Self-Harm History, Anxiety-Depression, Severity of Disease, and Insight Are Significantly Associated With Suicide Risk in Forensic Psychiatric Inpatients of China

Background: Forensic psychiatric patients have higher suicide risk than the general population. This study aimed to evaluate the extent of suicide risk and to explore the associated factors in forensic psychiatric inpatients in China.Methods: We conducted a cross-sectional study from 1st November, 2018 to 30th January, 2019 in the Forensic Psychiatric Hospital of Hunan Province, China. Patient's information on socio-demographic, clinical, and criminological characteristics was collected. The suicidality subscale of the MINI-International Neuropsychiatric Interview (M.I.N.I.), the Brief Psychiatric Rating Scale (BPRS), and the Severity of Illness of Clinical Global Impressions Scale (CGI-SI) were used to measure present suicide risks, psychiatric symptoms, and the severity of the patient's disease, respectively. Binary logistic regression models were used to examine factors associated with suicide risk.Results: Twenty-one percent (84/408) of the forensic psychiatric inpatients reported suicide risk. Logistic regression analysis suggested that self-harm history (OR:3.47, 95% confidence interval CI: 1.45–8.33), symptoms of anxiety-depression (OR:1.15, 95% CI:1.04–1.27), and more severe mental disorder (OR:1.42, 95% CI:1.08–1.87) were associated with elevated suicide risk, while insight disorder (OR:0.81, 95% CI:0.65–0.99) was related to decreasing suicide risk.Conclusion: The study supplied useful clinical information to recognize high suicide risk in forensic psychiatric inpatients and may aid the development of valuable strategies for preventing and reducing suicide events.

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Are Demoralization and Insight Involved in Suicide Risk? An Observational Study on Psychiatric Inpatients

Psychopathology ◽

10.1159/000515056 ◽

2021 ◽

pp. 1-9

Author(s):

Isabella Berardelli ◽

Marco Innamorati ◽

Salvatore Sarubbi ◽

Elena Rogante ◽

Denise Erbuto ◽

...

Keyword(s):

Suicide Risk ◽

Rating Scale ◽

Suicide Attempts ◽

Psychiatric Inpatients ◽

Clinical Factors ◽

Severity Rating ◽

Self Harm ◽

Demoralization Scale ◽

Insight Into Illness ◽

Insight Into

Introduction: Several features contribute to determining suicide risk. This study was designed with the aim of evaluating whether insight into illness and demoralization are involved in suicide risk (active suicidal ideation or behavior). Methods: For this purpose, in a sample of 100 adult psychiatric inpatients, we used the Columbia Suicide Severity Rating Scale to assess suicide risk, the Demoralization Scale for demoralization symptoms, and the Insight Scale to assess illness insight. We also investigated several demographic and clinical features, including gender, age, duration of untreated illness, previous suicide attempts, and nonsuicidal self-injurious behavior. Results: The results demonstrated that patients with higher scores on the insight-high dimension had 1.35 greater odds of having a higher suicide risk, and those with lifetime suicide attempts had 7.45 greater odds of having a higher suicide risk. Among the various clinical factors, the study indicated that only nonsuicidal self-harm behaviors in the last 3 months was a risk factor for suicide risk. Conclusions: The results indicated that greater illness insight is involved in suicide risk regardless of demoralization.

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Psychiatric Symptoms in Patients and Caregivers with Parkinson’s Disease

Oman Medical Journal ◽

10.5001/omj.2020.91 ◽

2020 ◽

Vol 35 (6) ◽

pp. e205-e205

Author(s):

Payam Saadat ◽

Mahbobeh Faramarzi ◽

Farnaz Salimkhani ◽

Soraya Khafri

Keyword(s):

Risk Factors ◽

Parkinson’S Disease ◽

Parkinson's Disease ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Cross Sectional ◽

Psychiatric Distress ◽

Compulsive Disorder ◽

Medical Disease ◽

Female Sex

Objectives: Psychiatric disorders in patients with Parkinson’s disease (PD) and their caregivers play an important role in patients’ treatment and follow-up. Our study aimed to examine the prevalence of psychiatric symptoms among patients with PD and their caregivers, demographic risk factors, and the influence of severity and manifestations of PD on psychiatric distress. Methods: We included 125 patients with PD and 125 of their primary caregivers in this descriptive cross-sectional study. The severity of PD was evaluated according to the Hoehn and Yahr severity scale from the Movement Disorder Society-Sponsored Revision of the Unified Parkinson’s Disease Rating Scale. PD patients and their caregivers completed the Symptom Checklist-25 to determine the presence of psychiatric distress. Also, demographic factors, including age, high level of education, occupation, residence, and cigarette smoking, were assessed in the PD patients and their caregivers. Results: The prevalence of psychiatric distress was 47.2% for PD patients and 18.4% for caregivers. Female sex, city residency, and medical disease were risk factors for more psychiatric symptoms in PD patients. Also, the female sex, single status, living in a village, and having a medical disease were risk factors for greater psychiatric symptoms in caregivers. PD patients in more advanced stages of disease suffered significantly from psychiatric distress, somatization, anxiety, interpersonal sensitivity, obsessive-compulsive disorder, and phobia compared to the lower severity of disease. PD patients with manifestation of postural instability showed a higher score of somatization, phobia, and psychiatric distress as compared with tremor, hypokinesia, and rigidity. Conclusions: Progression of PD influenced the psychiatric symptoms of both patients and their caregivers. A higher stage of PD is associated with higher scores of psychiatric distress, phobia, and somatization in the patients and their caregivers.

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De novo genesis of neuropsychiatric symptoms in Mild Cognitive Impairment (MCI)

International Psychogeriatrics ◽

10.1017/s1041610204000067 ◽

2004 ◽

Vol 16 (1) ◽

pp. 51-60 ◽

Cited By ~ 64

Author(s):

Yonas E. Geda ◽

Glenn E. Smith ◽

David S. Knopman ◽

Bradley F. Boeve ◽

Eric G. Tangalos ◽

...

Keyword(s):

Cognitive Impairment ◽

Mild Cognitive Impairment ◽

Rating Scale ◽

De Novo ◽

Psychiatric Symptoms ◽

Neuropsychiatric Symptoms ◽

Cross Sectional ◽

Neuropsychological Profile ◽

Pair Wise Comparison ◽

Normal Controls

Background: There is inadequate information regarding the neuropsychiatric aspect of Mild Cognitive Impairment (MCI).Objective: To determine the neuropsychiatric profile of MCI, and compare this with normal controls and patients with mild Alzheimer's Disease (AD).Design: Cross-sectional assessment of psychiatric symptoms in subjects that are enrolled in Mayo Clinic's longitudinal study of normal aging, MCI and dementia.Methods and Participants: The Neuropsychiatric Inventory (NPI) was administered to normal control subjects, MCI subjects and patients with early AD. Individual NPI domain scores and total NPI scores were compared among the three groups after controlling for age, educational status, Dementia Rating Scale (DRS) and Mini-Mental State Examination (MMSE) scores. Statistical analysis was performed by utilizing ANOVA, χ2 and Fisher's exact test.Results: Data were analyzed on 514 normal controls, 54 MCI subjects, and 87 subjects with mild AD (CDR of 0.5 or 1); females consisted of 60.3%, 53.7% and 57.5%; and, the average ages (SD) were 77.8 (1.95), 79 (4.6), 80.5 (14.6) respectively. ANOVA pair-wise comparison revealed that both MMSE and DRS differences among the three groups were significantly different at (p=0.05). The total NPI scores were significantly different (p=0.0001, F=107.93) among the three groups using ANOVA. Pair-wise comparison of individual behavioral domain of NPI showed statistically significant differences between MCI and normals; and MCI and AD (p=0.001). Group differences on NPI remained after controlling for age and education at p=0.0375 and p=0.0050 respectively.Conclusion: The neuropsychiatric pattern is reminiscent of the clinical, neuroimaging and neuropsychological profile of MCI. It gives further credence to the view that MCI is indeed the gray zone, with overlap on both ends of the pole.

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New Path to Recovery and Well-Being: Cross-Sectional Study on WeChat Use and Endorsement of WeChat-Based mHealth Among People Living With Schizophrenia in China

Journal of Medical Internet Research ◽

10.2196/18663 ◽

2020 ◽

Vol 22 (9) ◽

pp. e18663

Author(s):

Yu Yu ◽

Yilu Li ◽

Tongxin Li ◽

Shijun Xi ◽

Xi Xiao ◽

...

Keyword(s):

Quality Of Life ◽

College Students ◽

Psychiatric Symptoms ◽

Cost Effective ◽

Well Being ◽

The Elderly ◽

Cross Sectional Study ◽

Hunan Province ◽

Cross Sectional

Background The past few decades have seen an exponential increase in using mobile phones to support medical care (mobile health [mHealth]) among people living with psychosis worldwide, yet little is known about WeChat use and WeChat-based mHealth among people living with schizophrenia (PLS) in China. Objective This study aims to assess WeChat use, endorsement of WeChat-based mHealth programs, and health related to WeChat use among PLS. Methods We recruited a random sample of 400 PLS from 12 communities in Changsha City of Hunan Province, China. WeChat use was assessed using the adapted WeChat Use Intensity Questionnaire (WUIQ). We also compared psychiatric symptoms, functioning, disability, recovery, quality of life, and general well-being between WeChat users and nonusers using one-to-one propensity-score matching. Results The WeChat use rate was 40.8% in this sample (163/400); 30.7% (50/163) had more than 50 WeChat friends and nearly half (81/163, 49.7%) spent more than half an hour on WeChat, a pattern similar to college students and the elderly. PLS also showed higher emotional connectedness to WeChat use than college students. About 80.4% (131/163) of PLS were willing to participate in a WeChat-based mHealth program, including psychoeducation (91/163, 55.8%), professional support (82/163, 50.3%), and peer support (67/163, 41.1%). Compared with nonusers, WeChat users were younger, better educated, and more likely to be employed. WeChat use was associated with improved health outcomes, including lower psychiatric symptoms, lower depression, higher functioning, better recovery, and higher quality of life. Conclusions WeChat-based mHealth programs hold promise as an empowering tool to provide cost-effective interventions, to foster global recovery, and to improve both physical and mental well-being among PLS. WeChat and WeChat-based mHealth programs have the potential to offer a new path to recovery and well-being for PLS in China.

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Associations between symptom severity and well-being among Thai patients with schizophrenia: a cross-sectional analytical study

BMC Psychiatry ◽

10.1186/s12888-021-03358-0 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Teerapat Teetharatkul ◽

Arnont Vitayanont ◽

Tippawan Liabsuetrakul ◽

Warut Aunjitsakul

Keyword(s):

Logistic Regression ◽

Symptom Severity ◽

Negative Symptoms ◽

Rating Scale ◽

Well Being ◽

Self Report ◽

Subjective Well Being ◽

Multivariate Logistic Regression ◽

Cross Sectional ◽

Middle Income

Abstract Background Severity of symptoms in patients with schizophrenia is a determinant of patient’s well-being, but evidence in low- and middle-income countries is limited. We aimed to measure the symptom severity using objective measurements, the Brief Psychiatric Rating Scale (BPRS) and Clinical Global Impression-Severity scale (CGI-S), and their associations with well-being in patients with schizophrenia. Methods Patients with schizophrenia aged ≥18 years, without active psychosis including no history of hospitalization within the last 6 months, were included. Symptom severity was measured by the clinicians using BPRS and CGI-S. The patients’ well-being was assessed by self-report using the Subjective Well-being under Neuroleptic treatment scale (SWN) as continuous and binary outcomes (categorized into adequate or poor well-being). Correlations between symptom severity (BPRS and CGI-S scores) and well-being (SWN score) were analyzed using Pearson’s correlation. Association between well-being status and BPRS was analyzed using multivariate logistic regression. Results Of 150 patients, BPRS and CGI-S were inversely correlated with SWN score (r = − 0.47; p < 0.001 and − 0.21; p < 0.01, respectively). BPRS Affect domain had the highest correlation with SWN (r = − 0.51, p < 0.001). In multivariate logistic regression, BPRS score and being unemployed were associated with poor well-being status (adjusted OR 1.08; 95%CI 1.02–1.14; p = 0.006, and 4.01; 95%CI 1.38–11.7; p = 0.011, respectively). Conclusion Inverse relationships between symptom severity and well-being score were found. Higher BPRS Affect domain was significantly associated with lower patients’ well-being. The use of BPRS tool into routine clinical practice could serve as an adjunct to physician’s clinical evaluation of patients’ symptoms and may help improve patient’s well-being. Further research on negative symptoms associated with well-being is required.

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The impact of the COVID-19 pandemic on self-harm and suicidal behaviour: update of living systematic review

F1000Research ◽

10.12688/f1000research.25522.2 ◽

2021 ◽

Vol 9 ◽

pp. 1097

Author(s):

Ann John ◽

Emily Eyles ◽

Roger T. Webb ◽

Chukwudi Okolie ◽

Lena Schmidt ◽

...

Keyword(s):

Systematic Review ◽

Suicidal Behaviour ◽

Suicide Risk ◽

Research Evidence ◽

Inclusion Criteria ◽

Suicidal Thoughts ◽

Cross Sectional ◽

Self Harm ◽

Cross Sectional Studies ◽

The Impact

Background: The COVID-19 pandemic has caused considerable morbidity, mortality and disruption to people’s lives around the world. There are concerns that rates of suicide and suicidal behaviour may rise during and in its aftermath. Our living systematic review synthesises findings from emerging literature on incidence and prevalence of suicidal behaviour as well as suicide prevention efforts in relation to COVID-19, with this iteration synthesising relevant evidence up to 19th October 2020. Method: Automated daily searches feed into a web-based database with screening and data extraction functionalities. Eligibility criteria include incidence/prevalence of suicidal behaviour, exposure-outcome relationships and effects of interventions in relation to the COVID-19 pandemic. Outcomes of interest are suicide, self-harm or attempted suicide and suicidal thoughts. No restrictions are placed on language or study type, except for single-person case reports. We exclude one-off cross-sectional studies without either pre-pandemic measures or comparisons of COVID-19 positive vs. unaffected individuals. Results: Searches identified 6,226 articles. Seventy-eight articles met our inclusion criteria. We identified a further 64 relevant cross-sectional studies that did not meet our revised inclusion criteria. Thirty-four articles were not peer-reviewed (e.g. research letters, pre-prints). All articles were based on observational studies. There was no consistent evidence of a rise in suicide but many studies noted adverse economic effects were evolving. There was evidence of a rise in community distress, fall in hospital presentation for suicidal behaviour and early evidence of an increased frequency of suicidal thoughts in those who had become infected with COVID-19. Conclusions: Research evidence of the impact of COVID-19 on suicidal behaviour is accumulating rapidly. This living review provides a regular synthesis of the most up-to-date research evidence to guide public health and clinical policy to mitigate the impact of COVID-19 on suicide risk as the longer term impacts of the pandemic on suicide risk are researched.

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Prevalence and Measurement of Anxiety and Depression in Working Nurses in Nepal: A Reflection of Professional Hazard in Low Income Nation

10.21203/rs.2.16888/v1 ◽

2019 ◽

Author(s):

Pramila Karki ◽

George W. B. J. Katwal ◽

Ayush Chandra ◽

Avinash Chandra

Keyword(s):

Low Income ◽

Rating Scale ◽

Mental Health Problems ◽

Strong Association ◽

Cross Sectional Study ◽

Anxiety And Depression ◽

Cross Sectional ◽

General Anxiety Disorder ◽

Validated Questionnaire ◽

Anxiety Depression

Abstract Background Anxiety, Depression is one of the under reported, underdiagnosed in Nepal though it is the leading cause of incapacitation and is the leading healthcare burden worldwide. The prevalence of anxiety, depression among health personnel is not reported. In this study we attempted to assess the incidence and impact of depression and anxiety in nurses who are working upfront in different hospitals.Method A cross-sectional study was carried out and the sample was collected from nurses working in different hospitals who had spent 6 months or more time as a working nurse in those hospitals. Prevalence of anxiety and depression was assessed using a structured validated questionnaire, The Hamilton Anxiety Scale (HAM-A) with a cut-off score for various levels of anxiety. Similarly, General Anxiety Disorder Questionnaires (GAD), Hamilton Depression Rating Scale (HAM-D) was used to assess depression and anxiety.Result The analysis of these different scales revealed that disabling anxiety prevailed at highest (43.6%) in nursing staff according to HAM-A scale. Moderate anxiety also seemed to be higher (>20%) in GAD questionnaire. The moderate to severe anxiety prevailed in majority of our study participants in all these scales (HAM-A, HAM-D, GAD). Interestingly, there seemed a strong association between HAM-A to GAD (p=0.008).Conclusions This is probably the first study of its kind that reports on the prevalence of anxiety, depression in the nurses who work in different hospitals in Nepal. We hope this study also depicts the mental health problems that the medical professionals are suffering in other nations as well.

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Absconsion in forensic psychiatric services: a systematic review of literature

CNS Spectrums ◽

10.1017/s1092852920001881 ◽

2020 ◽

pp. 1-12

Author(s):

Andrew T. Olagunju ◽

Stephanie L. Bouskill ◽

Tinuke O. Olagunju ◽

Sebastien S. Prat ◽

Mini Mamak ◽

...

Keyword(s):

Psychiatric Symptoms ◽

Sexual Offending ◽

Risky Behaviors ◽

Psychiatric Services ◽

Recidivism Rate ◽

Cross Sectional ◽

Forensic Patients ◽

Psychiatric Units ◽

Forensic Psychiatric ◽

Meta Analyses

Abstract While serious concerns are often raised when patients abscond or leave unauthorized from psychiatric services, there is limited knowledge about absconsion in forensic psychiatric services. Following the preferred reporting items for systematic reviews and meta-analyses guideline, we searched Medline/PubMed, PsycINFO, EMBASE, CINAHL, Scopus, and Web of Science through May 2020 for eligible reports on absconsion in forensic patients with no language limits. The search string combined terms for absconsion, forensic patients, and psychiatry in various permutations. This was supplemented by snowball searching for additional studies. Of the 565 articles screened, 25 eligible studies, including two interventional, seven cross-sectional, and 16 case-controlled studies spanning five decades were included. Absconsion and re-absconsion rates ranged from 0.2% to 54.4% and 15% to 71%, respectively, albeit higher rates trended with less secure psychiatric units. Previous absconsion, aggression, substance use, high Historical Clinical Risk Management-20 score, anti-sociality, psychiatric symptoms, sexual offending, and poor treatment adherence were the factors reported with a degree of predictive value for absconsion. However, the construct of absconsion was heterogeneous in the included studies and the quality of evidence on the predictors of absconsion was limited. Serious risky behaviors including re-offending, violence, self-harm, suicide, rape, and manslaughter were perpetrated by patients during unauthorized leave. Nevertheless, the rates of re-offending were generally low in the included studies (highest recidivism rate = 0.11). There is need for standardized assessment and documentation of absconsion to improve risk analysis and management. Furthermore, it is necessary to develop a structured guideline for defining absconsion, and to create a protocol that operationalizes all absconsion-related behaviors/events to promote reliable assessment and comparative analysis in future studies.

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PRN prescribing in psychiatric inpatients – potential for pharmacokinetic drug interactions

Journal of Psychopharmacology ◽

10.1177/0269881107067242 ◽

2007 ◽

Vol 21 (2) ◽

pp. 153-160 ◽

Cited By ~ 27

Author(s):

Simon J. C. Davies ◽

Martin S. Lennard ◽

Parviz Ghahramani ◽

Peter Pratt ◽

Andrea Robertson ◽

...

Keyword(s):

Side Effects ◽

Psychiatric Symptoms ◽

Drug Prescription ◽

Plasma Concentrations ◽

Clinical Importance ◽

Psychiatric Inpatients ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Patient Request ◽

Old Age Psychiatry

Medications are commonly prescribed to psychiatric inpatients on a PRN ( pro re nata/as required) basis, allowing drugs to be administered on patient request or at nurses' discretion for psychiatric symptoms, treatment side effects or physical complaints. However, there has been no formal study of the pharmacokinetic implications of PRN prescribing. The objective of the study was to determine the prevalence of PRN drug prescription and administration, and to assess the potential for interactions involving CYP2D6 and CYP3A4 between drugs prescribed and administered to inpatients on psychiatry wards. A cross-sectional survey of prescriptions on general adult and functional elderly psychiatric wards in one city was carried out. Data were recorded from prescription charts of 323 inpatients (236 on general adult and 87 on functional elderly wards). Of 2089 prescriptions, 997 (48%) of prescriptions were on a PRN basis (most commonly benzodiazepines and other hypnotic agents, antipsychotics, analgesics and anticholinergic agents), but only 143 (14%) of these had been administered in the previous 24 hours. One fifth of patients were prescribed drug combinations interacting with CYP2D6 or CYP3A4 of potential clinical importance which included one or more drugs prescribed on a PRN basis. PRN prescribing is common among inpatients in psychiatry, and may lead to cytochrome P450 mediated interactions. Prescribers should be aware of the potential for unpredictability in plasma concentrations, side effects and efficacy which PRN prescribing may cause through these interactions, particularly in old age psychiatry and in treatment of acute psychosis.

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Suicidal Behavior and Club Drugs in Young Adults

Brain Sciences ◽

10.3390/brainsci11040490 ◽

2021 ◽

Vol 11 (4) ◽

pp. 490

Author(s):

Giovanni Martinotti ◽

Stefania Schiavone ◽

Attilio Negri ◽

Chiara Vannini ◽

Luigia Trabace ◽

...

Keyword(s):

Suicide Risk ◽

Drug Users ◽

Suicide Ideation ◽

Rating Scale ◽

Psychiatric Symptoms ◽

Self Control ◽

Study Cohort ◽

Club Drugs ◽

Severity Rating ◽

Loss Of Self

Psychoactive drugs play a significant role in suicidality when used for intentional overdose or, more frequently, when the intoxication leads to disinhibition and alterations in judgment, thereby making suicide more likely. In this study, we investigated suicidality prevalence among drug users and evaluated the differences in suicide ideation, taking into account the substance categories and the association of suicide ideation intensity with other psychiatric symptoms. Subjects admitted to the Can Misses Hospital’s psychiatry ward in Ibiza were recruited during summer openings of local nightclubs for four consecutive years starting in 2015. The main inclusion criterium was an intake of psychoactive substances during the previous 24 h. The Columbia Suicide Severity Rating Scale (C-SSRS) was used to assess the suicide risk. Suicidality was present in 39% of the study cohort. Suicide Ideation Intensity overall and in the previous month was higher in users of opioids and in general of psychodepressors compared to psychostimulants or psychodysleptics. Suicidality was not correlated with alterations in any of the major psychopathological scales employed to assess the psychiatric background of the study subjects. The presence of high levels of suicidality did not specifically correlate with any major symptom indicative of previous or ongoing psychopathological alterations. These findings suggest that impulsivity and loss of self-control may be determinants of the increased suicidality irrespectively of any major ongoing psychiatric background.

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