Aggression, Impulsivity and Suicidal Behavior in Depressive Disorders: A Comparison Study between New York City (US), Madrid (Spain) and Florence (Italy)

The association of aggression and impulsivity with suicidal behavior (SB) in depression may vary across countries. This study aimed (i) to compare aggression and impulsivity levels, measured with the Brown-Goodwin Scale (BGS) and the Barratt Impulsivity Scale (BIS), respectively, between New York City (NYC) (US), Madrid (Spain) and Florence (Italy) (ANOVA); and (ii) to investigate between-site differences in the association of aggression and impulsivity with previous SB (binary logistic regression). Aggression scores were higher in NYC, followed by Florence and Madrid. Impulsivity levels were higher in Florence than in Madrid or NYC. Aggression and impulsivity scores were higher in suicide attempters than in non-attempters in NYC and in Madrid. SB was associated with aggression in NYC (OR 1.12, 95% CI 1.07–1.16; p p = 0.032). Impulsivity was linked with SB in NYC (OR 1.01, 95% CI 1.00–1.02; p p < 0.001). The higher suicide rates in NYC, compared to Madrid or Florence, may be, in part, explained by these cross-cultural differences in the contribution of aggression-impulsivity to SB, which should be considered by future research on SB prevention

A pilot 1-year follow-up randomised controlled trial comparing metacognitive training to psychoeducation in schizophrenia: effects on insight

Poor insight in schizophrenia spectrum disorders (SSD) is linked with negative outcomes. This single-centre, assessor-blind, parallel-group 1-year follow-up randomised controlled trial (RCT) tested whether metacognitive training (MCT) (compared to psychoeducation) may improve insight and outcomes in outpatients with SSD assessed: at baseline (T0); after treatment (T1) and at 1-year follow-up (T2). Insight (primary outcome) was measured with (i) the Schedule for Assessment of Insight-Expanded version- (SAI-E), including illness recognition (IR), symptom relabelling (SR), treatment compliance (TC) and total insight scores (TIS); and (ii) the Beck Cognitive Insight Scale (BCIS). Between-group comparisons were nonsignificant, while within the MCT group (but not within controls) there was a significant medium effect size for improved TIS at T2 (d = 0.67, P = 0.02). Secondary outcomes included cognitive measures: Jumping to Conclusions (JTC), Theory of Mind (ToM), plus symptom severity and functioning. Compared to psychoeducation, MCT improved the PANSS excitement (d = 1.21, P = 0.01) and depressed (d = 0.76, P = 0.05) factors at T2; and a JTC task both at T1 (P = 0.016) and at T2 (P = 0.031). Participants in this RCT receiving MCT showed improved insight at 1-year follow-up, which was associated with better mood and reduced JTC cognitive bias. In this pilot study, no significant benefits on insight of MCT over psychoeducation were detected, which may have been due to insufficient power

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