September 2017 - Volume 205 - Issue 9

  • John A. Talbott, MD
  • 0022-3018
  • 1539-736X
  • 12 issues / year
  • 1.860

Article Summaries


Why We Need to Enhance Suicide Postvention: Evaluating a Survey of Psychiatrists' Behaviors after the Suicide of a Patient
Matthew D. Erlich, MD, Stephanie A. Rolin, MD, MPH, Lisa B. Dixon, MD, MPH, David A. Adler, MD, David W. Oslin, MD, Bruce Levine, MD, Jeffrey L. Berlant, MD, PhD, Beth Goldman, MD, MPH, Steve Koh, MD, MPH, MBA, Michael B. First, MD, Chaitanya Pabbati, MD, and Samuel G. Siris, MD

The Psychopathology Committee of the Group for the Advancement for Psychiatry surveyed a convenience sample of psychiatrists to better understand postvention activities. Ninety psychiatrists completed the survey; they were predominantly men (72%), with an average of 24.6 years of experience (SD, 16.7 years). Most had contact with the patient's family within 6 months of the suicide; few psychiatrists used a suicide postvention procedure or toolkit (9%). No psychiatrists stopped clinical practice after a patient suicide, although 10% stopped accepting patients whom they deemed at risk of suicide. Postvention efforts should be improved to better address survivor care.

The Rate of Improvement in Long-Term Dynamic Psychotherapy For Borderline Personality Disorder
J. Christopher Perry, MPH, MD, Michael Bond, MD, and Vera Békés, PhD

In a study of long-term dynamic psychotherapy, 16 subjects with borderline personality disorder (BPD) and 35 with non-BPD disorders were treated for a median of 3 years with a follow-up of 5 years. From periodic assessments, we calculated the rate of change for each subject over the course of the study on each measure of symptoms and functioning. At intake, borderline psychopathology was associated with higher levels on 76% of 17 measures of comorbid axis I disorders, symptoms, and functioning. BPD psychopathology was associated with faster (not slower) rates of improvement on three measures but, after controlling for the initial level of each measure, there were no significant associations.

The Comorbidity of Daydreaming Disorder (Maladaptive Daydreaming)
Eli Somer, PhD, Nirit Soffer-Dudek, PhD, and Colin A. Ross, MD

To determine the comorbidity profile of individuals meeting criteria for a proposed new disorder, daydreaming disorder (more commonly known as maladaptive daydreaming [MD]), the Structured Clinical Interview for DSM-5, and the Structured Clinical Interview for DSM-IV Dissociative Disorders were administered to 39 participants who met criteria for MD on a structured interview. We determined high rates of comorbidity: 74.4% met criteria for more than three additional disorders, and 41.1% met criteria for more than four. The most frequent comorbid disorder was attention deficit hyperactivity disorder (76.9%); 71.8% met criteria for an anxiety disorder, 66.7% for a depressive disorder, and 53.9% for an obsessive-compulsive or related disorder. Notably, 28.2% have attempted suicide. Individuals meeting criteria for MD have complex psychiatric problems spanning a range of DSM-5 disorders. This finding provides evidence that MD is different than normal daydreaming, and that these individuals experience considerable distress and impairment.

Posttraumatic Stress and Distress Tolerance: Associations With Suicidality in Acute-Care Psychiatric Inpatients
Anka A. Vujanovic, PhD, Jafar Bakhshaie, MD, MA, Colleen Martin, MA, Madhavi K. Reddy, PhD, and Michael D. Anestis, PhD

Trauma and posttraumatic stress disorder (PTSD) symptomatology have been associated with suicidality, including ideation and behavior. The current investigation evaluated, in acute-care psychiatric inpatients, the mediating role of perceived (self-reported) distress tolerance in the association between PTSD symptom severity and suicidality, defined as a) suicidal ideation, intent, or behavior leading to current psychiatric hospitalization; b) self-reported severity of suicidal desire; and c) percentage of days of suicidality during current hospitalization. Participants were composed of 105 adults (55.2% women; mean age, 33.9; SD, 10.9) admitted to a public psychiatric acute-care inpatient hospital in a large metropolitan area; 52.3% of the participants were hospitalized for suicidality. Results indicated that PTSD symptom severity (and severity of each PTSD symptom cluster) may exert an indirect effect on suicidality, specifically suicidality as a basis for current hospital admission and self-reported severity of suicidal desire, through perceived distress tolerance. Effects were documented after controlling for theoretically relevant covariates.

Comparing Affiliate Stigma Between Family Caregivers of People with Different Severe Mental Illness in Taiwan
Chih-Cheng Chang, MD, MS, Cheng-Fang Yen, MD, PhD, Fong-Lin Jang, MD, Jian-An Su, MD, MS, and Chung-Ying Lin, MS, PhD

This study aimed to compare the affiliate stigma across schizophrenia, bipolar disorder, and major depressive disorder, and to investigate potential factors associated with affiliate stigma. Each caregiver of family members with schizophrenia (n = 215), bipolar disorder (n = 85), and major depressive disorder (n = 159) completed the Affiliate Stigma Scale, Rosenberg Self-Esteem Scale, Caregiver Burden Inventory, Taiwanese Depression Questionnaire, and Beck Anxiety Inventory. After controlling for potential confounders, the hierarchical regression models showed that caregivers of a family member with schizophrenia had a higher level of affiliate stigma than those of bipolar disorder (β = −0.109; p < 0.05) and major depressive disorder (β = −0.230; p < 0.001). Self-esteem, developmental burden, and emotional burden were significant factors for affiliate stigma.

Suicidal Ideation and Psychological Strain Among Patients Diagnosed With Stomach Cancer: The Mediation of Psychopathological Factors
Xuekun Zhang, PhD (Cand), Jie Zhang, PhD, Nicholas Procter, RN, MBA, PhD, Xiaoyun Chen, MMed, Yonggang Su, MD, Fenglan Lou, BMed, and Fenglin Cao, PhD

A cross-sectional study was undertaken, involving subjects with no history of mental disorder, and questionnaires were administered by face-to-face interview. Patients who experienced more psychological strain, especially coping strain, are more likely to experience suicidal ideation. The mediation effects of hopelessness and psychological distress are significant. Psychological strain, hopelessness, and psychological distress may be the vital factors among patients with stomach cancer in the suicide risk assessment interview and for care planning and psychological intervention.

Dissociation From a Cross-Cultural Perspective: Implications of Studies in Brazil
Everton de Oliveira Maraldi, PhD, Stanley Krippner, PhD, Maria Cristina Monteiro Barros, MSc, and Alexandre Cunha, MS

The aim of this article was to discuss Brazilian research on the topic of dissociation, highlighting its contributions for the understanding of dissociative experiences in nonclinical populations and for the validity and relevance of dissociative disorders in the contexts of psychiatry, psychology, and psychotherapy. We also consider the ways in which dissociative experiences are assimilated by Brazilian culture and religious expressions, and the implications of Brazilian studies for the sociocultural investigation of dissociation.

Internet Game Addiction, Depression, and Escape From Negative Emotions in Adulthood: A Nationwide Community Sample of Korea
Dong Jun Kim, BS, Kiwon Kim, MD, Hae-Woo Lee, MD, PhD, Jin-Pyo Hong, MD, PhD, Maeng Je Cho, MD, PhD, Maurizio Fava, MD, David Mischoulon, MD, PhD, Jung-Yoon Heo, MD, and Hong Jin Jeon, MD, PhD

A total of 1401 adults aged between 18 and 74 years participated in this study. The adult Internet game addiction (IGA) group had significantly younger patients, and it showed a higher proportion of unmarried and unemployed adults, and higher rates of suicidal ideation, plan, and attempt than the non-IGA group. Multivariate logistic regression indicated that IGA was significantly associated with major depressive disorder, dysthymia, and depressive disorders adjusting for all variables. The Patient Health Questionnaire–9 score was significantly higher in the IGA group than in the non-IGA group for both young adults and middle groups. "Escape from negative emotions like nervousness, sadness, and anger" was the only significant item associated with depression among symptoms of IGA. This study suggests that adults with IGA and depression may use Internet games to escape from negative emotions.

Childhood Adversity, Cortisol Levels, and Psychosis: A Retrospective Investigation
Carlo Faravelli, MD, Giovanni Mansueto, PsyD, Sara Palmieri, PsyD, Carolina Lo Sauro, MD, PhD, Francesco Rotella, MD, PhD, Francesco Pietrini, MD, PhD, and Giulia Fioravanti, PhD

Eighty-five patients with psychosis and 170 control subjects were enrolled in the study. Childhood adversity (CA) was evaluated using the Florence Psychiatric Interview, and Childhood Experience of Care and Abuse Questionnaire. Positive symptoms (PS) were assessed using the Positive and Negative Syndrome Scale, and cortisol levels were evaluated in saliva samples. Patients experienced more CA and showed higher cortisol levels than controls. Patients with CA showed higher morning cortisol levels and more severe PS than those without CA. Patients with higher morning cortisol levels showed severe delusions. These findings suggest that both CA and dysregulation of the HPA axis could be related to psychosis.

Traumatic Brain Injury, Sleep Quality, and Suicidal Ideation in Iraq/Afghanistan Era Veterans
Bryann B. DeBeer, PhD, Nathan A. Kimbrel, PhD, Corina Mendoza, MA, Dena Davidson, PhD, Eric C. Meyer, PhD, Heidi La Bash, PhD, Suzy Bird Gulliver, PhD, and Sandra B. Morissette, PhD

Measures of traumatic brain injury (TBI) history, sleep quality, and suicidal ideation were administered to 130 Iraq/Afghanistan veterans. As expected, sleep quality mediated the effect of TBI history on current suicidal ideation (indirect effect, 0.0082; 95% confidence interval, 0.0019–0.0196), such that history of TBI was associated with worse sleep quality, which was, in turn, associated with increased suicidal ideation. These findings highlight the importance of assessing TBI history and sleep quality during suicide risk assessments for veterans.


Characterization of Risk-Taking in Adults With Bipolar Spectrum Disorders
Jonathan Reinharth, PhD, Raphael Braga, MD, and Mark Serper, PhD

Individuals with bipolar spectrum disorders experience higher morbidity and mortality rates relative to the general population because of increased commission of dangerous behaviors. Despite this impact, little is known about the overall rates of risk-taking behaviors in patients currently being treated for such illness. This study examined the frequency of a variety of risk-taking behaviors in 100 adults with bipolar spectrum disorders in an active outpatient psychiatric treatment. It was found that 70% of individuals assessed reported at least one risk-taking behavior over the preceding 7 days.

Suicidality and Survivability in Schizophrenia
Ahmed Naguy, MBBch, MSc, and Amna Al-Rabaie, Bch (Psych)

Natural Rest for Addiction, by Scott Kiloby and Jeff Foster
Reviewed by Pedro Ruiz, MD

Introduction to 100 Years of Psychiatry at Johns Hopkins: Erratum​




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