1. SUICIDE IS STILL WITH US
John A. Talbott, MD
Suicide has occupied the news media in recent years largely because of its shocking incidence among active duty and retired military personnel, but the publicity and concern have diverted our attention from its continuing existence among civilian populations. Three articles in this issue of the journal bring us back to those groups. While we do not have iron-clad methods to either predict who will attempt suicide or prevent suicide, studies like these “move the ball down the field” and we are closer to evaluating and treating persons who have or might attempt suicide. It is slow progress, but it is progress.
2. A RANDOMIZED TRIAL OF THE EFFECT OF FOUR SECOND GENERATION ANTIPSYCHOTICS AND ONE FIRST GENERATION ANTIPSYCHOTIC ON CIGARETTE SMOKING, ALCOHOL, AND DRUG USE IN CHRONIC SCHIZOPHRENIA
Somaia Mohamed, MD, PhD, Robert A. Rosenheck, MD, Haiqun Lin, PhD, Marvin Swartz, MD, Joseph McEvoy, MD, Scott Stroup, MD
The Clinical Antipsychotic Trial of Intervention Effectiveness (CATIE) study randomly assigned 1,432 patients formally diagnosed with schizophrenia to four second generation antipsychotic drugs and one first generation antipsychotic, perphenazine, and followed them for up to 18 months. Secondary outcome data documented cigarettes smoked in the past week and alcohol and drug use severity ratings. At baseline 61% of patients smoked, 35% used alcohol and 23% used illicit drugs. This study found no evidence that any antipsychotic was robustly superior to any other in a secondary analysis of data on substance use outcomes from a large 18-month randomized schizophrenia trial.
3. HEALTH BEHAVIOR IN HYPOCHONDRIASIS
Julia Schwind, MSc, Julia M. B. Neng, Dr, Volkmar Höfling, Dr, Florian Weck, Dr
One-hundred-twenty-six participants, consisting of 40 participants with a primary diagnosis of hypochondriasis, 41 participants with a primary diagnosis of anxiety disorder, and 45 healthy controls, completed a multidimensional questionnaire for the assessment of health behavior and the evaluation of general psychopathology, illness anxiety, depression and general anxiety. Patients with hypochondriasis revealed a less active way of life (d = 0.89) and lower hygiene (d = 0.60) than healthy controls. No differences were found in substance avoidance, security orientation, and diet.
4. UNDERSTANDING SUICIDE ATTEMPTS AMONG GAY MEN FROM THEIR SELF-PERCEIVED CAUSES
Jen Wang, MPH, PhD, Martin Plöder, Michael Häusermann, LSW, Mitchell G. Weiss, MD, PhD
Mental health surveys conducted among gay men in Geneva, Switzerland, from two probability-based time-space samples in 2007 and 2011 were merged to yield a combined sample N=762. 16.7% of the respondents reported a suicide attempt in their lifetime. At their latest attempt, over two thirds asserted intent to die, and half required medical assistance. Social/inter-personal problems constitute the most prominent category. Problems with love/relationship and accepting one’s homosexuality figure consistently among the top three causes. Problems with family are among the most common perceived causes at first attempt but not at the most recent subsequent attempt. Respondent-driven assessment yielded both common and idiosyncratic causes of suicide and their distinct effects.
5. PREDICTORS OF FUTURE SUICIDE ATTEMPTS AMONG INDIVIDUALS REFERRED TO PSYCHIATRIC SERVICES IN THE EMERGENCY DEPARTMENT: A LONGITUDINAL STUDY
Yunqiao Wang, MA, Joanna Bhaskaran, MA, Jitender Sareen, MD, JianLi Wang, PhD, Rae Spiwak, MSc, James M. Bolton, MD
This study examined which factors predict future suicide attempts (SAs) among people referred to psychiatric services in the emergency department (ED). It included consecutive adult (age 18+ years) presentations (N = 6919) over a 3-year period to the two tertiary care hospitals. Stepwise logistic regression and receiver operating characteristic curves examined the association between the baseline variables and future SAs within the next 6 months. 104 individuals re-presented to the ED with future SAs. Of the 19 baseline variables, only 2 independently accounted for the variance in future attempts. High-risk scores using this 2-item model were associated with elevated odds of future SA (odds ratio = 3.22; 95% confidence interval 1.62 to 6.42; P < .01), but this was tempered by low PPV. Further evaluation is required to determine if this 2-item tool could help identify people requiring more comprehensive risk assessment referred to psychiatry in the ED.
6. ARE SUICIDE ATTEMPTERS WIRED DIFFERENTLY? A COMPARISON WITH NON-SUICIDAL DEPRESSED INDIVIDUALS USING PLAN ANALYSIS
Juliane Brüdern, MSc, Thomas Berger, Prof, Konrad Michel, Prof, Anja Gysin Maillart, PhD, Isabelle Schmutz Held, PhD, Franz Caspar, Prof
We analyzed narrative interviews of 17 suicide attempters and intake interviews of 17 non-suicidal, depressive patients using Plan Analysis. Then, we developed a prototypical Plan structure for both groups. Suicidal behavior serves various Plans only found in suicide attempters. Plans of this group are especially related to social perfectionism and withdrawal in order to protect their self-esteem. Depressive patients employ several interpersonal control and coping strategies. The prototypical Plan structure of suicide attempters may be a valuable tool for clinicians to detect critical Plans and motives in their interaction with patients.
7. A META-ANALYSIS OF DEPRESSIVE SYMPTOM OUTCOMES IN RANDOMIZED, CONTROLLED TRIALS FOR PTSD
Julia McDougal Ronconi, MS, APRN, Brian Shiner, MD, MPH, Bradley V. Watts, MD, MPH
We searched literature databases for randomized controlled clinical trials of any treatment for PTSD published between 1980 and 2013. We selected articles in which all subjects were adults with a diagnosis of PTSD based on DSM criteria and valid PTSD and depressive symptom measures were reported. The sample consisted of 116 treatment comparisons drawn from 93 manuscripts. Evidence-based PTSD treatments are effective for comorbid depressive symptoms. Existing PTSD treatments work as well for comorbid depressive symptoms as they do for PTSD symptoms.
8. METACOGNITIVE DEFICITS IN SCHIZOPHRENIA: PRESENCE AND ASSOCIATIONS WITH PSYCHOSOCIAL OUTCOMES
Paul H. Lysaker, PhD, Jenifer Vohs, PhD, Kyle S. Minor, PhD, Leonor Irarrázaval, PhD, Bethany Leonhardt, PsyD, Jay A. Hamm, PsyD, Marina Kukla, PhD, Raffaele Popolo, MD, Lauren Luther, MSEd, Kelly D. Buck, PMHCNS-BC, Sara Wasmuth, PhD, Giancarlo Dimaggio, MD
The current review describes evidence that persons with schizophrenia experience decrements in their ability to form complex ideas about themselves to use to respond to psychological and social challenges. Studies are detailed which find greater levels of these impairments, defined as metacognitive deficits, in persons with schizophrenia in both early and later phases of illness as compared to other clinical and community groups. Further, studies linking metacognitive deficits with poorer psychosocial functioning and other variables closely linked to outcomes are summarized.
9. ADAPTED DIALECTICAL BEHAVIOUR THERAPY FOR ADOLESCENTS WITH SELF-INJURIOUS THOUGHTS AND BEHAVIORS
Darren B. Courtney, MD, FRCPC, Martine F. Flament, MD, PhD
The purpose of this study was to explore clinical changes observed in suicidal adolescents treated with an adapted form of Dialectical Behavior Therapy for adolescents (A-DBT-A) in a tertiary care setting. We conducted an open-label naturalistic study including 61 adolescents with self-injurious thoughts and behaviours and associated features of borderline personality disorder, who underwent a 15-week course of A-DBT-A. Self-harm, symptoms of borderline personality disorder, resiliency measures, predictors of response and predictors of attrition were also explored. Among participants who completed post-treatment measures, we found a significant reduction in suicidal ideation (n=31, p<0.001). Secondary outcomes also suggested improvement. Baseline substance use predicted attrition (HR 2.51; 95%CI 1.03-6.14; p<0.05), as did baseline impulsivity score on the Life Problems Inventory (HR 1.03; 95%CI 1.004-1.06; p<0.05). Overall, we observed clinical improvements in adolescents receiving A-DBT-A.
10. BINDING TEMPORAL CONTEXT IN MEMORY: IMPACT OF EMOTIONAL AROUSAL AS A FUNCTION OF STATE ANXIETY AND STATE DISSOCIATION
Rafaële J. C. Huntjens, PhD, Ineke Wessel, PhD, Albert Postma, PhD, Rineke van Wees-Cieraad, MSc, Peter J. de Jong, PhD
This study investigated the effect of emotional arousal on temporal binding and examined whether temporal binding varied as a function of state anxiety and/or state dissociation. Participants saw picture sequences that varied in arousal and valence. Following each sequence, participants were presented with all the pictures simultaneously and had to sort the pictures in the original order. Temporal context binding was indexed by sorting accuracy. Binding was generally lower for high than low arousing pictures. Reduced binding of arousing material was specifically pronounced in participants with high state anxiety, whereas it appeared independent of state dissociation. These findings point to the relevance of impaired temporal binding as a component of aberrant memory encoding in stressful situations.
11. RELIGIOSITY AND IMPULSIVITY IN MENTAL HEALTH: IS THERE A RELATIONSHIP?
André C. Caribé, MD, Marlos Fernando Vasconcelos Rocha, MD, Davi Félix Martins Junior, Paula Studart, Lucas C. Quarantini, MD, PhD, Nicolau Guerreiro, Ângela Miranda-Scippa MD, PhD
Our cross-sectional study included 61 healthy individuals and 93 patients. The instruments used were a sociodemographic data questionnaire, the Mini International Neuropsychiatric Interview, the Barratt Impulsiveness Scale, and the Duke University Religion Index. The healthy individuals presented higher scores in the religiosity domains. The patients presented higher scores in the impulsivity dimensions (attentional p=0.000; motor p=0.000; absence of planning p=0.000). In the patient group, intrinsic religiosity had a significant inverse relationship with total impulsivity (p=0.023), attentional (p=0.010) and absence of planning (p=0.007), even after controlling for sociodemographic variables. Just as mental illness might impair religious involvement, religiosity could diminish the expression of mental illness and impulsive behaviors.
12. AN EXAMINATION OF EXECUTIVE FUNCTIONING IN YOUNG ADULTS EXHIBITING BODY-FOCUSED REPETITIVE BEHAVIORS (BFRBs)
Christopher A. Flessner, PhD, Sarah Francazio, Yolanda E. Murphy, Elle Brennan
Body-focused repetitive behaviors (BFRBs), including hair pulling, nail biting, and skin picking are repetitive, habitual, and compulsive in nature. The present study recruited 53 participants from a larger sample of young adults. Participants completed an automated neurocognitive test battery including tasks of cognitive flexibility, working memory, and planning and organization. Results revealed that participants in the BFRB group demonstrated significantly poorer cognitive flexibility (d = 0.63) than controls. No differences were noted in other neurocognitive domains. However, planning and organization demonstrated a significant relationship with various BFRB severity measures.
13. HOUSING FIRST AND THE RISK OF FAILURE: A COMMENT ON WESTERMEYER AND LEE (2013)
Stefan G. Kertesz, MD, MSc, Erika Laine Austin, PhD, Sally K. Holmes, MBA, David E. Pollio, PhD, Carol VanDeusen Lukas, EdD
In a 16-person quasi-experimental study, 8 veterans who entered VA’s permanent supportive housing did poorly, while 8 veterans who remained in more traditional treatment did well. In this commentary, we suggest that the report was problematic in the conceptualization of the matters it sought to address and in its science. Nonetheless, it highlights challenges that must not be ignored. From this report and other research, we now know that even more attention is required to support clinical recovery for Housing First clients. Successful implementation of Housing First requires guidance from agency leaders, and their support for clinical staff when individual clients fare poorly.
14. HOUSING FIRST/HUD-VASH: IMPORTANCE, FLAWS, AND POTENTIAL FOR TRANSFORMATION: RESPONSE TO COMMENTARY
Joseph Westermeyer, MD, MPH, PhD, Kathryn Lee, BSN, RN, Tegan Batres y Carr, BS
We agree with the commentators that this is an extremely important topic and appreciate their concern for the poor-to-tragic outcomes in our Housing First/HUD-VASH patients. This useful interchange allows us to elaborate on (1) importance of this topic, (2) need for a more comprehensive framework that can foster improved outcomes and more judicious public spending, and (3) relevance of realist methodology in correcting unexpected consequences and suggesting salutary alternatives, with methodological clarifications as requested.