a case of a patient with an unusual presentation of KFD.

Long-Term Follow-Up of Multiple Myeloma (MM) Patients (pts) with Osteonecrosis of the Jaw (ONJ).

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 3519-3519 ◽  
Author(s):  
Ashraf Badros ◽  
T. Evangelos ◽  
O. Goloubeva ◽  
T. Meiller ◽  
E. Kastritis ◽  
...  
Keyword(s):  
Median Number ◽  
Dental Extraction ◽  
P Value ◽  
Single Episode ◽  
Dental Procedures ◽  
Increased Risk ◽  
The Us ◽  
Long Term Follow Up

Abstract Risk factors for ONJ in MM pts include dental extraction, bisphosphonates (BP) use, older age and longer survival. There is also an increased risk of skeletal related events (SRE) in ONJ pts (Badros, JCO 2006). The current study provides long term follow-up data for ONJ pts with regard to ONJ recurrence, SRE and MM status. The study included 97 pts: 60 from Greece and 37 from the US. Pts’ characteristics are summarized in the table below. Median follow-up time has not been reached; lower limit of the 95%CI was 3.2 yrs. ONJ resolved in 60 of 97 pts (62%), resolved and recurred in 12 pts (12%), and did not heal over a 9 months period in 25 pts (26%). Dental extraction preceded ONJ in 46 of 97 pts (47%) and was more common in pts with a single episode of ONJ (35 of 60, 58%) than in the recurrent and non-healing pts (11 of 37, 30%) (p-value=0.007). The median number of ONJ episodes in the recurrent group was 3 (range, 2–6); recurrence of ONJ was precipitated by re-initiation of BP and by dental procedures in 5 and 4 pts of 12, respectively. There was a trend toward higher ONJ recurrence rate in the US (8 of 37, 22%) versus the Greek (4 out of 60, 7%) pts (p-value=0.053). Surgery was performed more often in the US than in Greece 17 of 37 (45%) versus 19 of 60 pts (32%). BP reinitiation was more frequent in US 16 of 37 (43%) than in Greece 3 of 60 (5%). Non-healing ONJ lesions were managed with antibiotics; 10 of 25 pts developed fistulas and needed surgery; in 9 pts the lesions remained asymptomatic. Twenty-one ONJ pts had SRE including fractures (ribs, vertebrae and long bones, n=13) and avascular necrosis of the femur (n=8). The rate of MM relapse was higher in pts with recurrent and non-healing ONJ (84%) compared to pts with a single episode (62%) (p-value=0.02). The median OS from diagnosis of MM was 10.8 yrs (95% CI; 9.3 yrs- not reached) and did not differ between pts with single, recurrent/non-healing ONJ (p= 0.2). In summary, pts in whom ONJ followed dental procedures were less likely to have recurrence or non-healing, both, although infrequent, were linked to BP re-challenge, mostly in the setting of relapsed MM. Non-healing ONJ lesions remained stable/asymptomatic without extensive intervention. BP should be discontinuation until ONJ lesions heal. The decision to restart BP should be individualized based on MM-SRE risk. ONJ Pts characteristics and outcome AA, African American; ttt, treatment; CR, complete remission; PR, partial remission; PD, progressive disease; Dex, dexamethasone, thal, thalidomide; Len, lenalidomide; Bort, bortezomib; A, pamidronate; Z zoledronic acid. The Fisher’s Exact test was used, all p-values reported are two-sided. ONJ, n= 97 one episode, n=60 recurrent, n=12 non-healing, n=25 age at MM; median (range) 60 (26–77) 61 (26–77) 55 (43–76) 61 (36–73) Sex; male/female 59/38 38/22 8/4 13/12 Caucasian/AA 87/10 54/6 10/2 23/2 Isotype; IgG, A, D, LCH 60/20/1/16 36/11/1/12 7/2/0/3 17/7/0/1 MM ttt at ONJ (n=93); none/dex/thal/len/bort 22/31/26/6/8 11/25/16/4/2 5/1/3/1/1 6/5/7/1/4 MM status at ONJ diagnosis; CR/PR/PD 7/54/33 4/37/17 3/8/1 0/9/15 BP use; AZ/Z 59/35 34/23 10/2 15/10 Dental extraction 46 35 5 5 Restarted BP 19 11 6 2 bone complciations 21 14 3 4 MM course after ONJ; continous remission/Relapse 29/68 23/37 2/10 4/21 MM status at last follow up; CR/PR/PD (died) 3/59/35(28) 3/35/22(20) 0/10/2(2) 0/14/11(6)

Optional thinking ability among hospital-treated deliberate self-harm patients: A 1-year follow-up study

2008 ◽  
Vol 47 (1) ◽  
pp. 43-58 ◽  
Author(s):  
Carmel. McAuliffe ◽  
Paul. Corcoran ◽  
Portia. Hickey ◽  
Breda C. McLeavey
Keyword(s):  
Deliberate Self Harm ◽  
Follow Up Study ◽  
Thinking Ability ◽  
Self Harm

scholarly journals Suicide following deliberate self-harm: long-term follow-up of patients who presented to a general hospital

2003 ◽  
Vol 182 (6) ◽  
pp. 537-542 ◽  
Author(s):  
Keith Hawton ◽  
Daniel Zahl ◽  
Rosamund Weatherall
Keyword(s):  
General Hospital ◽  
Age Groups ◽  
First Year ◽  
Prevention Strategies ◽  
Deliberate Self Harm ◽  
Long Term Follow Up ◽  
Self Harm ◽  
Annual Risk

BackgroundDeliberate self-harm (DSH) is the strongest risk factor for future suicide. Up-to-date information on the extent of risk is lacking.AimsTo investigate the risk of suicide after DSH during a long follow-up period.MethodA mortality follow-up study to 2000 was conducted on 11583 patients who presented to hospital after DSH between 1978 and 1997. Data were obtained from a general hospital DSH register in Oxford and the Office for National Statistics, and from equivalent mortality registers in Scotland and Northern Ireland.ResultsThree hundred patients had died by suicide or probable suicide. The risk in the first year of follow-up was 0.7% (95% CI 0.6–0.9%), which was 66 (95% CI 52–82) times the annual risk of suicide in the general population. The risk after 5 years was 1.7%, at 10 years 2.4% and at 15 years 3.0%. The risk was far higher in men than in women (hazard ratio 2.8, 95% CI 2.2–3.6). In both genders it increased markedly with age at initial presentation.ConclusionsFollowing DSH there is a significant and persistent risk of suicide, which varies markedly between genders and age groups. Reduction in the risk of suicide following DSH must be a key element in national suicide prevention strategies.

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