Suicidal Ideation and Suicide Attempts in Panic Disorder and Attacks

Weissman, Myrna M.; Klerman, Gerald L.; Markowitz, Jacqueline; Ouellette, Robert

doi:10.1056/nejm198911023211801

Cited by 553 publications

(258 citation statements)

References 23 publications

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“…These ®ndings are also consistent with those of Kovacs (23), who reported that comorbidity appeared to be an indicator of severity among depressed children and adolescents. In contrast, our data do not support an association between comorbidity and suicide attempts as suggested by previous research (27,33,36,48). This discrepancy could be attributable to the fact that our sample is not representative of the whole population, since 19-year old men and 20-year old women have been followed during 15 years.…”

Section: Association Between Comorbidity and Symptom Severitycontrasting

confidence: 99%

Clinical significance and comorbidity of subthreshold depression and anxiety in the community

Preisig¹,

Merikangas²,

Angst³

2001

Acta Psychiatr Scand

122

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Objective: This report examines: 1) the magnitude of co-occurrence of threshold and subthreshold-level depression and anxiety in the community, and 2) the relationship between comorbidity and the diagnostic level of depression and anxiety and their clinical correlates. Method: A community sample of 591 subjects was interviewed prospectively ®ve times across 15 years from the ages of 20±35. The diagnostic interview allowed the assignment of diagnoses according to DSM-III criteria and operational de®nitions of subthreshold syndromes. Results: 1) Comorbidity between depression and anxiety was more frequent when one syndrome reached threshold level; 2) comorbidity at both the threshold and subthreshold diagnostic levels was associated with symptom severity, disability and treatment, whereas the diagnostic level was associated with disability and suicidal attempts. Conclusion: The systematic association between comorbidity across diagnostic threshold levels of anxiety and depression with clinical correlates suggests the importance of a more dimensional approach to their classi®cation.

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Section: Association Between Comorbidity and Symptom Severitycontrasting

confidence: 99%

Clinical significance and comorbidity of subthreshold depression and anxiety in the community

Preisig¹,

Merikangas²,

Angst³

2001

Acta Psychiatr Scand

122

View full text Add to dashboard Cite

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“…Panic disorder as a risk factor for suicide attempts has received inconsistent support in the literature, with the strongest evidence coming from earlier studies in which associated risk factors were not simultaneously examined (Johnson, Weissman, & Klerman, 1990; Weissman, Klerman, Markowitz, & Ouellette, 1989). Our lack of a significant finding with regard to panic disorder is consistent with more recent prospective studies (Brown et al, 2000;Warshaw et al, 2000), as well as reanalyses of the Epidemiologic Catchment Area (ECA) study in which panic disorder was not associated with an increased risk of suicide attempt after controlling for comorbid disorders (Hornig & McNally, 1995).…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, despite the lack of statistically significant differences in MDD between attempters and nonattempters in our sample, the high rate of baseline MDD (48%) and lifetime MDD (76%) among attempters remains striking and does not suggest that MDD lacks predictive or clinical utility. Rather, it suggests that in the presence of other psychiatric risk factors, a recent diagnosis of MDD does not appear to distinguish those who are likely to make a suicide attempt in a PD sample.Panic disorder as a risk factor for suicide attempts has received inconsistent support in the literature, with the strongest evidence coming from earlier studies in which associated risk factors were not simultaneously examined (Johnson, Weissman, & Klerman, 1990; Weissman, Klerman, Markowitz, & Ouellette, 1989). Our lack of a significant finding with regard to panic disorder is consistent with more recent prospective studies (Brown et al, 2000;Warshaw et al, 2000), as well as reanalyses of the Epidemiologic Catchment Area (ECA) study in which panic disorder was not associated with an increased risk of suicide attempt after controlling for comorbid disorders (Hornig & McNally, 1995).…”

mentioning

confidence: 99%

Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study.

Yen

Shea

Pagano

et al. 2003

Journal of Abnormal Psychology

171

120

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This study examined diagnostic predictors of prospectively observed suicide attempts in a personality disorder (PD) sample. During 2 years of follow-up, 58 participants (9%) reported at least 1 definitive suicide attempt. Predictors that were examined include 4 PD diagnoses and selected Axis I diagnoses (baseline and course). Multivariate logistic regression analyses indicated that baseline borderline personality disorder (BPD) and drug use disorders significantly predicted prospective suicide attempts. Controlling for baseline BPD diagnosis, proportional hazards analyses showed that worsening in the course of major depressive disorder (MDD) and of NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript substance use disorders in the month preceding the attempt were also significant predictors. Therefore, among individuals diagnosed with PDs, exacerbation of Axis I conditions, particularly MDD and substance use, heightens risk for a suicide attempt.Personality disorders (PDs) and Axis I disorders, particularly borderline personality disorder (BPD) and major depressive disorder (MDD), have long been established as risk factors for suicidal behavior (e.g., Friedman, Aronoff, Clarkin, Corn, & Hurt, 1983;McGlashan, 1986). However, because the base rates of suicide and suicide attempts are relatively low compared to the base rates of these disorders, diagnoses in and of themselves are of limited use in predicting suicidal events. Furthermore, it is not always clear whether improvement or deterioration of a psychiatric condition (particularly MDD) is the greater risk factor for suicidal behavior. Therefore, alternative means of investigating the predictive utility of psychiatric disorders, such as identifying high-risk combinations of co-occurring Axis I and Axis II disorders, or examining specific changes in the course of a disorder prior to a suicide event, may be more effective.In reviewing suicide research, various types of suicide behaviors need to be distinguished, particularly because each type of behavior is associated with different risk factors. Generally accepted classifications of suicide behavior include completed suicide, suicide attempt, and suicide ideation (Beck, Beck, & Kovacs, 1975;O'Carroll et al., 1996). The consistent findings that men are at greater risk for suicide completion and women are at greater risk for suicide attempt(s) (Hirschfeld & Davidson, 1988) highlight the importance of identifying risk factors specific to the behavior. Nonetheless, because history of past suicide attempt(s) is one of the greater risk factors for suicide completion, research on suicide attempts inevitably informs clinical judgment with regard to suicide completion (e.g., Goldstein, Black, Nasrallah, & Winokur, 1991;Roy, 1982). Furthermore, the distinction between suicide attempts and suicide gestures (or parasuicide) has been advocated on the basis of differing intent to die. Specifically, those who make a suicide gesture (or parasuicide) do not intend to die but do aim either to draw a...

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“…Patients with anxiety disorders are frequent users of emergency medical services (Klerman et al 1991;Wang et al 2005), are at a high risk for suicide attempts (Weissman et al 1989) and at risk for substance abuse (Brady and Lydiard 1993). Costs associated with the anxiety disorders represent Table III.…”

Section: Epidemiologymentioning

confidence: 99%

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

Bandelow

Zohar

Hollander

et al. 2008

The World Journal of Biological Psychiatry

699

410

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In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo-or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/ SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

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Suicidal Ideation and Suicide Attempts in Panic Disorder and Attacks

Cited by 553 publications

References 23 publications

Clinical significance and comorbidity of subthreshold depression and anxiety in the community

Clinical significance and comorbidity of subthreshold depression and anxiety in the community

Axis I and Axis II disorders as predictors of prospective suicide attempts: Findings from the Collaborative Longitudinal Personality Disorders Study.

World Federation of Societies of Biological Psychiatry (WFSBP) Guidelines for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-Traumatic Stress Disorders – First Revision

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