European College of Neuropsychopharmacology study: How to prevent suicide?

31 Aug

People of all ages may have feelings of profound sadness, loss, and depression. There is no one on earth, despite what the ads attempt to portray, who lives a perfect life. Every life has flaws and blemishes, it is just that some cope better than others. For every person who lives to a ripe old age, during the course of that life they may encounter all types of loss from loss of a loved one through death, divorce or desertion, loss of job, financial reverses, illness, dealing with A-holes and twits, plagues, pestilence, and whatever curse can be thrown at a person. The key is that they lived THROUGH whatever challenges they faced AT THAT MOMENT IN TIME. Woody Allen said something like “90% of life is simply showing up.” Let moi add a corollary, one of the prime elements of a happy life is to realize that whatever moment you are now in, it will not last forever and that includes moments of great challenge. A person does not have to be religious to appreciate the story of Job. The end of the story is that Job is restored. He had to endure much before the final victory, though.

Science Daily reported in How can we prevent suicide? Major study shows risk factors associated with depression:

A major multi-national study of suicides has identified the behaviour patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

The statistics for suicide are frightening. According to the WHO, more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young (in the UK for example, it is the leading cause of death in men under 35) see notes, below. Effective measures of suicide prevention are urgently needed.

The BRIDGE-II-MIX study is a major international study looking at depression and suicide. The researchers evaluated 2811 patients suffering from depression, of whom 628 had already attempted suicide. Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally-ill patient. The parameters studied included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, how they scored on the standard Global Assessment of Functioning scale, and other parameters. The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts.

According to author Dr. Dina Popovic (Barcelona):
‘We found that “depressive mixed states” often preceded suicide attempts. A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation,” or mania. We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact 40% of all the depressed patients who attempted suicide had a “mixed episode” rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.
We also found that the standard DSM criteria identified 12% of patients at showing mixed states, whereas our methods showed 40% of at-risk patients. This means that the standard methods are missing a lot of patients at risk of suicide.”

In a second analysis of the figures, they found that if a depressed patient presents any of the following symptoms:

• risky behaviour (e.g. reckless driving, promiscuous behaviour)
• psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions)
• impulsivity (acting on a whim, displaying behaviour characterized by little or no forethought, reflection, or consideration of the consequences),
then their risk of attempting suicide is at least 50% higher.
http://www.sciencedaily.com/releases/2015/08/150830152601.htm

Citation:

How can we prevent suicide? Major study shows risk factors associated with depression
Date: August 30, 2015

Source: European College of Neuropsychopharmacology

Summary:

A major multi-national study of suicides has identified the behavior patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

• Abstract

Send to:
J Clin Psychiatry. 2015 Mar;76(3):e351-8. doi: 10.4088/JCP.14m09092.
Mixed features in patients with a major depressive episode: the BRIDGE-II-MIX study.
Perugi G1, Angst J, Azorin JM, Bowden CL, Mosolov S, Reis J, Vieta E, Young AH; BRIDGE-II-Mix Study Group.
Author information

Abstract

OBJECTIVE:

To estimate the frequency of mixed states in patients diagnosed with major depressive episode (MDE) according to conceptually different definitions and to compare their clinical validity.

METHOD:

This multicenter, multinational cross-sectional Bipolar Disorders: Improving Diagnosis, Guidance and Education (BRIDGE)-II-MIX study enrolled 2,811 adult patients experiencing an MDE. Data were collected per protocol on sociodemographic variables, current and past psychiatric symptoms, and clinical variables that are risk factors for bipolar disorder. The frequency of mixed features was determined by applying both DSM-5 criteria and a priori described Research-Based Diagnostic Criteria (RBDC). Clinical variables associated with mixed features were assessed using logistic regression.

RESULTS:

Overall, 212 patients (7.5%) fulfilled DSM-5 criteria for MDE with mixed features (DSM-5-MXS), and 818 patients (29.1%) fulfilled diagnostic criteria for a predefined RBDC depressive mixed state (RBDC-MXS). The most frequent manic/hypomanic symptoms were irritable mood (32.6%), emotional/mood lability (29.8%), distractibility (24.4%), psychomotor agitation (16.1%), impulsivity (14.5%), aggression (14.2%), racing thoughts (11.8%), and pressure to keep talking (11.4%). Euphoria (4.6%), grandiosity (3.7%), and hypersexuality (2.6%) were less represented. In multivariate logistic regression analysis, RBDC-MXS was associated with the largest number of variables including diagnosis of bipolar disorder, family history of mania, lifetime suicide attempts, duration of the current episode > 1 month, atypical features, early onset, history of antidepressant-induced mania/hypomania, and lifetime comorbidity with anxiety, alcohol and substance use disorders, attention-deficit/hyperactivity disorder, and borderline personality disorder.

CONCLUSIONS:

Depressive mixed state, defined as the presence of 3 or more manic/hypomanic features, was present in around one-third of patients experiencing an MDE. The valid symptom, illness course and family history RBDC criteria we assessed identified 4 times more MDE patients as having mixed features and yielded statistically more robust associations with several illness characteristics of bipolar disorder than did DSM-5 criteria.
© Copyright 2015 Physicians Postgraduate Press, Inc.
Comment in
• “Mixed” depression: drawbacks of DSM-5 (and other) polythetic diagnostic criteria. [J Clin Psychiatry. 2015]
• Mixed depression: a farewell to differential diagnosis? [J Clin Psychiatry. 2015]
PMID:
25830457
[PubMed – indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/25830457

Here is the press release from the European College of Neuropsychopharmacology:

Public Release: 29-Aug-2015 How can we prevent suicide? Major study shows risk factors associated with depression

European College of Neuropsychopharmacology

A major multi-national study of suicides has identified the behaviour patterns which precede many suicide attempts. This may lead to changes in clinical practice in the care of patients affected with depression, as it shows the clinical factors which confer major risk of suicide attempts.

The statistics for suicide are frightening. According to the WHO, more than 800,000 people commit suicide every year, with perhaps 20 times that number attempting suicide. Suicide is one of the leading causes of death in the young (in the UK for example, it is the leading cause of death in men under 35) see notes, below. Effective measures of suicide prevention are urgently needed.

The BRIDGE-II-MIX study is a major international study looking at depression and suicide. The researchers evaluated 2811 patients suffering from depression, of whom 628 had already attempted suicide. Each patient was interviewed by a psychiatrist as if it were a standard evaluation of a mentally-ill patient. The parameters studied included previous suicide attempts, family history, current and previous treatment, patients’ clinical presentation, how they scored on the standard Global Assessment of Functioning scale, and other parameters. The study looked especially at the characteristics and behaviours of those who had attempted suicide, and compared these to depressed patients who had not attempted suicide. They found that certain patterns recur before suicide attempts.

According to author Dr. Dina Popovic (Barcelona):
‘We found that “depressive mixed states” often preceded suicide attempts. A depressive mixed state is where a patient is depressed, but also has symptoms of “excitation”, or mania. We found this significantly more in patients who had previously attempted suicide, than those who had not. In fact 40% of all the depressed patients who attempted suicide had a “mixed episode” rather than just depression. All the patients who suffer from mixed depression are at much higher risk of suicide.

We also found that the standard DSM criteria identified 12% of patients at showing mixed states, whereas our methods showed 40% of at-risk patients. This means that the standard methods are missing a lot of patients at risk of suicide”.

In a second analysis of the figures, they found that if a depressed patient presents any of the following symptoms:

• risky behaviour (e.g. reckless driving, promiscuous behaviour)
• psychomotor agitation (pacing around a room, wringing one’s hands, pulling off clothing and putting it back on and other similar actions)
• impulsivity (acting on a whim, displaying behaviour characterized by little or no forethought, reflection, or consideration of the consequences),
then their risk of attempting suicide is at least 50% higher.
Dr Popovic continued:

“In our opinion, assessing these symptoms in every depressed patient we see is extremely important, and has immense therapeutical implications. Most of these symptoms will not be spontaneously referred by the patient, the clinician needs to inquire directly, and many clinicians may not be aware of the importance of looking at these symptoms before deciding to treat depressed patients.

This is an important message for all clinicians, from the GPs who see depressed patients and may not pay enough attention to these symptoms, which are not always reported spontaneously by the patients, through to secondary and tertiary level clinicians. In highly specialized tertiary centres, clinicians working with bipolar patients are usually more aware of this, but that practice needs to extent to all levels.

The strength of this study is that it’s not a clinical trial, with ideal patients – it’s a big study, from the real world”.
Commenting ECNP President, Professor Guy Goodwin (Oxford) said:

The recognition of increased activation in the context of a severe depression is an important practical challenge. While many psychiatrists recognize that this constitutes an additional risk for suicide, and would welcome better scales for its identification, the question of treatment remains challenging. We need more research to guide us on best practice. http://www.eurekalert.org/pub_releases/2015-08/econ-hcw082615.php

What Should You Do if You Know Someone Who Thinking About Suicide?

If you are thinking of suicide or you know someone who is thinking about suicide, GET HELP, NOW!!!! The Suicide Prevention Resource Center http://www.sprc.org/basics/roles-suicide-prevention has some excellent advice about suicide prevention http://www.sprc.org/basics/roles-suicide-prevention
Resources:

Suicide Prevention
http://www.cdc.gov/violenceprevention/pub/youth_suicide.html

Teen Suicide Overview
http://www.teensuicidestatistics.com/

Teen’s Health’s Suicide
http://kidshealth.org/teen/your_mind/feeling_sad/suicide.html

American Academy of Adolescent Psychiatry http://www.aacap.org/AACAP/Families_and_Youth/Facts_for_Families/Facts_for_Families_Pages/Teen_Suicide_10.aspx

Suicide Prevention Resource Center
http://www.sprc.org/basics/roles-suicide-prevention

Teen Depression
http://helpguide.org/mental/depression_teen.htm

Jared Story.Com
http://www.jaredstory.com/teen_epidemic.html

CNN Report about suicide                                                                                                                                    http://www.cnn.com/2009/LIVING/10/20/lia.latina.suicides/index.html

American Foundation for Suicide Prevention
http://www.afsp.org This group is dedicated to advancing the knowledge of suicide and the ability to prevent it.

SA\VE – Suicide Awareness\Voices of Education
http://www.save.org SA\VE offers information on suicide prevention. Call (800) SUICIDE

About.Com’s Depression In Young Children                                                                                            http://depression.about.com/od/child/Young_Children.htm

Psych Central’s Depression In Young Children                                                                                          http://depression.about.com/od/child/Young_Children.htm

Psychiatric News’ Study Helps Pinpoint Children With Depression
http://psychnews.psychiatryonline.org/newsarticle.aspx?articleid=106034

Family Doctor’s What Is Depression?
http://familydoctor.org/familydoctor/en/diseases-conditions/depression.html

WebMD’s Depression In Children
http://www.webmd.com/depression/guide/depression-children

Healthline’s Is Your Child Depressed?
http://www.healthline.com/hlvideo-5min/how-to-help-your-child-through-depression-517095449

Medicine.Net’s Depression In Children                                                                                                             http://www.onhealth.com/depression_in_children/article.htm

If you or your child needs help for depression or another illness, then go to a reputable medical provider. There is nothing wrong with taking the steps necessary to get well.

Where information leads to Hope. © Dr. Wilda.com

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