Psychiatric disorders and clinical correlates of suicidal patients admitted to a psychiatric hospital in Tokyo

<p>Abstract</p> <p>Background</p> <p>Patients admitted to a psychiatric hospital with suicidal behavior (SB) are considered to be especially at high risk of suicide. However, the number of studies that have addressed this patient population remains insufficient compared to that of studies on suicidal patients in emergency or medical settings. The purpose of this study is to seek features of a sample of newly admitted suicidal psychiatric patients in a metropolitan area of Japan.</p> <p>Method</p> <p>155 suicidal patients consecutively admitted to a large psychiatric center during a 20-month period, admission styles of whom were mostly involuntary, were assessed using Structured Clinical Interviews for DSM-IV Axis I and II Disorders (SCID-I CV and SCID-II) and SB-related psychiatric measures. Associations of the psychiatric diagnoses and SB-related characteristics with gender and age were examined.</p> <p>Results</p> <p>The common DSM-IV axis I diagnoses were affective disorders 62%, anxiety disorders 56% and substance-related disorders 38%. 56% of the subjects were diagnosed as having borderline PD, and 87% of them, at least one type of personality disorder (PD). SB methods used prior to admission were self-cutting 41%, overdosing 32%, self-strangulation 15%, jumping from a height 12% and attempting traffic death 10%, the first two of which were frequent among young females. The median (range) of the total number of SBs in the lifetime history was 7 (1-141). Severity of depressive symptomatology, suicidal intent and other symptoms, proportions of the subjects who reported SB-preceding life events and life problems, and childhood and adolescent abuse were comparable to those of the previous studies conducted in medical or emergency service settings. Gender and age-relevant life-problems and life events were identified.</p> <p>Conclusions</p> <p>Features of the studied sample were the high prevalence of affective disorders, anxiety disorders and borderline PD, a variety of SB methods used prior to admission and frequent SB repetition in the lifetime history. Gender and age appeared to have an influence on SB method selection and SB-preceding processes. The findings have important implications for assessment and treatment of psychiatric suicidal patients.</p

Boletín de Segovia: Número 40 - 1898 abril 4

Copia digital. Madrid : Ministerio de Cultura. Subdirección General de Coordinación Bibliotecaria, 200

Motivation factors for suicidal behavior and their clinical relevance in admitted psychiatric patients

<div><p>Background</p><p>Suicidal behavior (SB) is a major, worldwide health concern. To date there is limited understanding of the associated motivational aspects which accompany this self-initiated conduct.</p><p>Aims</p><p>To develop a method for identifying motivational features associated with SB by studying admitted psychiatric patients, and to examine their clinical relevance.</p><p>Methods</p><p>By performing a factor analytic study using data obtained from a patient sample exhibiting high suicidality and a variety of SB methods, Motivations for SB Scale (MSBS) was constructed to measure the features. Data included assessments of DSM-IV psychiatric and personality disorders, suicide intent, depressive symptomatology, overt aggression, recent life events (RLEs) and methods of SB, collated from structured interviews. Association of identified features with clinical variables was examined by correlation analyses and MANCOVA.</p><p>Results</p><p>Factor analyses elicited a 4-factor solution composed of Interpersonal-testing (IT), Interpersonal-change (IC), Self-renunciation (SR) and Self-sustenance (SS). These factors were classified according to two distinctions, namely interpersonal vs. intra-personal directedness, and the level of assumed influence by SB or the relationship to prevailing emotions. Analyses revealed meaningful links between patient features and clinical variables. Interpersonal-motivations (IT and IC) were associated with overt aggression, low suicidality and RLE discord or conflict, while SR was associated with depression, high suicidality and RLE separation or death. Borderline personality disorder showed association with IC and SS. When self-strangulation was set as a reference SB method, self-cutting and overdose-taking were linked to IT and SS, respectively.</p><p>Conclusions</p><p>The factors extracted in this study largely corresponded to factors from previous studies, implying that they may be useful in a wider clinical context. The association of these features with SB-related factors suggests that they constitute an integral part of the process leading to SB. These results provide a base for further research into clinical strategies for patient management and therapy.</p></div

Multivariate Analysis of Covariance (MANCOVA) regression of MSBS scores in relation to SB methods.

<p>Multivariate Analysis of Covariance (MANCOVA) regression of MSBS scores in relation to SB methods.</p

Multivariate Analysis of Covariance (MANCOVA) regression of MSBS in relation to psychiatric and personality disorders (groups).

<p>Multivariate Analysis of Covariance (MANCOVA) regression of MSBS in relation to psychiatric and personality disorders (groups).</p

Multivariate Analysis of Covariance (MANCOVA) regression of MSBS scores in relation to SB methods.

<p>Multivariate Analysis of Covariance (MANCOVA) regression of MSBS scores in relation to SB methods.</p

Multivariate Analysis of Covariance (MANCOVA) regression of MSBS in relation to interpersonal recent life events.

<p>Multivariate Analysis of Covariance (MANCOVA) regression of MSBS in relation to interpersonal recent life events.</p