Multicomponent intervention for patients admitted to an emergency unit for suicide attempt: an exploratory study

Suicide is a major cause of premature deaths worldwide and belongs to the top priority public health issues. While suicide attempt is the most important risk factor for completed suicide, intervention for suicide attempters (SA) have produced mixed results. Since an important proportion of SA request medical care, emergency units (EU) are an opportune setting to implement such interventions. This exploratory study evaluated the feasibility and acceptability of a multicomponent intervention for SA admitted to an EU. The intervention consisted of coordination by a case manager of a joint crisis plan (JCP), an early meeting with relatives and the existing care network, as well as phone contacts during 3 months after suicide attempt. Among 107 SA admitted to the emergency unit during the study period, 51 could not be included for logistical reason, 22 were excluded, and intervention was offered to 34. Of these, 15 refused the intervention, which was thus piloted with 19 SA. First-time attempters most frequently declined the intervention. Feasibility and acceptability of phone contacts and case manager were good, while JCPs and meetings were difficult to implement and perceived as less acceptable. Refusal pattern questions the global acceptability and is discussed: JCPs and meetings will have to be modified in order to improve their feasibility and acceptability, especially among first-time attempters

Consciousness related neural events viewed as brain state space transitions

This theoretical and speculative essay addresses a categorical distinction between neural events of sensory-motor cognition and those presumably associated with consciousness. It proposes to view this distinction in the framework of the branch of Statistical Physics currently referred to as Modern Critical Theory (Stanley, Introduction to phase transitions and critical phenomena, 1987; Marro and Dickman, Nonequilibrium phase transitions in lattice, 1999). Based on established landmarks of brain dynamics, network configurations and their role for conveying oscillatory activity of certain frequencies bands, the question is examined: what kind of state space transitions can systems with these properties undergo, and could the relation between neural processes of sensory-motor cognition and those of events in consciousness be of the same category as is characterized by state transitions in non-equilibrium physical systems? Approaches for empirical validation of this view by suitably designed brain imaging studies, and for computational simulations of the proposed principle are discussed