Suicides in Mood Disorders in Psychiatric Settings in Nordic National Register-Based Studies

Objective Although risk factors for nonfatal suicidal behavior in mood disorders have been vastly investigated, rate and risk factors of suicide deaths are less well known. Extensive health care and other population registers in the Nordic countries (Denmark, Finland, Iceland, Norway, and Sweden) allow national-level studies of suicide rates and risk factors. This systematic review examined Nordic studies of suicide in mood disorders. Methods National Nordic studies published after 1.1.2000 reporting on suicide mortality or relative risk in diagnosed unipolar depression or bipolar disorder treated in psychiatric settings; temporal variations in suicide risk after discharge, or risk factors for suicide were systematically reviewed. Results Altogether 16 longitudinal studies reported on rate and risk of suicide in depression. They found 2%-8% of psychiatric inpatients with depression to have died by suicide. However, in Finland suicide risk among depressive inpatients halved since the early 1990s. Nine studies investigated suicide risk in bipolar disorder, finding 4%-long term. The relative risk of suicide was consistently found extremely high (SMR > 100) during the first weeks postdischarge, declining steeply over time to approximately SMR of five after five years. Male gender, preceding suicide attempts, high severity of depression and substance abuse were found risk factors for suicide in depression, with only minor gender differences in risk factors, but major differences in lethal methods. Three studies investigated risk factors for suicide in bipolar disorder, finding male gender, preceding suicide attempts, and depressive episodes and psychiatric comorbidity to be associated with risk. Conclusions Overall, of psychiatric inpatients with depressive of bipolar disorders in the Nordic countries, 2%-8% have died by suicide in the last few decades, but current rates may be lower. Suicide risk is approximately similar or somewhat higher among patients with bipolar disorder, risk factor studies of whom are fewer. Risk of suicide is remarkably high immediately after discharge, and higher among males than females, those with preceding suicide attempts, high severity of depression, or concurrent substance abuse. Generalizability of findings from these Nordic studies to other countries need to be investigated, and their methodological limitations understood.Peer reviewe

Psychological pain and suicidal behavior : A review

Despite accumulation of clinical research on risk factors for suicidal process, understanding of the mechanisms and pathways underlying the emergence of suicidal thoughts and their progression to acts is insufficient. The suicidal process has been conceptualized in multiple psychological theories that have aimed to shed light on the interplay of contributing factors. One of the central concepts included in both the cubic model of suicide and the three-step theory of suicide is psychological pain (mental pain or psychache). Over the two last decades, interest in psychological pain has increased considerably, particularly since the discovery of the complex link between the pain processing system and the neurobiology of suicide, and the putative antisuicidal effect of buprenorphine. Growing evidence supports the association between experiencing psychological pain and suicidal ideation and acts in both clinical and non-clinical samples. However, many questions related to the concept of psychological pain and its role in prediction of suicidal behavior remain to be answered in future research. In this narrative review, we have outlined the history of the concept, the definition of psychological pain, and the tools developed for its measurement, summarized the empirical research on psychological pain in relation to suicidal behavior, and suggested future directions for clinical research on psychological pain and suicidal behavior.Peer reviewe

Masennuslääkkeiden hyödyt ja haitat depression hoidossa

Masennuslääkkeitä on tutkittu sadoissa kliinisissä kokeissa. Niiden tehosta ja haitoista depression hoidossa käydään usein keskustelua julkisuudessa. •Meta-analyysien tilastolliset arviot lääkkeiden tehosta lumeeseen verrattuna ovat suuruusluokaltaan ¬yhdenmukaisia. Yleensä erimielisyydet koskevat havaitun tehon kliinistä merkitystä. •Hoitotuloksessa yhdistyvät todellinen lääkevaikutus ja lumevaikutus. Pelkkää lumetta ei terveydenhuollossa käytetä, vaan aktiivista hoitoa joko annetaan tai ei. •Potilaalle tehoton tai haittoja aiheuttava lääkehoito yleensä lopetetaan jo akuuttivaiheessa. •Lyhytpsykoterapiat ja lääkkeet tehoavat depression oireisiin lähes yhtä hyvin. Yleensä tehokkainta on niiden yhdistäminen.Peer reviewe

Kliinistä merkittävyyttä on tulkittava johdonmukaisesti

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Vastine Järviselle

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Smartphone-based monitoring of mood disorders : a review

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Itsemurhaa yrittäneen turvasuunnitelma

Vertaisarvioitu. Näin hoidan.Turvasuunnitelma on lyhytinterventio itsemurhaa yrittäneille potilaille sekä henkilöille, joiden itsemurhariskin arvioidaan muuten suurentuneen. Terveydenhuollon ammattilainen pyrkii yhdessä potilaan kanssa löytämään itsemurha-ajattelua laukaisevat tekijät ja tekemään suunnitelman, miten potilas voisi mahdollisissa tulevissa kriisitilanteissa hallita itsemurhaimpulssejaan vahingoittamatta itseään. Tarkoituksena on luoda ennalta määritelty lista selviytymisstrategioista, tukea antavista henkilöistä ja toiminnoista, joihin potilas voi olla yhteydessä tai joita potilas voi tehdä vähentääkseen välitöntä itsetuhoisen käyttäytymisen riskiään sekä etukäteen suojata itseään kuoleman aiheuttavien itsemurhamenetelmien saatavuudelta. Lisäksi pohditaan syitä, joiden vuoksi potilas haluaa elää. Interventiossa tuotetaan kirjallinen yhden sivun asiakirja potilaalle mukaan otettavaksi. Yhteistoiminta ja terapeuttinen yhteistyö ovat keskeistä turvasuunnitelman teossa ja potilaan sitouttamisessa hoitoon