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Consultation-liaison psychiatry holds a special place, especially in general hospital setting. We wanted to study the socio-demographic variables, reasons for referral, and clinical correlates of psychiatric referrals from different wards in a tertiary care hospital. MethodsThis was a retrospective chart-review study carried out in the Gauhati Medical College Hospital, Guwahati, for a period of one month (May 2019). Demographic data of the participants was collected. Their primary medical / surgical diagnoses were noted along with the department where they were admitted. The reason for psychiatric consultation as well as the psychiatric diagnoses were analysed by descriptive statistics with the use of GraphPad InStat. ResultsMost of the sample was men (men: women: 106:72), mostly between 11 to 30 years (44.38%) and Hindus (Hindu: Muslim: 140:38). Majority of the consultations was from the Department of Medicine (47.19%), followed by Orthopaedics (15.17%) and Surgery (14.61%). Among the surgical/medical illnesses, most of them had fractures (ten), closely followed by neurological conditions like cerebrovascular accident (five) and head injury (four). Deliberate self-harm was the most common reason for psychiatric liaison (56), that constituted a high number with poisoning (45) as well as hanging (six) and cut neck (five). Psychiatric consultation was asked for use of alcohol in a substantial number of patients (45). ConclusionsAddressing the psychiatric comorbidity while continuing treatment for the surgical/medical illnesses gives a holistic approach towards our patients that can influence not only the course but also the quality of life of them.
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Background & objectives: The major limiting factor in the prevention of suicide is the limited knowledge on molecular insights in individuals at risk. Identification of peripheral protein markers which can classify individuals at high-risk of suicide might aid in early diagnosis and effective medical intervention. The aim of the present study was, therefore, to analyze the differential regulation of plasma proteins in individuals with deliberate self-harm compared to controls. Methods: Using two-dimensional gel electrophoresis coupled with matrix-assisted laser desorption-ionization mass spectrometry, differentially expressed plasma proteins were identified in study participants with deliberate self-harm compared to age- and gender-matched controls. The finding was validated using mass spectrometry-based isotope-labelled relative quantification and Western blot analysis in a new set of individuals with deliberate self-harm and controls. Results: The plasma proteomic analysis showed that apolipoprotein A-IV (Apo A-IV ) was downregulated by 2.63-fold (confidence interval: 1.52-4.54) in individuals with deliberate self-harm (n=10) compared to matched controls, which was consistent in mass spectrometry-based relative quantification and Western blot analysis performed in an independent set of individuals with deliberate self-harm (n=18). In addition, plasma levels of total cholesterol, esterified cholesterol and high-density lipoprotein (HDL) were observed to be significantly lower individuals with deliberate self-harm compared to controls. Interpretation & conclusions: Apo A-IV, which plays a crucial role in the esterification of free cholesterol, was found to be downregulated with concomitantly decreased levels of HDL, esterified cholesterol and total cholesterol in individuals with deliberate self-harm compared to matched controls. The present findings might provide a link between the differential regulation of plasma proteins and the previously reported results on altered cholesterol levels in individuals with deliberate self-harm.
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Abstract This study aimed to describe the social representations about the functions of deliberate self-harm and to compare these representations from adolescents with and without a history of deliberate self-harm and adults without a history of these behaviours. We conducted a qualitative study involving the thematic analysis of forty-one semi-structured interviews. The participants consisted of 11 adolescents with a history of deliberate self-harm, 15 adolescents without a history of deliberate self-harm and 15 adults also without a history of behaviours. The interviewees mentioned eight functions of deliberate self-harm consistent with the existing literature, namely interpersonal functions (Communication Attempt, Interpersonal Boundaries, Interpersonal Influence, and Peer Bonding) and intrapersonal functions (Affect Regulation, Anti-Dissociation, Escape Mechanism, and Self-Punishment). Also, two new functions not described in the literature were mentioned (Introspective Mechanism and Replacement of Suffering). Regarding the differences between the three groups, several disparities emerged. Overall, results revealed that the group of adults referenced more interpersonal functions, while both groups of adolescents emphasized intrapersonal functions. This study provides insight regarding the social representations about the functions of deliberate self-harm, also focusing on the differences between adolescents with and without a history of these behaviours and adults without a history of deliberate self-harm.
Resumo Este estudo teve como objetivo descrever as representações sociais sobre as funções dos comportamentos auto-lesivos e comparar as representações de adolescentes com e sem uma história de comportamentos auto-lesivos e de adultos sem uma história destes comportamentos. Foi realizado um estudo qualitativo que envolveu a análise de conteúdo de 41 entrevistas semi-directivas. Os participantes consistiram em 11 adolescentes com uma história de comportamentos auto-lesivos, e 15 adolescentes e 15 adultos sem uma história destes comportamentos. Os participantes referiram oito funções dos comportamentos auto-lesivos consistentes com a literatura existente, nomeadamente funções interpessoais (Influência Interpessoal, Ligação com os Pares, Limites Interpessoais, e Tentativa de Comunicação) e funções intrapessoais (Auto-Punição, Auto-Regulação do Afecto, Anti-Dissociação, e Mecanismo de Fuga). Duas novas funções não descritas na literatura foram também mencionadas (Mecanismo Introspectivo e Substituição do Sofrimento). No que se refere às diferenças entre os três grupos, no geral, o grupo de adultos referenciou mais funções interpessoais, enquanto os grupos de adolescentes destacaram as funções intrapessoais. Este estudo contribui para a compreensão das representações sociais sobre as funções dos comportamentos auto-lesivos, focando igualmente as diferenças entre adolescentes com e sem uma história destes comportamentos e adultos sem uma história de comportamentos auto-lesivos.
Resumen Este estudio tuvo como objetivo describir las representaciones sociales sobre las funciones de comportamientos autolesivos y comparar las representaciones de adolescentes con y sin antecedentes de comportamientos autolesivos y adultos sin antecedentes de estos comportamientos. Realizamos un estudio cualitativo que incluía el análisis de contenido de 41 entrevistas semiestructuradas. Los participantes fueron 11 adolescentes con antecedentes de comportamientos autolesivos, y 15 adolescentes y 15 adultos sin antecedentes de estos comportamientos. Los entrevistados mencionaron ocho funciones de autolesión deliberada coherentes con la literatura existente, a saber, funciones interpersonales (Influencia Interpersonal, Intento de Comunicación, Límites Interpersonales, y Vinculación entre Pares) y funciones intrapersonales (Anti-Disociación, Autocastigo, Mecanismo de Escape, y Regulación del Afecto). Además, se mencionaron dos funciones nuevas no descritas en la literatura (Mecanismo Introspectivo y Reemplazo de Sufrimiento). Respecto a las diferencias entre los tres grupos, en general, los resultados revelaron que el grupo de adultos hizo referencia a más funciones interpersonales, mientras que ambos grupos de adolescentes destacaron las funciones intrapersonales. Este estudio proporciona información sobre las representaciones sociales acerca de las funciones de los comportamientos autolesivos, y también se enfoca en las diferencias entre adolescentes con y sin antecedentes de estos comportamientos y adultos sin antecedentes de comportamientos autolesivos.
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Background: The relationship of alcohol and suicide is well documented. The interactions of alcohol use and suicide are complex. Neurobiological, genetic, psychological, social, cultural, and environmental factors are postulated to influence the outcome Aim was to find the frequency of alcohol use in suicide attempters and evaluate the association of alcohol use and its correlates in subjects who use alcohol to facilitate the attempt.Methods: It is a cross sectional observational study set in rural background in south India. Consecutive referrals of suicide attempters (n=175) were selected for the study. Details regarding the socio-demographic profile, suicide related details like lethality, intent, suicidal ideation, previous attempts, and alcohol related details like frequency, quantity and age at onset of alcohol consumption were recorded. Statistical significance of various socio demographic and clinical variables in correlation with use to facilitate attempt were analyzed. Logistic regression was used to determine the predictors in this at risk group of suicide attempters.Results: Over 43.43% of suicide attempters consumed alcohol. Intentional alcohol use prior to attempt to facilitate the attempt group constitutes about 18.29 %. High suicide intent and previous suicide attempt emerged as risk factors when alcohol was used to facilitate the attempt.Conclusions: Determinants, which increase the risk of suicide with alcohol use in rural south India, were identified.
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Abstract@#Introduction: This study is part the Investigator Initiated Research (IIR) project under the mental health suicide and para suicide cluster. Self-harm is an important predictor of suicide and leaves a significant long-lasting psychological effect. Despite the increasing prevalence of rate of self-harm, very little research had been done in Asian countries. The objective of this study is to determine the prevalence of self-harm in selected hospitals, demographic profiles and factors associated with development of self-harm. Methods: This is a multi-centred cross sectional study. Six months of data collection was performed between the 1st November 2013 and 30th April 2014. All cases that were identified to have carried out Self-Harm were interviewed using The World Health Organization (WHO) SUPRE-MISS Questionnaire Annexe 1 which had been adapted to the Malaysian culture by the research committee members. Results: A total of 99 samples were obtained for this study. They mostly came from low socioeconomic background. Majority of the patients were females, and this was consistent with studies worldwide. Poisoning by pesticides was the most frequent method of choice and about 30% of the patients had previous attempts. Conclusion: Sociodemographic factors play a significant role in self-harm. It is important to know the sociodemographic profile to identify which group of people are at risk and intervention can be focused.
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Objectives: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in children from low- and middle-income countries. We investigated the prevalence of DSH and its clinical and maternal psychopathological associations in Brazilian children (n=2,508, ages 6-14y) in a community-based study. Methods: Participants of the High Risk Cohort Study for the Development of Childhood Psychiatric Disorders (HRC) and their mothers were assessed in structured interviews. Current (last month) and lifetime DSH were estimated, including analysis stratified by age groups. Logistic regressions were performed to investigate the role of the children's clinical diagnoses and maternal psychopathology on DSH prevalence estimates, adjusting for potential confounding factors. Results: The prevalence of current DSH was 0.8% (children 0.6%, adolescents 1%) and lifetime DSH was 1.6% (1.8% and 1.5%, respectively). Current and lifetime DSH were more frequent in children with depression, attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD), even in multiple models accounting for demographic variables and co-occurring psychiatric disorders. Maternal anxiety disorder was strongly associated with current and lifetime DSH in offspring; whereas current DSH, specifically in young children, was associated with maternal mood disorder. Conclusion: Diagnoses of depression, ADHD and ODD were consistently associated with DSH, as was having a mother with anxiety disorder.
Subject(s)
Humans , Male , Female , Child , Adolescent , Suicide, Attempted/statistics & numerical data , Self-Injurious Behavior/epidemiology , Anxiety Disorders/psychology , Psychopathology , Attention Deficit Disorder with Hyperactivity/psychology , Socioeconomic Factors , Suicide, Attempted/psychology , Brazil/epidemiology , Prevalence , Risk Factors , Cohort Studies , Self-Injurious Behavior/psychology , Depression/psychology , Maternal BehaviorABSTRACT
BACKGROUND: Suicide in young people is one of most common cause of death; and deliberate self-harm (DSH) is important indicator of suicide. It is currently unclear how old the rate begins to increase or when it reaches to the same level with adults. The purpose of this study was to find beginning age of DSH and compare their characteristics with adults. METHODS: This study retrospectively reviewed 5 years of nationwide prospective registry named Emergency Department-based Injury In-depth Surveillance (EDIIS) registry composed of all injured patients who were admitted to twenty tertiary university hospital emergency departments. Injured patients aged 29 years or younger from January 1, 2011 to December 31, 2015 were included. Incidence rate of DSH in all age was described. Patients were stratified by age: early teenage (11–15 years), late teenage (16–19 years), and early adulthood (20–29 years). Data of early teenage group were compared to those of other groups for examining their characteristics. RESULTS: Among 588,549 injury patients, 8,400 patients reported DSH. The rate began to rise at age 11 and reach at age 16 which was equivalent to that of age 20 to 29. Early teenage had significantly higher excess mortality ratio based injury severity score (EMR-ISS) and had almost same level without significant difference in operation incidence or mortality compared to late teenage and early adulthood. CONCLUSION: DSH rate began to rise at age 11, reaching adulthood level at age 16 in Korea.
Subject(s)
Adult , Humans , Cause of Death , Emergencies , Emergency Service, Hospital , Incidence , Injury Severity Score , Korea , Mortality , Prospective Studies , Retrospective Studies , Self-Injurious Behavior , SuicideABSTRACT
Deliberate self-harm refers to an intentional act of causing physical injury to oneself without wanting to die. It is frequently encountered in adolescents who have mental health problems. Primary care physicians play an important role in the early detection and timely intervention of deliberate self-harm in adolescents. This article aims to outline the associated risk factors and possible aetiologies of deliberate self-harm in adolescents, as well as provide suggestions for clinical assessment and appropriate management within the primary care setting.
Subject(s)
Adolescent , Female , Humans , Adolescent Behavior , Adolescent Medicine , Methods , Empathy , Primary Health Care , Methods , Referral and Consultation , Risk Factors , Self-Injurious Behavior , Diagnosis , Psychology , Surveys and QuestionnairesABSTRACT
Background Non-Suicidal Self-Injury (NSSI) is defined as the intentional direct injury of the own bodily tissue without suicidal intent. In areas with a Caucasian majority population, such as the USA, Canada and Europe, it is a rapidly increasing phenomenon, especially among young people. However, from a European point of view, little scientific information is found on NSSI in Latin America. Method A study of English, Spanish and Portuguese literature on NSSI in Latin America was conducted using electronic search engines. During a ten-month period of field work in Belo Horizonte, Brasil, a systematic search was conducted of the international press, the popular local press, television broadcasts, Internet sites and blogs. Semi-structured elite interviews were conducted of academic professionals and practitioners. Spontaneous conversations on NSSI took place with local inhabitants. Results Three reasons for the authors' prior lack of success in finding publications on NSSI in Latin America could be distinguished: the gap between academic professionals, practitioners and inhabitant population, the language of the publications, and the existing confusion in terminology and research traditions regarding NSSI. Conclusion NSSI has a high prevalence in Latin America, which can be compared to that of the northern hemisphere. Although there are some differences in the ways of engaging in NSSI and in its functions, there are also important similarities. Scientific information on NSSI in Latin America remains difficult to find for researchers in other parts of the world. Therefore we advocate a consensus in terminology and suggest that all publications would provide English key words and would be included in international scientific databases to ensure a world-wide dissemination. An alternative is the construction of one centralized global Latin American database for Spanish and Portuguese publications.
Antecedentes La autolesión sin intención de suicidarse (NSSI) se define como un daño directo e intencional a los propios tejidos del cuerpo sin la intención de suicidarse. En zonas con población mayoritariamente caucásica, como Estados Unidos, Canadá y Europa, es un fenómeno en rápido aumento, especialmente entre los jóvenes. Sin embargo, desde el punto de vista europeo, se encuentra poca información científica acerca del NSSI en América Latina. Método Se desarrolló un estudio de la bibliografía en inglés, español y portugués acerca de NSSI en América Latina por medio de páginas electrónicas de búsqueda. Durante el estudio de campo en Belo Horizonte, Brasil, durante diez meses se llevó a cabo una búsqueda sistemática de información en los medios de comunicación. Entrevistas de elite semiestructuradas se realizaron a profesionales académicos y clínicos. Resultados Las autoras señalan que las causas por las que se ha encontrado poca información respecto a la NSSI en América Latina son: la brecha entre académicos profesionales, clínicos y habitantes en general; el idioma de las publicaciones y la confusión en la terminología y tradiciones de investigación concernientes a la NSSI. Conclusión La incidencia de NSSI en América Latina es tan alta que se puede comparar con la del hemisferio norte. Aunque hay algunas diferencias en las formas de NSSI y las funciones que cumple en América Latina, también hay importantes similitudes. La información científica sobre NSSI en América Latina sigue siendo difícil de encontrar para los investigadores en otras partes del mundo. Por lo tanto, es necesario un consenso sobre la terminología y se sugiere que todas las publicaciones utilicen palabras clave en inglés y que se incluyan artículos en las bases de datos científicas internacionales para asegurar una difusión mundial de la información. Una alternativa sería construir una base de datos global centralizada para todas las publicaciones en lengua española y portuguesa.
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Introduction Emotional Dysregulation (ED) is the decreased capacity to experiment and differentiate an ample range of emotions, as well as to monitor, evaluate and modify intense emotional states. ED is associated with the most frequent emotional problems such as depression, anxiety, and with maladaptive behaviors thought to serve an emotion and impulsivity regulating function, including deliberate self-harm. The Difficulties in Emotion Regulation Scale (DERS) was developed for adults, has good internal consistency (Cronbach's α=0.93), and good test-retest reliability (r=0.88). Objectives To translate and determine the psychometric properties of the Spanish version of the DERS (DERS-E) in a nonclinical Mexican adolescent's sample. Method 455 students of a public junior high school in Mexico City participated; the mean age was 13.1 ±.95 years old. The scale was administrated in groups of 40 students, who concurrently answered the Spanish version of the following measures: i) Self-injury Schedule; ii) Beck Depression Inventory; and iii) Plutchik's Impulsivity Scale. Results The first confirmatory factorial analysis (CFA) showed that the data did not replicate the original six-factor structure with 36 items (χ2=22339.4, df= 6, p<0.05). An exploratory factorial analysis showed that the data adjusted with a 24 items and 4-factor model (corroborated with a second CFA: χ2=259.729, df=230, p>0.05); the subscales Cronbach' a were from .85 to .68. The validity through contrasted groups and the correlation with concurrent scales showed significant results (Pearson's r of .51 to .76, p<0.05). Conclusions The DERS-E with adolescents did not replicate the factorial structure of the original scale, but showed a similar and multidimensional structure of four factors and showed good psychometric properties with respect to internal consistency and concurrent validity.
La desregulación emocional (DE) es la capacidad disminuida para experimentar y diferenciar un amplio rango de emociones, así como para monitorear, evaluar y modificar estados emocionales intensos. La DE se ha asociado a los más frecuentes padecimientos, como depresión, ansiedad y conductas desadaptativas, incluidas la impulsividad y las autolesiones no suicidas. La escala Difficulties in Emotion Regulation Scale (DERS por sus siglas en inglés) fue desarrollada para evaluar estas dificultades en adultos, posee una buena consistencia interna (α de Cronbach=0.93) y buena confiabilidad test-retest (r=0.88). Objetivos Traducir y determinar las propiedades psicométricas de la DERS en español (DERS-E) en una muestra no clínica de adolescentes mexicanos. Método Participaron 455 estudiantes de una escuela secundaria pública de la Ciudad de México, de los cuales 226 eran hombres (49.7%) y 229 mujeres (50.3%); la edad promedio fue de 13.1±.95 años. La escala fue administrada grupalmente (grupos de 40 estudiantes), quienes contestaron concurrentemente los inventarios de: i) Autolesiones, ii) Depresión de Beck, iii) Impulsividad de Plutchik. Resultados El primer análisis factorial confirmatorio (AFC) mostró que los datos no replicaban la estructura original de seis factores con 36 reactivos (χ²=22339.4, gl=6, p<0.05). Un análisis factorial exploratorio mostró que los datos se ajustaban a un modelo de 24 reactivos y cuatro factores (corroborados con un segundo AFC: χ²=259.729, gl=230, p>0.05). Las alphas de Cronbach de cada subescala tuvieron un rango entre .85 y .68. La validez por medio de grupos contrastados y la correlación con las medidas concurrentes mostraron resultados significativos (r de Pearson de .51 a .76, p<0.05). Discusión y conclusiones La DERS-E con adolescentes no replicó la estructura factorial de la escala original, pero sí presentó una estructura similar, multidimensional, con cuatro factores y mostró buenas características psicométricas, tanto de consistencia interna como de validez concurrente.
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Objective: To study the nature of deliberate self-harm (DSH) in children and to identify the associated factors. Setting: Child Guidance Clinic attached to the Department of Pediatrics of a teaching hospital in South India. Subjects: Children with history of deliberate self harm who were referred to the CGC for psychological evaluation during a 10 year period. Methods: Children and parents were interviewed together and separately and details regarding age, sex, family and school environment, stresses and nature of self harm were documented. Psychiatric diagnosis was made based on DSM IV diagnostic criteria. Results: Among the 30 children included in the study, 21 were boys and 9 were girls. Majority of children were between the ages of 11 and 13 years, the youngest being 6 years old. 76% of children had history of acute stressful life events and 62% of them had chronic ongoing stress. 62 % of children had stress in the family and 41% had stress at school. Stress in the family included death of a parent, conflicts with parents or siblings, mental illness in the family, parental alcoholism and parental disharmony. Stress at school included conflicts with classmates, punishment or negative comments by teachers and learning problems. Psychiatric disorders were present in 52% of children, the commonest being depressive disorder. The commonest mode of DSH was self poisoning, and rat poison (zinc phosphide) was the commonest substance used. Conclusions: Deliberate self harm occurs in young children and the risk factors are comparable to those in adolescents.