Suicidal behaviour of psychiatric in‐patients

Spießl, Hermann; Hübner-Liebermann, Bettina; Cording, Clemens

doi:10.1034/j.1600-0447.2002.02270.x

Cited by 58 publications

(48 citation statements)

References 27 publications

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“…A reanalysis of studies of suicide in affective illness in three groups of patients-outpatients, inpatients, and suicidal patients-found a risk of those ever hospitalized of 8.6% (3). Other studies confirmed the risk of suicide to be particularly high in hospitalized depressed patients (4)(5)(6). Profound hopelessness, hypochondriacal ruminations or delusions, and thoughts of suicide or self-harm during depression predict future suicide (7).…”

mentioning

confidence: 99%

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Kellner¹,

Fink²,

Knapp³

et al. 2005

AJP

261

164

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Objective-This study assessed the incidence, severity, and course of expressed suicidal intent in depressed patients who were treated with ECT. The data are from the first phase of an ongoing, collaborative multicenter study, the overall aim of which was to compare continuation ECT with pharmacotherapy in the prevention of relapse after a successful course of ECT.Method-Suicidal intent, as expressed by patients during an interview, was scored at baseline and before each ECT session with item 3 on the 24-item Hamilton Depression Rating Scale in 444 patients with unipolar depression.Results-One hundred thirty-one patients (29.5%) reported suicidal thoughts and acts (score of 3 or 4) at baseline. Scores decreased to 0 after 1 week (three ECT sessions) in 38.2% of the patients, after 2 weeks (six ECT sessions) in 61.1%, and in 80.9% at the end of the course of treatment.Conclusions-Expressed suicidal intent in depressed patients was rapidly relieved with ECT. Evidence-based treatment algorithms for major depressive mood disorders should include dichotomization according to suicide risk, as assessed by interview. For patients at risk, ECT should be considered earlier than at its conventional "last resort" position.Suicide and suicide attempts are risks of the major psychiatric illnesses, with mortality rates markedly higher than for the general population (1). A lifetime risk of 15% for suicide was the conclusion of a meta-analysis of hospitalized patients by Guze and Robins (2). A reanalysis of studies of suicide in affective illness in three groups of patients-outpatients, inpatients, and suicidal patients-found a risk of those ever hospitalized of 8.6% (3). Other studies confirmed the risk of suicide to be particularly high in hospitalized depressed patients (4-6). Profound hopelessness, hypochondriacal ruminations or delusions, and thoughts of suicide or self-harm during depression predict future suicide (7).Antidepressant medications are the principal agents used to treat affective disorders today. Their impact on suicide risk is not well defined, however, and they are generally viewed as less effective than ECT in relieving depression and suicidal thoughts. Hordern et al. (8) reported no suicides at the 6-month follow-up in 34 women treated with ECT but found two in the 84 patients treated with antidepressants (2.4%). Avery and Winokur (9) suicidal behavior in the 6 months following the treatment of depression in 519 patients. Suicide attempts were recorded in 0.8% of the ECT patients compared to 4.2% of those who had received "adequate" and 7% "inadequate" antidepressant medication treatment. Khan et al. (10) found antidepressant drugs to be no more effective than placebo in reducing suicide rates in seriously ill depressed patients.The experience with ECT is also unclear. A comparison of the frequency of suicides in different decades found decreased rates when ECT was the dominant treatment for mental illness (11). An examination of the records of 1,397 completed suicides in Finland within a 12-m...

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mentioning

confidence: 99%

Relief of Expressed Suicidal Intent by ECT: A Consortium for Research in ECT Study

Kellner¹,

Fink²,

Knapp³

et al. 2005

AJP

261

164

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“…These include socio-demographic factors such as age (Christiansen and Jensen, 2007;Corcoran et al, 2004), unemployment (Tejedor et al, 1999), not being married (Kreitman and Foster, 1991) or low educational level (Christiansen and Jensen, 2007) which have been associated with repetition of suicidal behaviour (Osvath et al, 2003). Clinical factors include lethality of the index attempt (Gibb et al, 2005), poor physical health (Colman et al, 2004), and mental illness or psychiatric comorbidity, which has been noted to be a risk factor for repetition in studies on parasuicides (Colman et al, 2004;Osvath et al, 2003), non-fatal suicidal behaviours (Kapur et al, 2006) and SAs among inpatients (Spiessl et al, 2002).…”

Section: Introductionmentioning

confidence: 99%

Distinguishing the relevant features of frequent suicide attempters

López-Castromán

Perez‐Rodriguez

Jaussent

et al. 2011

Journal of Psychiatric Research

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a b s t r a c tBackground: In spite of the high prevalence of suicide behaviours and the magnitude of the resultant burden, little is known about why individuals reattempt. We aim to investigate the relationships between clinical risk factors and the repetition of suicidal attempts. Methods: 1349 suicide attempters were consecutively recruited in the Emergency Room (ER) of two academic hospitals in France and Spain. Patients were extensively assessed and demographic and clinical data obtained. Data mining was used to determine the minimal number of variables that blinded the rest in relation to the number of suicide attempts. Using this set, a probabilistic graph ranking relationships with the target variable was constructed. Results: The most common diagnoses among suicide attempters were affective disorders, followed by anxiety disorders. Risk of frequent suicide attempt was highest among middle-aged subjects, and diminished progressively with advancing age of onset at first attempt. Anxiety disorders significantly increased the risk of presenting frequent suicide attempts. Pathway analysis also indicated that frequent suicide attempts were linked to greater odds for alcohol and substance abuse disorders and more intensive treatment. Conclusions: Novel statistical methods found several clinical features that were associated with a history of frequent suicide attempts. The identified pathways may promote new hypothesis-driven studies of suicide attempts and preventive strategies.

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“…Schizophrenia, in particular, is associated with a higher risk of suicide than in the general population [9], with men being at higher risk than women [10][11][12][13][14][15]. Furthermore, it seems that, in schizophrenic patients, active illness, depressive symptoms, alcoholism and a history of previous suicide attempts and/or suicidal ideation are highly prevalent immediately before suicide [10,[14][15][16].…”

Section: Discussionmentioning

confidence: 99%