Suicide models and treatment models are separate entities. What does it mean for clinical suicide prevention?

Theoretical models of suicide are based on risk factors associated with suicide, such as psychiatric pathology, genetics, epigenetics, functional brain disorders, and impaired decision making. In current clinical practice, the predominant risk model is the medical model, which posits that treating suicide risk is primarily a matter of treating psychiatric disorders. However, even comprehensive risk factor models cannot overcome the basic problem that, by their nature, they cannot accommodate the suicidal person’s psychological experience of suicidality. Risk factor models do not translate into effective treatment models. Suicide risk is highly personal and fluid, and is related to individual vulnerabilities and to person-specific events triggering suicidal thoughts and actions. Clinicians need treatment models that are meaningful to suicidal patients. Understanding the single person’s suicidality requires a patient-centered approach. Therapeutic interventions that effectively reduce the risk of suicidal behavior have been developed from general principles of psychotherapy. Therapy process factors associated with effective therapies are working alliance, validation of the individual patient’s thoughts and feelings, active treatment engagement. Psychological therapies need patients who are active participants in a collaborative working relationship between therapist and patient. The goal must be to jointly develop a meaningful understanding of the suicidal crisis. In view of the limited personal resources in health care systems it is important that effective therapies are brief and effective. Future research must aim to improve our understanding of the factors involved in effective therapies in order to optimize treatments for individuals at risk. This may also include the integration of biological risk factors in psychological treatment models

Humor, Kreditierung und Vertrauensaufbau in einem Erstgespräch nach Suizidversuch: Theoretische und technische Überlegungen zur Verbindung des freudschen Konzepts der humoristischen Einstellung mit dem modernen technischen Konzept der Kreditierung

Zusammenfassung: Ausgehend von der Untersuchung einer auf den ersten Blick irritierenden Intervention einer Therapeutin im Erstgespräch mit einer Patientin nach Suizidversuch gehen die Autoren der Frage nach, was diese Intervention humorvoll macht und was eine solche, potenziell riskante Intervention für die Entwicklung der Begegnung bedeuten kann. Anhand der gesprächsanalytischen Untersuchung dieser konkreten Episode im Feintranskript befasst sich dieser Beitrag mit der konzeptuellen Beziehung zwischen der humoristischen Einstellung Freuds und dem modernen behandlungstechnischen Konzept der Kreditierung. Der Begriff der Kreditierung verweist auf eine entwicklungsfördernde therapeutische Haltung, die auf einer wohlwollend fordernden Einstellung gegenüber dem Patienten basiert. Therapeutisch eingesetzter Humor kann so als eine taktvolle Taktlosigkeit verstanden werden, die den Patienten zur spielerischen Übernahme einer alternativen Selbstpositionierung einlädt. Die humorvolle Zumutung kann als Einladung zu einem therapeutischen Spiel verstanden werden, das, ähnlich dem Spiel des Kindes, einen Übergangsraum eröffnet und narzisstische Restitution anbietet. Abschließend werden theoretische und technische Überlegungen zur Verwandtschaft des Konzepts der Kreditierung mit dem klassischen Konzept der humoristischen Einstellung besproche

Suicide reporting in Swiss print media

All articles in Swiss newspapers with suicide or attempted suicide as the main topic were collected over a time span of 8 months. The aim was the investigation of a potential imitation effect and the extent of preventive messages given. A rating scheme for an assumed imitation effect based on different items for heading, text and picture was developed. The results show that approximately two-fifttis of all 151 articles were inappropriate in some aspects and were considered as bearing a high potential for imitation effect. The rating was significantly more unfavourable for the main Swiss tabloid paper than the other newspapers. A reason for suicide was specified in 41.7% of all articles, half of them in a very simple and monocausal way. Relevant preventive information was only given In 10% of cases. We conclude that media guidelines for suicide reporting are needed. A preventive strategy to influence the policy of suicide reporting in newspapers must primarily concentrate on a few papers with a high circulation (popular press)

Suicide reporting in Swiss print media: Responsible or irresponsible?

All articles in Swiss newspapers with suicide or attempted suicide as the main topic were collected over a time span of 8 months. The aim was the investigation of a potential imitation effect and the extent of preventive messages given. A rating scheme for an assumed imitation effect based on different items for heading, text and picture was developed. The results show that approximately two-fifttis of all 151 articles were inappropriate in some aspects and were considered as bearing a high potential for imitation effect. The rating was significantly more unfavourable for the main Swiss tabloid paper than the other newspapers. A reason for suicide was specified in 41.7% of all articles, half of them in a very simple and monocausal way. Relevant preventive information was only given In 10% of cases. We conclude that media guidelines for suicide reporting are needed. A preventive strategy to influence the policy of suicide reporting in newspapers must primarily concentrate on a few papers with a high circulation (popular press

Improving the Therapeutic Relationship When Prescribing Antidepressants: A Pilot Study.

Studies indicate that the quality of the doctor-patient relationship moderates the effect of pharmacotherapy. To enhance the quality of the therapeutic relationship in the pharmacotherapy of depression, we developed a brief manual with interactive materials for residents in psychiatry and their patients. In a pilot study at a psychiatric university hospital's outpatient department, we compared patient-centered treatment parameters of a first patient group treated as usual and a second patient group treated using the manual. The study had no influence on the choice of medication. In the manual group, patient satisfaction with the doctor-patient relationship increased significantly at the three-month follow-up. Depression parameters declined in both groups, without group differences. Continuation of antidepressant medication at six months was higher in the manual group. In conclusion, a simple intervention using written materials for doctors prescribing antidepressants improved doctors' and patients' satisfaction with treatment

Life Cycle Inventory for Use of Waste Solvent as Fuel Substitute in the Cement Industry - A Multi-Input Allocation Model (11 pp)

Background: The Swiss chemical industry produces large amounts of organic waste solvents. Some of these solvents cannot be recovered. A common option for the treatment of such organic waste solvents is the incineration in hazardous waste incinerators. Alternatively, the waste solvents can be used as fuel in cement production. On the one hand, solvent incineration in cement kilns saves fossil fuels such as coal and heavy fuel oil. On the other hand, fuel-bound emissions may change as well. These emission changes can either have a negative or a positive net ecological impact, depending on the chemical nature of the waste solvent used. Goal and Scope: The aim of our work was to develop a multi-input allocation model, which allows one to calculate life cycle inventories for specific waste solvents. These LCIs can then be used in further applications, e.g. a comparison of different waste solvent treatment options. Results and Discussion: A multi-input allocation model was developed that takes into account the physico-chemical properties of waste solvents such as elementary composition and net calorific value. The model is based on a set of equations and data on fuel mix, fuel composition as well as transfer coefficients for heavy metals. The model calculates "avoided inputs” and "changes in emissions” which arise from substituting fossil fuels with waste solvents. Life cycle inventories can be calculated for specific waste solvents if the elementary composition and the net calorific value are known. The application of the model is illustrated in a case study on four waste solvents. The results show that solvent incineration in cement kilns generally reduces the overall impact of clinker production because fossil fuels are replaced. A sensitivity analysis revealed that the model is especially sensitive to the fuel mix and coal properties, such as net calorific value as well as the content of nitrogen and carbon. The transfer coefficients are also uncertain, but this uncertainty is not relevant as the amount of heavy metal emitted into the atmosphere is small. Conclusions and Outlook: The proposed model serves to calculate inventory data for the combustion of liquid alternative fuels such as waste solvents in cement kilns. Although our model represents Swiss cement production conditions, it can be applied to other countries by fitting the most sensitive parameters of fuel mix and coal properties. In case the technology used is very different to the Swiss situation, the transfer coefficients also need to be adapte

Suicide reporting in the Swiss print media: Frequency, form and content of articles

All the Swiss newspapers were screened for the target words ‘suicide' and ‘attempted suicide' and all relevant articles were analysed for form and content over a period of 8 months. In 151 out of 208 articles suiclde/attempted suicide was the major topic. Large differences between the newspapers regarding the frequency and format of the articles (e.g. placement on front page) were found. In a few newspapers with a large circulation suicide is clearly treated as a major topic of news sensation. The majority of articles reported cases of completed suicide, mainly shooting and hanging by young persons. Attempted suicide was only reported for persons with celebrity status. This survey shows that there is reason for concern in view of the danger of imitation effect

Modélisation, Supervision et optimisation du déroulement d'un procédé médical - CHIP

National audienceLa Chimio-Hyperthermie Intra-péritonéale (CHIP) s'est révélée comme un traitement efficace et intéressant pour les cancers d'origine digestive. L'association de l'hyperthermie et de la chimiothérapie a prouvé ses résultats cytotoxiques indéniables pour les cellules cancéreuses. Cependant l'application de cette technique à ventre fermé ne garantit pas une homogénéité de la répartition de la température et du médicament dans la cavité abdominale. Cet article porte essentiellement sur la modélisation de l'aspect thermique de la CHIP et propose un outil de supervision en temps réel et in vivo du processus. Un modèle adaptatif, permettant de simuler la température de sortie de la cavité abdominale est présenté et validé à l'aide de données réelles, acquises in vivo au cours de plusieurs CHIP réalisées au sein des Centres hospitaliers - partenaires du projet de recherche : CH Lyon-Sud (CHLS), CHU Bellevue (Saint-Etienne)

Repetition of attempted suicide among immigrants in Europe

Objectives: To compare frequencies of suicide attempt repetition in immigrants and local European populations, and the timing of repetition in these groups. Method: Data from 7 European countries, comprising 10 574 local and 3032 immigrant subjects, were taken from the World Health Organization European Multicentre Study on Suicidal Behaviour and the ensuing Monitoring Suicidal Behaviour in Europe (commonly referred to as MONSUE) project. The relation between immigrant status and repetition of suicide attempt within 12-months following first registered attempt was analyzed with binary logistic regression, controlling for sex, age, and method of attempt. Timing of repetition was controlled for sex, age, and the recommended type of aftercare. Results: Lower odds of repeating a suicide attempt were found in Eastern European (OR 0.50; 95% CI 0.41 to 0.61, P < 0.001) and non-European immigrants (OR 0.68; 95% CI 0.51 to 0.90, P < 0.05), compared with the locals. Similar patterns were identified in the sex-specific analysis. Eastern European immigrants tended to repeat their attempt much later than locals (OR 0.58; 95% CI 0.35 to 0.93, P < 0.05). In general, 32% of all repetition occurred within 30 days. Repetition tended to decrease with age and was more likely in females using harder methods in their index attempt (OR 1.29; 95% CI 1.08 to 1.54, P < 0.01). Large variations in the general repetition frequency were identified between the collecting centres, thus influencing the results. Conclusions: The lower repetition frequencies in non-Western immigrants, compared with locals, in Europe stands in contrast to their markedly higher tendency to attempt suicide in general, possibly pointing to situational stress factors related to their suicidal crisis that are less persistent over time. Our findings also raise the possibility that suicide attempters and repeaters constitute only partially overlapping populations