Monday, August 27, 2007

Articles on Suicide

Psychiatry Drug Alerts reviewed three studies, with a combined total of 109,000 patients. Attempts increased prior to treatment, peaking in the month prior to treatment, dropping steeply after the start of treatment, and continuing to decrease as treatment continued. This conclusion contradicts the FDA Psychopharmacology Committee black box warning, and makes it garbage science. The same conclusion resulted from a separate VA study of adults, that SSRI anti-depressants do not increase the risk of suicide. (Psychiatry Drug Alerts 21: 57-58)

Decision making in suicidal patients was tested with a standardized gambling test. Subjects learn to defer immediate rewards to get long-term rewards. Their score correlated with interpersonal difficulties in the affective domain. (J Affect Disord 99:59-62, 2007)

Patients over 50 with major depression had more impulsive suicide attempts with cognition problems, disability, and impaired self-care. They prepared for a suicide more often when older, isolated or living alone. (J Affect Disord 97:123-128, 2007)

Blacks do not have lower rates of suicidality. The lifetime prevalence of attempts was 4.1%, for suicidal ideas, 11.7%. In the first year of ideas, 77% progressed to an attempt. Increased risk associated with a younger cohort, lower educational attainment, living in the Midwest. These rates are those of the general population, and not lower. (JAMA 26:2112-2123, 2006)

Compared to depressed controls, adult patients with depression and a history of child abuse more often attempted suicide, got rated as impulsive and aggressive. Those who attempted suicide (71% v. 43% in the control group), had higher scores for impulsivity and aggression. (Am J Pscyhiat 158:1871-1877, 2001)

Of over 3000 female twins, ages 13 to 19, 4% reported attempting suicide before age 17. About half the attempters and a twelfth of the non-attempters had depression. Other risk factors included childhood physical abuse, social phobia, alcohol dependence, being black, and having conduct disorder. Risk increased 4 to 10 fold if a relative had died of suicide. The identical twin concordance rate was 25%, and 13% for dizygotic twins. Aside from psychopathology association with suicide, a familial link exists. (J Am Acad Child Adol Psychiat 40:1300-1207, 2001)

The highest levels of suicidal ideas take place in bipolar patients during the mixed phase. Age and depth of depression predicted suicide attempts. Anxiety did not. Patients did not make suicide attempts during mania. (J Affect Disord 2007; 97:101-107)

Among depressed patients, 16% reported prior suicide attempts. These were less educated, less likely married, more likely unemployed, with more substance abuse, co-morbidities, and PTSD. They had earlier onsets, increased severity, more episodes, and greater risk of suicidal behavior than the other depressed patients. (J Affect Disord 97:77-84, 2007)

A quarter of elderly depressed patients had suicidality. In half the suicidal patients, suicidality resolved after a month. In a quarter, it emerged late in treatment. About a quarter never experienced suicidality at any time. Suicidal and non-suicidal patients had equal severity of depression. The suicidal group has more anxiety, earlier onsets, more low self-eateem, and partial or no response to treatment. (J Affect Disord 2007; 98:153-161)

Anxiety symptoms associated with suicidal ideation in bipolar patients. It was ruminations, especially, that best linked to suicidal ideation. (J Affect Disord 97: 91-99, 2007)

At risk youth endorsed maladaptive coping strategies, increasingly more often with increasing risk factors. They avoided help seeking behavior. Such thinking requires persuasion during psychotherapy to change coping reactions. (J Am Acad Child Adol Psychiat 43:1124-1133, 2004)

Suicide rates peak in May, are lowest in February. Season represents a risk factor for suicide. Sunspot activity and geomagnetic field change did not. (J Affect Disord 81:133-139, 2004).

Among very depressed patients, these features predicted a higher risk of suicide attempt: a history of suicide attempt, subjective ratings of depression severity, cigarette smoking, aggression or impulsivity. (Am J Psychiat 161:1433-1441, 2004).

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