Suicide Risk in Schizophrenia - a follow-up study after 20 years. Part 2: Symptomatology and pharmacotherapy

Objective: This study prospectively re-evaluated, after a period of 20 years, a cohort of patients with schizophrenia who had been considered to be at high risk for suicide. The outcome and social factors associated with their suicide risk were investigated over the 2 decades. Method Subjects were contacted and interviewed face-to-face by following a questionnaire devised for this purpose. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was administered. Cross tabulations were performed to identify factors associated with increased suicide risk. A psychological autopsy was performed, for those subjects who had committed suicide since the original study.Results:Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Male gender, poor social support, early age of illness onset, current admission to or recent discharge from hospital and a higher level of education were all factors associated with increased suicide risk. Conclusion: Demographic factors and those related to illness course, found in this study to be associated with suicide risk in patients with schizophrenia, are congruous with those mentioned in the literature.

Download Full-text

Suicide Risk in Schizophrenia, a 20 Year Cohort Study, Part 1: Outcome and associated social factors

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v15i3.193 ◽

2009 ◽

Vol 15 (3) ◽

pp. 6

Author(s):

G Lippi ◽

D J Smit ◽

J C Jordaan ◽

J L Roos

Keyword(s):

Adverse Effects ◽

Social Factors ◽

Suicide Risk ◽

Suicide Attempts ◽

Current Knowledge ◽

Social Withdrawal ◽

Depression Scale ◽

Original Study ◽

Psychological Autopsy ◽

Formal Thought Disorder

Objective: This study prospectively followed up, after a period of 20 years, a group of patients with schizophrenia who were considered to be at high risk for suicide. In Part 1, we reported on outcome and associated social factors, and in this paper we discuss re-evaluated suicide risk in these patients and investigated symptomology and pharmacotherapy over the last 2 decades. Method: The subjects were interviewed, and a questionnaire evaluating suicide risk was completed. The Beck Hopelessness Scale (BHS) was administered and ratings were compared to those from the original study. The Calgary Depression Scale for Schizophrenia (CDSS) was also administered. Cross tabulations were then performed to identify factors associated with increased suicide risk. For those subjects who committed suicide since the original study, a psychological autopsy was performed.Results: Fourteen of the original 33 high suicide risk schizophrenia patients were found. Three subjects committed suicide during the 20 year period. Among the living subjects, risks for suicide were found to be lower than 20 years ago. Hopelessness and depressive symptoms correlated with independently evaluated suicide risk. Social withdrawal, blunting of affect and delusions were also associated with elevated risk. Good insight into illness and a history of previous suicide attempts correlate with high suicide risk. Cannabis abuse, poor or periodic adherence to treatment, as well as weight gain, akathisia and parkinsonian adverse effects were also associated with an increase in risk for suicide. Formal thought disorder, avolition and cognitive impairment were associated with lower risk of suicide.Conclusion: Hopelessness, depression, certain positive symptoms and adverse effects of medication, found in this study to be congruent with suicide risk in patients with schizophrenia, coincide with those mentioned in the literature. Despite current knowledge about this subject, suicide remains notoriously and ominously unpredictable in patients with schizophrenia.

Download Full-text

16: POSTPARTUM DEPRESSION SCREENING IN A PEDIATRIC ED

Journal of Investigative Medicine ◽

10.1136/jim-2016-000080.32 ◽

2016 ◽

Vol 64 (3) ◽

pp. 813.1-813

Author(s):

L Jarvis ◽

G Badolato ◽

K Breslin ◽

M Goyal

Keyword(s):

Postpartum Depression ◽

Positive Impact ◽

Private Insurance ◽

Depression Scale ◽

Safety Net ◽

Suicidal Thoughts ◽

Convenience Sample ◽

Factors Associated ◽

Young Infants

Purpose of StudyPostpartum depression (PPD) occurs in up to 20% of mothers. The American Academy of Pediatrics recommends routine screening for PPD. The pediatric emergency department (PED) serves as a safety-net for vulnerable, high-risk populations, and may be a useful site for screening. This study investigates (1) prevalence of PPD positive screens, (2) factors associated with a positive PPD screen, (3) frequency of mothers who had not completed a PPD screen previously, and (3) acceptability and impact of PPD screening.Methods UsedWe performed a prospective, cross-sectional survey of a convenience sample of mothers of infants </=6 months of age presenting with low-acuity complaints. Mothers completed a computerized survey that included a validated PPD screening tool (Edinburgh Postnatal Depression Scale). We calculated frequency of positive screens and performed bivariable logistic regression to identify factors associated with a positive PPD screen. PPD positive-screened mothers were contacted for phone follow-up at one-month.Summary of Results121 mothers were screened for PPD (mean age=28± SD 6 years; 86% English vs. Spanish language; 50% non-Hispanic Black race/ethnicity; 75% non-private insurance) during presentation to the ED with their infant (mean age=3±SD 2 months; 51% female). Twenty-seven mothers (22%) screened positive for PPD with eight mothers (7%) reporting suicidal thoughts. Forty-seven percent (57/121) of mothers had never previously been screened, including 59% (16/27) of PPD-positive screened and those endorsing suicidal thoughts (5/8, 63%). Infants of PPD-screened positive mothers had more ED visits than those whose mothers screened negative (median 2 vs. 1). Seventy-four percent (90/121) of participants viewed ED-based PPD screening favorably. At one-month follow-up 100% (n=12) reported ED-based PPD screening acceptable and the majority endorsed positive impact of screening, including increased access to support (8/12, 67%) and improved activities of daily living (10/12, 83%).ConclusionsPPD is reported by approximately 1 in 5 mothers in an urban PED and the majority of PED-screen positive mothers had not been screened previously. PED-based screening was well-accepted and had a positive impact. Our study informs future efforts for interventions to support mothers of young infants who use the PED for care.

Download Full-text

The Desire to Better Understand Older Adults with Solid Tumors to Improve Management: Assessment and Guided Interventions—The French PACA EST Cohort Experience

Cancers ◽

10.3390/cancers11020192 ◽

2019 ◽

Vol 11 (2) ◽

pp. 192 ◽

Cited By ~ 7

Author(s):

Rabia Boulahssass ◽

Sebastien Gonfrier ◽

Noémie Champigny ◽

Sandra Lassalle ◽

Eric François ◽

...

Keyword(s):

Solid Tumors ◽

Nutritional Assessment ◽

Geriatric Depression Scale ◽

Geriatric Oncology ◽

Depression Scale ◽

Mini Nutritional Assessment ◽

Factors Associated ◽

Independent Risk Factors ◽

State Examination

Todays challenge in geriatric oncology is to screen patients who need geriatric follow-up. The main goal of this study was to analyze factors that identify patients, in a large cohort of patients with solid tumors, who need more geriatric interventions and therefore specific follow-up. Between April 2012 and May 2018, 3530 consecutive patients were enrolled in the PACA EST cohort (France). A total of 3140 patients were finally enrolled in the study. A Comprehensive Geriatric Assessment (CGA) was performed at baseline. We analyzed the associations between factors at baseline (geriatric and oncologic factors) and the need to perform more than three geriatric interventions. The mean age of the population was 82 years old with 59% of patients aged older than 80 years old. A total of 8819 geriatric interventions were implemented for the 3140 patients. The percentage of patients with three or more geriatric interventions represented 31.8% (n = 999) of the population. In multivariate analyses, a Mini Nutritional assessment (MNA) <17, an MNA ≤23·5 and ≥17, a performans status (PS) >2, a dependence on Instrumental Activities of Daily Living (IADL), a Geriatric Depression Scale (GDS) ≥5, a Mini Mental State Examination (MMSE) <24, and a Screening tool G8 ≤14 were independent risk factors associated with more geriatric interventions. Factors associated with more geriatric interventions could assist practitioners in selecting patients for specific geriatric follow-up.

Download Full-text

Association of Stress Management with Success of Smoking Cessation in Korean Female Emotional Labor Workers for Service and Sales

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18063023 ◽

2021 ◽

Vol 18 (6) ◽

pp. 3023

Author(s):

Haena Kim ◽

Kang-Sook Lee

Keyword(s):

Smoking Cessation ◽

Stress Management ◽

Emotional Labor ◽

Management Program ◽

Stress Tests ◽

Smoking Cessation Counseling ◽

Face To Face ◽

Factors Associated ◽

Quit Smoking

Emotional labor is paid work that involves managing and regulating one’s emotions during the job including evoking and suppressing one’s feelings. This study examined the factors associated with successful smoking cessation through tailored smoking cessation counseling including stress management among female emotional labor workers. The study was conducted from 1 September 2015 to 31 December 2017. A total of 2674 women registered in the Comprehensive Smoking Cessation Service System and were grouped as either emotional labor workers for service and sales (1002) or other occupations (1672) for analysis. The participants received nine sessions of face-to-face and telephone smoking cessation counseling over 6 months, and follow-up assessments were conducted 4, 6, 12, and 24 weeks after counseling. Smoking cessation counseling involved a stress management program comprising stress tests, depression tests, color therapy, and a buddy program including peer support. Factors associated with successful smoking cessation included the number of counseling sessions, motivation rulers (Importance, Confidence, Readiness), average daily smoking amount, expired carbon monoxide (CO), and nicotine dependence. The most associated factor was the number of counseling sessions. Since counseling focused on stress management, it was the most important factor in smoking cessation, and continuous counseling could help those wanting to quit smoking.

Download Full-text

Factors associated with loss to follow-up of outpatients with depression in general hospitals

Journal of International Medical Research ◽

10.1177/0300060520925595 ◽

2020 ◽

Vol 48 (5) ◽

pp. 030006052092559

Author(s):

Jingjing Zhang ◽

Chenyu Ye

Keyword(s):

Depression Scale ◽

Disease Diagnosis ◽

Tertiary Hospital ◽

Chinese Patients ◽

Loss To Follow Up ◽

Factors Associated ◽

Self Rating ◽

Hamd Score ◽

Lost To Follow Up

Objective We aimed to understand the reasons behind outpatient loss to follow-up and the views of Chinese patients with depression regarding disease diagnosis and antidepressant therapy. Methods Consecutive outpatients with newly diagnosed depressive disorder between September 2012 and August 2013 at the Shanghai First People’s Hospital (a tertiary hospital) were categorized into follow-up and lost-to-follow-up groups. We collected information on demographics, the Hamilton depression (HAMD) scale, Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale, and Symptom Checklist-90. Patients were routinely followed at 2, 4, 8, and 12 weeks. Any missed appointment was considered lost to follow-up. Results After 12 weeks of treatment, only 42.2% (70/166) of patients were continuing follow-up. Patients lost to follow-up were significantly younger (median, 42.5 vs. 56.5 years), had different marital status, higher education level, higher SDS score (43.8 ± 10.8 vs. 40.2 ± 10.9), and higher HAMD score (median, 21 vs. 19). Age (odds ratio (OR) = 0.97, 95% confidence interval (CI): 0.95–0.997), and HAMD score (OR = 1.14, 95% CI: 1.01–1.29) were independently associated with loss to follow-up. Conclusion Young age, higher HAMD score, and poor knowledge of depression and treatment were the main factors associated with loss to follow-up during depression management among our Chinese patients.

Download Full-text

Temporal lung changes on thin-section CT in patients with COVID-19 pneumonia

Scientific Reports ◽

10.1038/s41598-020-76776-x ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Zhiyan Zhang ◽

Runhui Tang ◽

Heyang Sun ◽

Haiyang Dai ◽

Kangyin Chen ◽

...

Keyword(s):

Thin Section ◽

Chest Ct ◽

Illness Onset ◽

Group 4 ◽

Lung Abnormalities ◽

Group 3 ◽

Time Periods ◽

Group 2 ◽

Discharge From Hospital

AbstractWe examined characteristics of chest CT across different time periods for patients with COVID-19 pneumonia in Huizhou, China. This study included 56 COVID-19 patients with abnormal CT acquired between January 22 and March 3, 2020. The 141 scans of 56 patients were classified into four groups (Groups 1–4) based on dates on which scans were obtained at the 1st, 2nd, 3rd week or longer than three weeks after illness onset. Forty-five patients with follow-up scans were categorized into four groups (Groups A–D) according to extent that lesions reduced (≥ 75%, 50–75%, 25–50% and < 25%). Ground-glass opacities (GGO) was prevalent in Groups 1–4 (58.1–82.6%), while percentages of consolidation ranged between 9.7% in Group 4 and 26.2% in Group 2. The highest frequency of fibrous stripes occurred in Group 3 (46.7%). Total CT scores were on average higher in Groups 2–3. Among 45 follow-up patients, 11 (24.4%) of them recovered with lesions reducing ≥ 75%, with the lowest median age and total CT scores on admission. There are temporal patterns of lung abnormalities in COVID-19 patients, with higher extent of lesion involvement occurring in the 2nd and 3rd week. Persisting lung changes indicate some patients may need isolation after discharge from hospital.

Download Full-text

Reducing risk factors for cognitive decline through psychological interventions: a pilot randomized controlled trial

International Psychogeriatrics ◽

10.1017/s1041610218001485 ◽

2018 ◽

Vol 31 (07) ◽

pp. 1015-1025 ◽

Cited By ~ 2

Author(s):

Viviana M. Wuthrich ◽

Ronald M. Rapee ◽

Brian Draper ◽

Henry Brodaty ◽

Lee-Fay Low ◽

...

Keyword(s):

Quality Of Life ◽

Cognitive Decline ◽

Controlled Trial ◽

Social Activity ◽

Face To Face ◽

Factors Associated ◽

Randomized Controlled ◽

Anxiety Depression

ABSTRACTObjectives:Modifiable factors associated with increased risk of cognitive decline include emotional (anxiety, depression), cognitive (low social and mental stimulation), and health factors (smoking, alcohol use, sedentary lifestyle, obesity). Older adults with anxiety and depression may be at heightened risk due to direct and indirect impacts of emotional distress on cognitive decline.Design:Randomized controlled trialSetting:Community sample attending a university clinic. Participants: 27 participants (female = 20) aged over 65 years (M = 72.56, SD = 6.74) with an anxiety and/or mood disorder. Interventions: two cognitive behavioral therapy (CBT) interventions (face-to-face or low intensity) that targeted emotional, health, and cognitive risks for cognitive decline.Measurements:Participants completed diagnostic interviews; self-report measures of anxiety, depression, quality of life, and lifestyle factors at baseline; post-treatment; and 3-month follow-up.Results:Both interventions resulted in significant and sustained improvements in depression, anxiety, quality of life, and physical and social activity. At post-treatment, face-to-face CBT demonstrated significantly greater improvements in emotional symptoms, alcohol use, and memory (exercise approached significance). At 3-month follow-up, gains were maintained and there were significantly greater increases in mental activity for face-to-face CBT, with social activity approaching significance. Conclusions: This study demonstrates the feasibility of CBT interventions to reduce emotional as well as lifestyle risk factors associated with cognitive decline in at-risk older participants. Large studies are needed to evaluate the long-term impact on cognitive decline. The trial was registered with the Australian and New Zealand Clinical Trials Registry (Trial Registration No. ACTRN12618000939291).

Download Full-text

EP.WE.1Hybrid Surgical Hot Clinic (HSHC): evaluation of Surgical Hot Clinic services during COVID-19 lockdown

British Journal of Surgery ◽

10.1093/bjs/znab308 ◽

2021 ◽

Vol 108 (Supplement_7) ◽

Author(s):

Adeel Abbas Dhahri ◽

Raheel Ahmad ◽

Bilal Fazal Shaikh ◽

Olubunmi Sajinyan ◽

Ibrahim Warrag ◽

...

Keyword(s):

Emergency Service ◽

Symptomatic Treatment ◽

Radiology Department ◽

Outpatient Basis ◽

Surgical Service ◽

Face To Face ◽

The United Kingdom ◽

Novel Coronavirus ◽

Discharge From Hospital

Abstract Aims Surgical Hot Clinic (SHC) is an acute emergency service for management provided on an outpatient basis in the United Kingdom. Following the start of global Novel Coronavirus (COVID-19) pandemic and as per the statement released by the Association of Surgeons of Great Britain and Ireland (ASGBI), we modified SHC service to mainly provide telephonic follow-up with an occasional face-to-face service. Methods After developing a local pathway for SHC services during COVID-19 lockdown, a quality improvement audit was conducted from 30th March till 26th May 2020. Through this pathway, telephonic consultation carried out in most patients while for selective face-to-face consultation designated Medical Ambulatory area used. The analysis then performed using SPSS version 20 to assess the serviceability of modified hybrid SHC. Results Among 149 patients, 54(36.2%) were male, and 95(63.8%) were female, referred during Coronavirus lockdown. Out of these 149, 87(58.3%) referred from Accident & Emergency (A&E), 2(1.3%) from GP, 9(6.04%) after scan through radiology department while 51(34.2%) after discharge from hospital. Out of those who have telephonic consultation (n = 98), 12 patients were called in for review with either blood tests or further clinical examination. In total, only 10 out of 149 patients required admission to the hospital, either for intervention or symptomatic treatment. Conclusion Hybrid surgical hot clinic (HSHC) with both telephonic & face-to-face consultation, as per requirement, is flexible, effective and safe patient-focused acute surgical service during COVID-19 like a crisis.

Download Full-text

Psychopathology 8½ Years Post Parasuicide

Crisis ◽

10.1027//0227-5910.20.3.115 ◽

1999 ◽

Vol 20 (3) ◽

pp. 115-120 ◽

Cited By ~ 9

Author(s):

Stephen Curran ◽

Michael Fitzgerald ◽

Vincent T Greene

Keyword(s):

Rating Scales ◽

Psychiatric Morbidity ◽

Parental Bonding ◽

Social Maladjustment ◽

Term Outcome ◽

Long Term Outcome ◽

Face To Face ◽

Long Term Follow Up

There are few long-term follow-up studies of parasuicides incorporating face-to-face interviews. To date no study has evaluated the prevalence of psychiatric morbidity at long-term follow-up of parasuicides using diagnostic rating scales, nor has any study examined parental bonding issues in this population. We attempted a prospective follow-up of 85 parasuicide cases an average of 8½ years later. Psychiatric morbidity, social functioning, and recollections of the parenting style of their parents were assessed using the Clinical Interview Schedule, the Social Maladjustment Scale, and the Parental Bonding Instrument, respectively. Thirty-nine persons in total were interviewed, 19 of whom were well and 20 of whom had psychiatric morbidity. Five had died during the follow-up period, 3 by suicide. Migration, refusals, and untraceability were common. Parasuicide was associated with parental overprotection during childhood. Long-term outcome is poor, especially among those who engaged in repeated parasuicides.

Download Full-text

Research Participation Experiences of Informants of Suicide and Control Cases

Crisis ◽

10.1027/0227-5910/a000025 ◽

2010 ◽

Vol 31 (5) ◽

pp. 238-246 ◽

Cited By ~ 9

Author(s):

Paul W. C. Wong ◽

Wincy S. C. Chan ◽

Philip S. L. Beh ◽

Fiona W. S. Yau ◽

Paul S. F. Yip ◽

...

Keyword(s):

Ethical Issues ◽

Research Participation ◽

Self Report ◽

Initial Contact ◽

Psychological Autopsy ◽

Autopsy Study ◽

The People ◽

And Control ◽

The Impact

Background: Ethical issues have been raised about using the psychological autopsy approach in the study of suicide. The impact on informants of control cases who participated in case-control psychological autopsy studies has not been investigated. Aims: (1) To investigate whether informants of suicide cases recruited by two approaches (coroners’ court and public mortuaries) respond differently to the initial contact by the research team. (2) To explore the reactions, reasons for participation, and comments of both the informants of suicide and control cases to psychological autopsy interviews. (3) To investigate the impact of the interviews on informants of suicide cases about a month after the interviews. Methods: A self-report questionnaire was used for the informants of both suicide and control cases. Telephone follow-up interviews were conducted with the informants of suicide cases. Results: The majority of the informants of suicide cases, regardless of the initial route of contact, as well as the control cases were positive about being approached to take part in the study. A minority of informants of suicide and control cases found the experience of talking about their family member to be more upsetting than expected. The telephone follow-up interviews showed that none of the informants of suicide cases reported being distressed by the psychological autopsy interviews. Limitations: The acceptance rate for our original psychological autopsy study was modest. Conclusions: The findings of this study are useful for future participants and researchers in measuring the potential benefits and risks of participating in similar sensitive research. Psychological autopsy interviews may be utilized as an active engagement approach to reach out to the people bereaved by suicide, especially in places where the postvention work is underdeveloped.

Download Full-text