Lithium and clozapine in suicidality: shedding some light to get out of the dark

2015 ◽  
Vol 5 (5) ◽  
pp. 237-243 ◽  
Author(s):  
Amber Riesselman ◽  
Eric Johnson ◽  
Emma Palmer
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Suicidal Behavior ◽  
Patient Population ◽  
Holistic Approach ◽  
Specific Role ◽  
The Past

Abstract Introduction Suicide is currently on the rise with rates increasing alarmingly during the past decade. There are many risk factors for suicidal behavior, and mental illness is at the top of the list. Methods Although a variety of medications have been evaluated in the literature, lithium and clozapine continue to have the most evidence supporting their use in decreasing suicidality. Results It is clear that medications are indispensable regarding the reduction of suicidality; however, a holistic approach must be taken when caring for this patient population. Discussion This review focuses on the specific role that lithium and clozapine have in the reduction of suicidal behavior.

The Comprehensive Narrative-Crisis Model of Suicide

2017 ◽  
Author(s):  
Jessica Briggs
Keyword(s):  
Risk Factors ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Emotional State ◽  
Life Story ◽  
Affective Dysregulation ◽  
The Past ◽  
Suicidal Crisis ◽  
Static Risk ◽  
Over Time

The narrative crisis model of suicide posits that individuals attempt suicide when they experience a distinct emotional state termed the suicide crisis syndrome. This chapter describes the model, which has three components: trait vulnerability, suicidal narrative, and the suicidal crisis syndrome. Trait vulnerability includes all static risk factors, which are relatively stable over time and distal to acute suicidal behavior. Suicidal narrative describes a suicidal person’s perception of his or her life story in which the past has led to an intolerable present and a future that is unimaginable. The suicidal crisis syndrome (SCS) is a distinct emotional state characterized by entrapment, affective dysregulation, and loss of cognitive control. The result is the suicidal act, brought on by an emotional urge to end the intolerable mental pain of SCS. Imminent suicide risk is primarily determined by SCS intensity, to which both trait vulnerability and the suicidal narrative also contribute independently.

scholarly journals The many roads to psychosis: recent advances in understanding risk and mechanisms

F1000Research ◽  
2018 ◽  
Vol 7 ◽  
pp. 1883 ◽  
Author(s):  
Carrie E. Bearden ◽  
Jennifer K. Forsyth
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Genetic Architecture ◽  
Biological Processes ◽  
The Core ◽  
The Past ◽  
Recent Advances ◽  
New Findings ◽  
The Many ◽  
Major Progress

Schizophrenia is a chronic and severe mental illness which frequently leads to substantial lifelong disability. The past five years have seen major progress in our understanding of the complex genetic architecture of this disorder. Two major barriers to understanding the core biological processes that underlie schizophrenia and developing better interventions are (1) the absence of etiologically defined biomarkers and (2) the clinical and genetic heterogeneity of the disorder. Here, we review recent advances that have led to changes in our understanding of risk factors and mechanisms involved in the development of schizophrenia. In particular, mechanistic and clinically oriented approaches have now converged on a focus on disruptions in early neurodevelopment and synaptic plasticity as being critical for both understanding trajectories and intervening to change them. Translating these new findings into treatments that substantively change the lives of patients is the next major challenge for the field.

Recovery and recidivism reduction for offenders with mental illness

2017 ◽  
Author(s):  
Merrill Rotter ◽  
Virginia Barber-Rioja ◽  
Faith Schombs
Keyword(s):  
Risk Factors ◽  
Mental Illness ◽  
Criminal Justice ◽  
Clinical Success ◽  
Holistic Approach ◽  
Psychosocial Interventions ◽  
Criminal Recidivism ◽  
Traditional Treatment ◽  
Community Functioning ◽  
Offenders With Mental Illness

Treatment of individuals with mental illness who have justice involvement has the same goals as the treatment of those without justice involvement: ameliorating symptoms, minimizing disability, maximizing community functioning, and supporting individualized recovery goals. The attainment of these goals are challenged, if not precluded, when a person is incarcerated, making the overrepresentation of individuals with mental illness all the more tragic, and decreasing criminal justice activity all the more important for both clinical success and public safety. Understanding and addressing the risk of criminal recidivism (i.e., re-arrest and return to jail for offenders with mental illness) is, therefore, a critical skill for the forensic clinician. In this chapter, we review risk factors for recidivism with specific focus on those relevant for offenders with mental illness, and present a holistic approach that incorporates both traditional treatment and recidivism-focused psychosocial interventions.

Suicidal Behavior in Black South Africans

Crisis ◽  
2003 ◽  
Vol 24 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Lourens Schlebusch ◽  
Naseema B.M. Vawda ◽  
Brenda A. Bosch
Keyword(s):  
South African ◽  
Suicidal Behavior ◽  
Health Care Facilities ◽  
South African Society ◽  
South Africans ◽  
The Past ◽  
The People ◽  
Care Facilities ◽  
Black South Africans ◽  
To Come

Summary: In the past suicidal behavior among Black South Africans has been largely underresearched. Earlier studies among the other main ethnic groups in the country showed suicidal behavior in those groups to be a serious problem. This article briefly reviews some of the more recent research on suicidal behavior in Black South Africans. The results indicate an apparent increase in suicidal behavior in this group. Several explanations are offered for the change in suicidal behavior in the reported clinical populations. This includes past difficulties for all South Africans to access health care facilities in the Apartheid (legal racial separation) era, and present difficulties of post-Apartheid transformation the South African society is undergoing, as the people struggle to come to terms with the deleterious effects of the former South African racial policies, related socio-cultural, socio-economic, and other pressures.

Validity of Proxy-Based Reports of Impulsivity and Aggression in Chinese Research on Suicidal Behavior

Crisis ◽  
2010 ◽  
Vol 31 (3) ◽  
pp. 137-142 ◽  
Author(s):  
Jing An ◽  
Michael R. Phillips ◽  
Kenneth R. Conner
Keyword(s):  
Risk Factors ◽  
Suicidal Behavior ◽  
Rural China ◽  
Suicide Attempters ◽  
Barratt Impulsiveness Scale ◽  
Single Location ◽  
Aggression Questionnaire ◽  
Community Controls

Background: In studies about the risk factors for suicidal behavior, the assessment of impulsiveness and aggression often depend on information from proxy informants. Aims: To assess the validity of proxy informants’ reports on impulsiveness and aggression in China. Methods: Modified Chinese versions of the Barratt Impulsiveness Scale (BIS-CV) and the Buss-Perry Aggression Questionnaire (AQ-CV) were administered to 131 suicide attempters treated at a hospital in rural China, to coresident relatives about the attempters, to 131 matched community controls, and to coresident relatives about the controls. Results: BIS-CV and AQ-CV total scores and subscale scores were all significantly higher for suicide attempters than for matched controls. Proxy informants considered subjects slightly more impulsive and aggressive than the subjects reported themselves. Subject-proxy concordance for total BIS-CV and AQ-CV scores were excellent for both attempters and controls (ICCs = 0.76–0.83). Concordance for the three BIS-CV subscales was 0.74–0.81 for attempters and 0.74–0.83 for controls. Concordance for the five AQ-CV subscales was 0.66–0.85 for attempters and 0.56–0.82 for controls. Limitations: Results are based on respondents from a single location in rural China. Conclusions: The results support the validity of the BIS-CV and AQ-CV and of research on suicidal behavior in China that uses proxy-based reports of impulsiveness and aggression.

Suicidal Behavior in Patients with Adjustment Disorders

Crisis ◽  
2001 ◽  
Vol 22 (3) ◽  
pp. 125-131 ◽  
Author(s):  
Ludmila Kryzhanovskaya ◽  
Randolph Canterbury
Keyword(s):  
Personality Disorder ◽  
Suicidal Behavior ◽  
Suicide Attempts ◽  
Adjustment Disorder ◽  
Adjustment Disorders ◽  
Involuntary Hospitalization ◽  
Axis Ii ◽  
The Past ◽  
Substance Abuse Disorders ◽  
Axis I

Summary: This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.

Protective Factors and Suicidality in Members of Arab Kindred

Crisis ◽  
2012 ◽  
Vol 33 (2) ◽  
pp. 80-86 ◽  
Author(s):  
Sami Hamdan ◽  
Nadine Melhem ◽  
Israel Orbach ◽  
Ilana Farbstein ◽  
Mohammad El-Haib ◽  
...  
Keyword(s):  
Risk Factors ◽  
Protective Factors ◽  
Suicidal Behavior ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Suicidal Risk ◽  
Arab Population ◽  
Psychiatric Interview ◽  
History Of

Background: Relatively little is known about the role of protective factors in an Arab population in the presence of suicidal risk factors. Aims: To examine the role of protective factors in a subsample of in large Arab Kindred participants in the presence of suicidal risk factors. Methods: We assessed protective and risk factors in a sample of 64 participants (16 suicidal and 48 nonsuicidal) between 15 and 55 years of age, using a comprehensive structured psychiatric interview, the Composite International Diagnostic Interview (CIDI), self-reported depression, anxiety, hopelessness, impulsivity, hostility, and suicidal behavior in first-degree and second-relatives. We also used the Religiosity Questionnaire and suicide attitude (SUIATT) and multidimensional perceived support scale. Results: Suicidal as opposed to nonsuicidal participants were more likely to have a lifetime history of major depressive disorder (MDD) (68.8% vs. 22.9% χ2 = 11.17, p = .001), an anxiety disorder (87.5% vs. 22.9, χ2 = 21.02, p < .001), or posttraumatic stress disorder (PTSD) (25% vs. 0.0%, Fisher’s, p = .003). Individuals who are otherwise at high risk for suicidality have a much lower risk when they experience higher perceived social support (3.31 ± 1.36 vs. 4.96 ± 1.40, t = 4.10, df = 62, p < .001), and they have the view that suicide is somehow unacceptable (1.83 ± .10 vs. 1.89 ± .07, t = 2.76, df = 60, p = .008). Conclusions: Taken together with other studies, these data suggest that the augmentation of protective factors could play a very important role in the prevention of incidental and recurrent suicidal behavior in Arab populations, where suicidal behavior in increasing rapidly.

Stress, Cortisol and Suicide Risk

2019 ◽  
Author(s):  
Daryl Brian O'Connor
Keyword(s):  
Risk Factors ◽  
Suicidal Behavior ◽  
Suicide Risk ◽  
Stressful Events ◽  
Additional Risk ◽  
Global Health Issue ◽  
History Of ◽  
Hpa Axis Activity ◽  
The Impact

Suicide is a global health issue accounting for at least 800,000 deaths per annum. Numerous models have been proposed that differ in their emphasis on the role of psychological, social, psychiatric and neurobiological factors in explaining suicide risk. Central to many models is a stress-diathesis component which states that suicidal behavior is the result of an interaction between acutely stressful events and a susceptibility to suicidal behavior (a diathesis). This article presents an overview of studies that demonstrate that stress and dysregulated hypothalamic-pituitary-adrenal (HPA) axis activity, as measured by cortisol levels, are important additional risk factors for suicide. Evidence for other putative stress-related suicide risk factors including childhood trauma, impaired executive function, impulsivity and disrupted sleep are considered together with the impact of family history of suicide, perinatal and epigenetic influences on suicide risk.

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

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