Emotional Modulation of Response Inhibition in Adolescents During Acute Suicidal Crisis: Event-Related Potentials in an Emotional Go/NoGo Task

Objectives. Suicide is the second leading cause of adolescent deaths and may be linked to difficulties with inhibitory and emotional processing. This study assessed the neural correlates of cognitive inhibition during emotional processing in adolescents hospitalized for a suicidal crisis. Methods. Event-related potentials were recorded during an emotional Go/NoGo task in 12 adolescents who attempted suicide and 12 age- and sex-matched healthy controls. Results. Compared to the control group, the suicidal group showed significantly reduced positivity at the time of the P3d (difference waveform reflecting NoGo minus Go trials) in response to happy and neutral, but not sad stimuli. For happy stimuli, this group difference was restricted to the right hemisphere. Further analyses indicated that the suicidal group had a reversed pattern of P3 amplitude in response to inhibition, with lower amplitudes in the NoGo compared to the Go conditions. Suicidal symptoms severity strongly correlated with lower amplitude of the P3d in response to neutral faces. Conclusions. These findings provide more insight into inhibition difficulties in adolescents with acute suicidal risk. Interactions between emotional and inhibition processing should be considered when treating acutely suicidal youths.

The Impacts of Working with People Experiencing Suicidal Ideation: Mental Health Nurses Describe Their Experience

<p>New Zealand has one of the highest suicide rates in the world and mental health nurses are the most likely professionals to assess a person presenting with suicidal ideation. Managing a suicidal crisis is acknowledged as being one of the most difficult and frightening challenges facing mental health professionals. This research aimed to have mental health nurses who work in acute mental health settings describe the impact that working with people experiencing suicidal ideation has on their personal and professional lives. This study followed the tenets of fundamental qualitative description as presented by Sandelowski (2000). Five mental health nurses participated in individual semi structured interviews. The data collected under-went systematic thematic analysis and the extracted findings were presented as a straight description. The findings from this study revealed that personal philosophies of care, the work place culture, organisational and professional expectations and their personal concepts about suicide all influenced the experiences of these participants. Mental exhaustion, tension and feelings of isolation and alienation from family and society were universal experiences. Two recommendations have been made based on the insights gained from this research. These are; tertiary institutions should offer post graduate studies on the subject of suicide as it relates to mental health nursing and national guidelines for the provision of supervision to mental health nurses need to be developed.</p>

The Impacts of Working with People Experiencing Suicidal Ideation: Mental Health Nurses Describe Their Experience

<p>New Zealand has one of the highest suicide rates in the world and mental health nurses are the most likely professionals to assess a person presenting with suicidal ideation. Managing a suicidal crisis is acknowledged as being one of the most difficult and frightening challenges facing mental health professionals. This research aimed to have mental health nurses who work in acute mental health settings describe the impact that working with people experiencing suicidal ideation has on their personal and professional lives. This study followed the tenets of fundamental qualitative description as presented by Sandelowski (2000). Five mental health nurses participated in individual semi structured interviews. The data collected under-went systematic thematic analysis and the extracted findings were presented as a straight description. The findings from this study revealed that personal philosophies of care, the work place culture, organisational and professional expectations and their personal concepts about suicide all influenced the experiences of these participants. Mental exhaustion, tension and feelings of isolation and alienation from family and society were universal experiences. Two recommendations have been made based on the insights gained from this research. These are; tertiary institutions should offer post graduate studies on the subject of suicide as it relates to mental health nursing and national guidelines for the provision of supervision to mental health nurses need to be developed.</p>

“A Sustained, Productive, Constructive Relationship with Someone Who Can Help”—A Qualitative Exploration of the Experiences of Help Seekers and Support Persons Using the Emergency Department during a Suicide Crisis

For Australians experiencing a suicide crisis, the emergency department (ED) is the recommended point of contact for intervention and to ensure personal safety. However, negative ED experiences can deter individuals from returning, thus impacting future suicide risk. In order to improve the ED environment for individuals in suicidal crisis, an in-depth understanding of this experience is needed. In-depth semi-structured interviews with 17 help seekers and 16 support persons were conducted. A grounded theory approach uncovered a core organising concept—all participants wanted a “a sustained, productive, constructive relationship with someone who can help” during the ED visit—which guided analysis. Thematic analysis resulted in two themes and four subthemes exploring the systemic and interpersonal aspects of the ED visit and the roadblocks and pathways to development of the relationship. Interpersonal factors included aspects of staff interaction and presence of a support person. Systemic factors related to aspects controlled by the physical space and internal policies and procedures and included aspects such as the chaotic environment, long waiting times, and access to staff. Overwhelmingly, there were more roadblocks than pathways reported by participants. Improving the ED environment, increasing staff training and encouraging the presence of support persons may help mitigate some of these roadblocks.

Nonwillingness to Return to the Emergency Department and Nonattendance of Follow-Up Care Arrangements Following an Initial Suicide-Related Presentation

Background: For people experiencing a suicidal crisis the emergency department (ED) is often the only option to find help. Aims: The aims of this study were (a) to identify predictors of patients' nonwillingness to return to the ED for help with a future suicidal crisis, and (b) whether nonwillingness to return was associated with follow-up appointment nonattendance. Method: This study utilized baseline data from the RESTORE online survey, and included 911 participants who had presented to an ED for suicidal crisis in the past 18 months, across participating local health districts in the Australian Capital Territory and New South Wales. Results: Patients who reported a more negative ED experience and longer triage wait times were less willing to return. Those who were less willing to return were also less likely to attend their follow-up appointment. Limitations: Due to the cross-sectional study design, causal inferences are not possible. Additionally, the self-report measures used are susceptible to recall bias. Conclusion: Patients' experience of service at EDs is a key indicator to drive improvement of patient outcomes for individuals experiencing a suicidal crisis.

The Brief Suicide Cognitions Scale: Development and Clinical Application

The study explored the development of the Brief Suicide Cognitions Scale (B-SCS), a simple and brief measure of suicide risk. The B-SCS provides a brief measure that captures critical aspects of suicide risk embedded in core beliefs about the self as unlovable, one's emotional experience as unbearable, and life problems as unsolvable (i.e., the suicidal belief system), resulting in chronic or enduring suicide risk and heightened vulnerability for acute episodes secondary to internal and external triggers. Data were analyzed from three diverse samples, including a student sample (N = 349), an inpatient psychiatric sample (N = 160), and a sample of emergency department (ED) patients presenting secondary to a suicidal crisis (N = 94). Those in the student and inpatient samples completed additional symptom measures (hopelessness, anxiety, depression) and the ED sample provided 6-month follow-up data for suicide attempts. Reliability (internal consistency, test-retest), concurrent validity, construct (divergent, convergent) validity, factorial, incremental, and predictive validity were evaluated, along with calculation of predictive value of negative and positive tests, sensitivity, and specificity estimates. The B-SCS demonstrated good reliability and validity, a unidimensional factor structure across samples, along with good predictive validity and value in real-world clinical settings. The B-SCS is a brief, reliable and valid measure of suicide risk, with good ability to identify those with enduring risk for subsequent suicide attempts. The B-SCS offers a unique contribution to understanding and assessing the nature of suicide risk over time targeting the suicidal belief system, with easy application across inpatient and outpatient clinical settings, and good predictive value.

Teaching emergency situations during a psychiatry residency programme using a blended learning approach: a pilot study

Background Emergency psychiatry is an essential component in the training of psychiatry residents who are required to make patient-centred orientation decisions. This training calls for specific knowledge as well as skills and attitudes requiring experience. Kolb introduced a theory on experiential learning which suggested that effective learners should have four types of abilities: concrete experience, reflective observation, abstract conceptualisation and active experimentation. We aimed to evaluate a resident training programme that we designed for use in an emergency psychiatry setting based on the experimental learning theory. Methods We designed a four-step training programme for all first-year psychiatry residents: (i) theoretical teaching of psychiatric emergency knowledge, (ii) concrete experience of ability teaching involving an initial simulation session based on three scenarios corresponding to clinical situations frequently encountered in emergency psychiatry (suicidal crisis, hypomania and depressive episodes), (iii) reflective observation and abstract conceptualisation teaching based on videos and clinical interview commentary by a senior psychiatrist for the same three scenarios, (iv) active experimentation teaching during a second simulation session based on the same three frequently encountered clinical situations but with different scenarios. Training-related knowledge acquisition was assessed after the second simulation session based on a multiple-choice quiz (MCQ), short-answer questions and a script concordance test (SCT). The satisfaction questionnaire was assessed after the resident had completed his/her initial session in order to evaluate the relevance of teaching in clinical practice. The descriptive analyses were described using the mean (+/- standard deviation). The comparative analyses were conducted with the Wilcoxon or Student’s t tests depending on data distribution. Results The residents’ mean MCQ and short-answer question scores and SCT were 7.25/10 (SD = 1.2) 8.33/10 (SD = 1.4), 77.5/100 (SD = 15.8), respectively. The satisfaction questionnaire revealed that 67 % of residents found the teaching consistent. Conclusion We designed a blended learning programme that associated, classical theoretical learning to acquire the basic concepts, a learning with simulation training to experiment the clinical situations and a video support to improve learning of interview skills and memory recall. The residents indicate that this training was adequate to prepare them to be on duty. However, despite this encouraging point, this program needs further studies to attest of its efficiency.

Protective Effects of Reasons for Living Against Suicidal Ideation in Daily Life

How do individuals resist suicidal urges in a suicidal crisis? Deterrents for suicide can be conceptualized as reasons for living (RFL), but our understanding of their protective effects is predominantly informed by cross-sectional research. We examined the protective effects of RFL on suicidal ideation (SI) in daily life in a high-risk sample. We also tested whether personality traits moderated the strength of the dynamic RFL-SI link. Adults with a borderline personality disorder diagnosis (n=153, 105 suicide attempters) completed a 21-day ambulatory assessment protocol. Daily endorsements of RFL were negatively linked to SI at the within-person but not the between-person level. Whereas suicide attempters endorsed RFL less frequently than non-attempters, their protective effect was undiminished in this group. While people high on openness and extraversion endorsed RFL more often, this increase was not protective against SI, indicating that RFL reflect heterogeneous underlying psychological processes, only some of which are protective against SI.