10 research outputs found
Suicide completion in secondary mental healthcare:a comparison study between schizophrenia spectrum disorders and all other diagnoses
BACKGROUND: Suicide completion is a tragic outcome in secondary mental healthcare. However, the extent to which demographic and clinical characteristics, suicide method and service use-related factors vary across psychiatric diagnoses remains poorly understood, particularly regarding differences between ‘schizophrenia spectrum disorders (SSD)’ and ‘all other diagnoses’, which may have implications for suicide prevention in high risk groups. METHODS: 308 patients who died by suicide over 2007–2011 were identified from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre Case Register. Demographic, clinical, services use-related factors, ‘full risk assessment’ ratings and the Health of the Nation Outcome Scale (HONOS) scores were compared across psychiatric diagnoses. Specifically, differences between patients with and without SSD were investigated. RESULTS: Patients with SSD ended their lives at a younger age, were more frequently of Black ethnicity and had higher levels of social deprivation than other diagnoses. Also, these patients were more likely to have HONOS and ‘risk assessment’ completed. However, patients who had no SSD scored significantly higher on ‘self-injury’ and ‘depression’ HONOS items and they were more likely to have the following ‘risk assessment’ items: ‘suicidal ideation’, ‘hopelessness’, ‘feeling no control of life’, ‘impulsivity’ and ‘significant loss’. Of note, ‘disengagement’ was more common in patients with SSD, although they had been seen by the staff closer to the time of suicide than in all-other diagnoses. Whilst ‘hanging’ was the most common suicide method amongst patients with non-SSD, most service users with a SSD diagnosis used ‘jumping’ (from heights or in front of a vehicle). CONCLUSIONS: Suicide completion characteristics varied between SSD and other diagnoses in patients receiving secondary mental healthcare. In particular, although clinicians tend to more frequently recognize suicide risk as a focus of concern in patients who have SSD, who are therefore more likely to have a detailed risk assessment documented; ‘known’ suicide risk factors appear to be more relevant in patients with non-SSD. Hence, the classic suicide prevention model might be of little use for SSD
Laminin-332 coordinates mechanotransduction and growth cone bifurcation in sensory neurons
Laminin-332 is a major component of the dermo-epidermal skin basement membrane and maintains skin integrity. The transduction of mechanical force into electrical signals by sensory endings in the skin requires mechanosensitive channels. We found that mouse epidermal keratinocytes produce a matrix that is inhibitory for sensory mechanotransduction and that the active molecular component is laminin-332. Substrate-bound laminin-332 specifically suppressed one type of mechanosensitive current (rapidly adapting) independently of integrin-receptor activation. This mechanotransduction suppression could be exerted locally and was mediated by preventing the formation of protein tethers necessary for current activation. We also found that laminin-332 could locally control sensory axon branching behavior. Loss of laminin-332 in humans led to increased sensory terminal branching and may lead to a de-repression of mechanosensitive currents. These previously unknown functions for this matrix molecule may explain some of the extreme pain experienced by individuals with epidermolysis bullosa who are deficient in laminin-332