Experiencias latinoamericanas en la prevención de la suicidalidad en jóvenes y adolescentes: una revisión teórica / Latin American experiences in the prevention of suicidality in young people and adolescents: a theoretical review

Resumen Introducción: A nivel latinoamericano el suicidio en jóvenes y adolescente representa una problemática grave, por lo que es necesario trabajar en su prevención. En ese sentido, este trabajo presenta una revisión teórica narrativa sobre la temática. Objetivo: Conocer las principales experiencias de prevención de la suicidalidad en jóvenes y adolescentes de Latinoamérica en los últimos 15 años. Método: Se revisaron y analizaron 44 estudios empíricos, realizando búsquedas bibliográficas en revistas científicas indexadas en Scopus, Scielo, WoS, REDALYC y ERIH PLUS y motores de búsqueda como Google Académico y EBSCO. Resultados: Los hallazgos obtenidos en los 44 estudios se organizaron en tres categorías: 1) diagnósticos sobre suicidalidad realizados en población juvenil y adolescente; 2) intervenciones psicoterapéuticas destinadas a tratamiento en suicidalidad; y 3) intervenciones en base a programas, estrategias y técnicas enfocadas en la prevención del suicidio juvenil y adolescente. Discusión: Los principales diagnósticos asociados a la suicidalidad están vinculados a disfuncionalidades emocionales, donde las mujeres son las principales afectadas, la familia y el entorno surgen como principales factores protectores o de riesgo dependiendo de su funcionalidad y cohesión. Además, las intervenciones más valoradas están asociadas a los modelos clásicos de psicoterapia y las estrategias psicoeducativas aparecen como los principales focos de los programas preventivos. Conclusión: Por la multifactoriedad del fenómeno, se debería realizar un cambio paradigmal en el enfrentamiento de la suicidalidad.

Abstract Introduction: At the Latin American level, suicide in young people and adolescents represents a serious problem, so it is necessary to work on its prevention. In this sense, this work presents a narrative theoretical review on the subject. Objective: To know the main experiences of suicide prevention in young people and adolescents in Latin America in the last 15 years. Method: 44 empirical studies were reviewed and analyzed, performing bibliographic searches in scientific journals indexed in Scopus, Scielo, WoS, REDALYC and ERIH PLUS and search engines such as Google Scholar and EBSCO. Results: The findings obtained in the 44 studies were organized into three categories: 1) diagnoses of suicidality made in the youth and adolescent population; 2) psychotherapeutic interventions aimed at treating suicidality; and 3) interventions based on programs, strategies and techniques focused on the prevention of youth and adolescent suicide. Discussion: The main diagnoses associated with suicidality are linked to emotional dysfunctionalities, where women are the main affected, the family and the environment appear as the main protective or risk factors depending on their functionality and cohesion. In addition, the most valued interventions are associated with the classic models of psychotherapy and psychoeducational strategies appear as the main focuses of preventive programs. Conclusion: Due to the multifactorial nature of the phenomenon, a paradigm shift should be made in the confrontation of suicidality.

The association between neurocognitive functioning and clinical features of borderline personality disorder

Objective: To investigate the relationship between neurocognitive profiles and clinical manifestations of borderline personality disorder (BPD). Methods: Forty-five patients diagnosed with BPD and 35 healthy volunteers were included in the study. The BPD group was evaluated with the Borderline Personality Inventory for dissociative, impulsivity and suicidal dimensions. The Verbal Memory Processes Test and the Cambridge Neurophysiological Assessment Battery were administered to both the BPD and healthy control groups. Results: BPD patients differed from controls in sustained attention, facial emotion recognition, and deteriorated verbal memory function. A model consisting of the Dissociative Experiences Scale - Taxon (DES-T), motor impulsivity and Scale for Suicidal Behavior scores explained 52% of the variance in Borderline Personality Inventory scores. It was detected that motor impulsivity, decision-making and recognizing sadness may significantly predict DES-T scores, and response inhibition and facial emotion recognition scores may significantly predict impulsivity. Conclusion: Our findings demonstrate that the disassociation, impulsivity, and suicidality dimensions are sufficient to represent the clinical manifestations of BPD, that they are related to neurocognitive differences, and that they interact with clinical features.

Somatic Symptoms in Depression and Their Correlation with Suicidality - A Cross-Sectional Study

Diagnostic criteria for MDD is based on psychological and vegetative symptoms. However, other somatic and pain symptoms are frequent in these patients. We wanted to study the prevalence of somatic symptoms in 1st episode of depression and assess its correlation with suicidality. METHODSPatients aged 18 – 65 yrs. attending psychiatry outpatient department and admitted in wards, meeting the inclusion criteria were included in the study. A total of 177 patients was included. Patients were assessed with sociodemographic proforma. M.I.N.I. was used to diagnose major depressive disorder and to rule out the presence of other comorbid psychiatric illness. PHQ - 15 was used to detect the presence of somatic symptoms. Suicidality was assessed with Beck’s Hopelessness Scale. Statistical analysis was done using SPSS. Descriptive statistics, Kruskal Wallis Test, Fisher's Exact Test, Chi - Squared Test, and Spearman correlation. RESULTSThere is 100 % prevalence of somatic symptoms in depression out of which Somatic Symptom Severity was minimal in 11.9 %, low in 54.2 %, medium in 32.2 %, and severe in 1.7 %. There was a strong positive correlation between PHQ - 15 Score and BHS Score, and this correlation was statistically significant (rho = 0.61, p = <0.001). CONCLUSIONSMany patients presenting predominantly with somatic complaints are misdiagnosed when they are evaluated in the primary care or medical clinics. In view of the high prevalence of somatic symptoms in depression, it is important to include these symptoms in the diagnostic criteria of depression, so as to increase the sensitivity and specificity of the diagnosis.

Suicidality and its Relationship to Psychological and Sociodemographic Factors among Individuals with Obsessive Compulsive Disorders in Jordan

@#Introduction: Obsessive Compulsive Disorder (OCD) is a chronic mental disorder causing severe social and occupational dysfunction leading to high risk of suicidal ideas and behaviours. The purpose of the study was to investigate the prevalence of suicidality and its relationship to psychological (depressive and anxiety symptoms) and sociodemographic factors among individuals with Obsessive Compulsive Disorder in Jordan. Methods: this is a descriptive correlational study. Data was collected using self-reported questionnaire from 90 individuals diagnosed with OCD from outpatient departments receiving care at public and private health institutions in Jordan. Data were collected regarding suicidality, anxiety, and depressive symptoms. Results: Suicidal risk was detected in 34.4% % (N= 31) of the individuals with OCD, 90% had mild to severe depressive symptoms, 70% had mild to severe anxiety symptoms. Significant positive correlation found between suicidality, anxiety and depressive symptoms (p<.05). Individuals with OCD and suicidality had significantly lower educational level, contamination, trichotillomania, and sexual obsessions. Depressive symptoms and type of OCD were significant predictors for suicidality among individuals known to have OCD. Conclusion: Individuals with OCD have high risk for suicidality and should be carefully monitored. Health care professionals in the outpatients’ clinics are recommended to actively investigate suicidality risk as part of OCD comprehensive assessment per visit.

Validación de la escala de suicidalidad OKASHA para adolescencia temprana en Chile / Validation of the "OKASHA" suicidal scale for the Chilean early adolescent population

El suicidio adolescente es un problema a nivel mundial que ha impulsado diversos esfuerzos de prevención, siendo relevante poder detectar a tiempo el riesgo a edades tempranas. A pesar de que existen diversos instrumentos para este propósito, sobre todo en adultos, en Chile no existe uno validado en población menor a 15 años de edad, donde se ha visto un aumento progresivo del riesgo durante los últimos años. Este estudio es una validación de la escala de suicidalidad OKASHA en población de 10 a 14 años. El instrumento presentó buenas propiedades psicométricas, tanto en la predicción de intentos reales de suicidio como en su correlación con otros predictores de riesgo descritos en la literatura. Debido a su buen poder predictivo, fácil administración y poco tiempo requerido, el instrumento resulta idóneo para ser utilizado en contextos como la atención primaria de salud o en la comunidad, donde la detección oportuna del riesgo y la adecuada derivación son de vital importancia, especialmente en una población donde dicho riesgo ha sido muchas veces invisibilizado y por ende no abordado hasta cometerse el acto propiamente tal.

Adolescent suicide is a worldwide problem that has triggered diverse prevention efforts. Detecting the risk as quickly as possible at an early age is highly relevant. Although there are various instruments that exist for this very purpose, mostly for adults, there is no validated instrument for those under 15 years of age. Incidentally, in the past couple of years this same age group has had an increased risk in this area. This study is a validation of the suicidal scale "OKASHA" for the population between 10 and 14 years old. The instrument presented good psychometric properties in both the prediction of real suicidal attempts and in its correlation with other risk predictors taken from literature. Due to its good predictive ability, easy administration, and the little time that is required, the instrument is ideal for being used in contexts such as in primary healthcare. It can also be used in the community, where detecting risk and referral in a timely fashion are of vital importance, especially in a population where such risk has been made invisible and for this reason, has not been detected until the final act has been accomplished.

Quality of Life and Suicidality in Obsessive Compulsive Disorder as Evaluated by WHO BREF

Obsessive Compulsive Disorder (OCD) is a chronic, distressing, anxiety disorder associated with significant functional impairment. Patient with OCD often suffer from one or more co-morbid disorders. Major depression has been the most common co-morbid syndrome. OCD in association with comorbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness and past history of suicide attempts have been associated with worsening levels of suicidality. As per data Thirty-six percent of the patients of OCD report lifetime suicidal thoughts and 11% have a history of attempted suicide. There is a reasonable probability that the patient of OCD has suicidal thoughts, plans or a suicidal attempt in the past. Methods: This study was conducted on 50 patients diagnosed with OCD as per ICD 10 criteria, both outpatient & indoor, from department of psychiatry, Teerthanker Mahaveer Medical College & Hospital, Moradabad, Uttar Pradesh, India. A socio-demographic proforma, Hamilton Depression rating scale, Yale Brown Obsessive Compulsive Scale and WHOQOL-BREF-Hindi version were administered. Results: The majority of the patients suffering from OCD were below 40 years of age. The prevalence of OCD was maximum in housewives and they mostly belonged to 25-34 years age group. All the patients who had current suicidal ideation showed low scores on all the domains of Quality of life. Also, the patients who had attempted suicide in the past showed same low scores on all domains of Quality of life and both results were statistically significant. Conclusion: Hence the assessment of Quality of life in OCD patient is a strong predictor of suicidality in these patients

Self-esteem as a Moderator of the Effects of Happiness, Depression, and Hostility on Suicidality Among Early Adolescents in Korea / 예방의학회지

OBJECTIVES: The purpose of this study was to investigate the role of self-esteem as a moderator of the factors influencing suicidality among middle-schoolers. METHODS: Moderated multiple regression analysis was applied to assess the influence of happiness, depression, and hostility on suicidality and to determine the degree to which self-esteem served as a moderator of those relationships. Data were collected from 268 students at a middle school in Busan, Korea, using a self-administered structured questionnaire. RESULTS: Happiness, depression, and hostility had significant direct effects on suicidality. Self-esteem showed no direct effect, but had a significant moderating effect on the relationship between hostility and suicidal behavior. CONCLUSIONS: These results suggest that various interventions, such as counseling programs, should be designed to alleviate hostility and depression and to enhance happiness and self-esteem among early adolescents.

The Association between Depressive Mood and Cholesterol Levels in Korean Adolescents

OBJECTIVE: Previous studies have shown that there is a correlation between lipid levels and depressive mood, and that lipids could be useful biomarkers for depression. We conducted this study to clarify the association between lipid levels and depressive mood in adolescents, especially in community samples. METHODS: We analyzed data from the Korea National Health and Nutrition Examination Survey (KNHANES) that was conducted from 2013 to 2016. A total of 2,454 adolescents aged 12–18 years (1,273 boys, 1,181 girls) participated in the Survey. We conducted a cross-sectional study using multiple logistic regression, adjusting for age, household income, daily energy intake, daily fat intake, and daily cholesterol intake, to assess the association between depressive mood and serum lipid levels. RESULTS: Depressive mood was found in 8.7% of those included in the study. Borderline (110–129 mg/dL) and high (≥130 mg/dL) levels of low-density lipoprotein cholesterol (LDL-C) were significantly associated with depressive mood [Borderline level: odds ratio (OR)=5.55, 95% confidence interval (CI) 1.56–19.81, p=0.01; High level: OR=5.73, 95% CI 1.06–31.08, p=0.04]. However, this association was not found in girls. CONCLUSION: Our findings indicate that depressive mood in boys is associated with higher LDL-C levels. Further investigation regarding this relationship and the underlying biological mechanisms is needed.

Suicidal Ideation Predicts Functioning and Quality of Life Over One Year after Acute Coronary Syndrome

OBJECTIVE: This study investigated the associations of suicidal ideation (SI) evaluated within 2 weeks after an acute coronary syndrome (ACS) episode with functioning, disability, and quality of life (QOL) at a 1-year follow-up assessment. METHODS: This study recruited 1152 consecutive patients within 2 weeks of a confirmed ACS episode; 828 of these patients who were followed up 1 year later comprised the study sample. SI was determined at baseline using the “suicidal thoughts” item of the MontgomeryÅsberg Depression Rating Scale. At both examinations, social and occupational functioning were measured by the Social and Occupational Functioning Assessment Scale (SOFAS), disability was estimated by World Health Organization Disability Assessment Schedule-12 (WHODAS-12), and QOL was assessed using the World Health Organization Quality of Life-Abbreviated form (WHOQOL-BREF). Baseline covariates included sociodemographic data, depression characteristics, cardiovascular risk factors, and current cardiac status. RESULTS: SI at baseline was independently associated with less improved or decreased scores on the SOFAS, WHODAS-12, and WHOQOL-BREF over 1 year after adjusting for relevant covariates. CONCLUSION: SI within 2 weeks of an ACS episode predicted poorer functioning and QOL at a 1-year follow-up assessment. Thus, the simple evaluation of SI in patients with recently developed ACS could be helpful in screening for functioning and QOL during the chronic phase of this disease.

Frecuencia de tendencias suicidas (suicidalidad) y factores asociados en mujeres durante el primer año posparto / Frequency of suicidality and associated factors in women during the first postpartum year

Objetivos: Estimar la frecuencia de tendencias suicidas (suicidalidad) y explorar su relación con diversas variables en mujeres atendidas en un hospital público peruano durante el primer año del periodo posparto. Material y Métodos: Se realizó un análisis secundario de datos de un trabajo de investigación realizado en el Hospital Cayetano Heredia (Lima, Perú) que incluía 321 mujeres durante el primer año posparto, con registros de variables sociodemográficas, ginecológicas, clínico-psiquiátricas y de suicidalidad definida como la presencia del síntoma 9 del criterio A de Episodio Depresivo Mayor evaluado mediante la Entrevista Clínica Estructurada para el DSM-IV (Structured Clinical Interview for DSM-IV Disorders, SCID). Resultados: Se encontró una frecuencia de 15,58 % (IC 95%: 11,79-20,01%) de suicidalidad en mujeres durante el primer año posparto. El análisis bivariado mostró relación significativa entre la presencia de suicidalidad y depresión mayor (OR = 14,52; p <0,001), trastorno obsesivo-compulsivo (OR = 3,96; p= 0,001), trastorno disfórico premenstrual (OR=3,25; p=0,002) y episodio maniaco o hipomaniaco previo (OR=2,12; p=0,025). Asimismo, el análisis multivariado encontró relación significativa con status de separada/divorciada (OR = 6,96; p = 0,027), abortos previos (OR = 2,92; p = 0,006), sueño menor de 6 horas (OR=5,34; p=0,003) y lactancia materna (OR=0,15; p=0,004). Conclusiones: Las tendencias suicidas en mujeres con menos de un año posparto fueron detectadas en 15,58% de la muestra y se relacionaron con una serie de variables de diversa índole, las cuales deben ser tenidas en cuenta para eventuales intervenciones preventivas y/o de atención clínica focalizada.

Objectives: To estimate the frequency of suicidality and to explore its relation with different variables in women seen in a Peruvian public hospital during their first year of their postpartum period. Material and Methods: A secondary data analysis of a research study carried out in the Hospital Cayetano Heredia (Lima, Peru) was conducted on 321 women seen during their first postpartum year, with focus on sociodemographic, psychiatric, gynecological and suicidality variables. Suicidality was defined as the presence of symptom 9 of criterion A of a Major Depressive Episode assessed through the Structured Clinical Interview for DSM-IV Disorders (SCID). Results: Suicidality was found in 15.58% (95% CI: 11.79-20.01%) of the sample. Bivariate analyses showed a significant relationship between suicidality and major depression (OR = 14.52, p <0.001), obsessive-compulsive disorder (OR = 3.96, p = 0.001), premenstrual dysphoric disorder (OR=3.25, p = 0.002) and previous manic or hypomanic episode (OR = 2.12, p = 0.025). In addition, multivariate analysis found a significant relationship with being separated / divorced (OR = 6.96, p = 0.027), previous abortions (OR = 2.92, p = 0.006), sleep of less than 6 hours (5.34, p = 0.003) and breastfeeding (OR = 0.15, p = 0.004). Conclusions: The suicidality in women with less than one year postpartum had a frequency of 15.58% and was related to a series of variables to be taken into account for eventual preventive and/or focused clinical interventions.

Gender Differences in Relations of Smoking Status, Depression, and Suicidality in Korea: Findings from the Korea National Health and Nutrition Examination Survey 2008-2012

OBJECTIVE: As mental health problems may play an important role in initiating and maintaining cigarette smoking in females and there are an increasing number of female smokers, we evaluated the relationship between smoking status and mental health problems including depression and suicide ideation in women in Korea. METHODS: We analyzed the 5-year cumulative data (19 years of age or older, n=32,184) from the Korean National Health and Nutrition Examination Survey (KNHANES) conducted from 2008 to 2012. Logistic regression analyses were used to evaluate associations between cigarette smoking status and mental health parameters while controlling for potentially confounding variables. RESULTS: Among current smokers, females showed higher lifetime prevalence in having a depressive episode, a doctor-diagnosed major depression, a current diagnosis of depression, or receiving treatment for depression in comparison with males. In addition, females were more likely to report on having a depressive episode, suicidal ideation and attempts, and psychiatric counselling within the previous year, as compared to males. Female former smokers showed intermediate characteristics in parameters of mental health status within the previous year, ranking between lifetime non-smokers and the current smokers. CONCLUSION: Identifying the factors related to mental health status among current smokers can increase opportunities for an early intervention and help reduce the prevalence of smoking and increase smoking cessation rates particularly in females. Developing adaptive coping strategies other than smoking in female youth is potentially important in reducing the initiation of smoking.

Gender Differences in Somatic Symptoms and Current Suicidal Risk in Outpatients with Major Depressive Disorder

OBJECTIVE: Although somatic symptoms are common complaints of patients with major depressive disorder (MDD), their associations with suicide are still unclear. METHODS: A total of 811 MDD outpatients of aged between 18 to 64 years were enrolled nationwide in Korea with the suicidality module of the Mini-International Neuropsychiatric Interview (MINI) and the Depression and Somatic Symptom Scale (DSSS). RESULTS: On stepwise regression analysis, current suicidality scores were most strongly associated with chest pain in men, and neck or shoulder pain in women. Severe chest pain was associated with higher current suicidality scores in men than in women, whereas severe neck or shoulder pain showed no significant differences between the genders. In conclusion, MDD patients of both sexes with suicidal ideation showed significantly more frequent and severe somatic symptoms than those without. Current suicidal risk was associated with chest pain in men, and neck or shoulder pain in women. CONCLUSION: We suggest that clinicians pay attention to patients' somatic symptoms in real world practice.

Prevalence and Predictors of Suicidality Among Medical Students in A Public University

Background: Undergraduate medical students have been the most distressed group among the student population. Depression and anxiety have been found to be more prevalent in this group of students compared to others. Objective: This study was conducted to determine the prevalence and predictors of suicidality among undergraduate medical students in a public university. Methods: This was an analytical cross-sectional study, conducted in a public university in Selangor, Malaysia. Data were collected using self-administered questionnaires from January to February 2013, and analysed using the Statistical Package for Social Sciences Software (version 21). Results: Out of 625 undergraduate medical students, 537 (85.9%) participated in the study. The prevalence of the suicidality among undergraduate medical students was 7.0%. The significant predictors of suicidality based on multiple logistic regression were the respondent’s lifetime suicide attempts (Adjusted Odds Ratio, AOR 10.4, 95% CI 2.7 to 40.9); depression (AOR 5.9, 95% CI 1.5 to 23.0); breaking off a steady love relationship (AOR 5.4, 95% CI 1.3 to 22.4); hopelessness (AOR 4.9, 95% CI 1.1 to 21.6); and something valued being lost or stolen (AOR 4.4, 95% CI 1.2 to 15.9). Conclusion: These findings indicate that mental health care services should be strengthened at university level. The results show a need for an intervention programme to reduce suicidality among the undergraduate medical students.

Risk Factors of Socio-Demographic Variables to Depressive Symptoms and Suicidality in Elderly Who Live Alone at One Urban Region / 정신신체의학

OBJECTIVES: To understand the risk factors of demographic data in geriatric depression scale, and suicidality among in elderly who live alone at one urban region. METHODS: In 2009, 589 elderly who live alone(age> or =65) were carried out a survey about several socio-demographic data, Korean version of the Geriatric Depression Scale(SGDS-K) and Suicidal Ideation Questionnaire (SIQ). Statistical analysis was performed for the collected data. RESULTS: Mean age of elderly who live alone is 75.69(SD 6.17). 40.1% of participants uneducated, 31.4% graduate from elementary school, 12.9% graduate from high school, 11.7% graduate from middle school, 3.2% graduate from university. Religionless, having past history of depression or physical diseases, low subjective satisfaction of family situation, and not having any social group activity have significance to depressive symptoms of elderly who live alone. Having past history of depression, religionless, low subjective satisfaction of family situation have significance to suicidality. Especially, low subjective satisfaction of family situation and having past history of depression are powerful demographic factor both depressive symptoms and suicidality of elderly who live alone. CONCLUSIONS: When we take care elderly who live alone, we should consider many things, but especially the social support network such as family satisfaction and past history of depression for reducing or preventing their depression and suicide both elderly depression and suicide who live alone.

Risk factors of suicidality in major depressive disorder patients with and without anxious characteristics / 中国心理卫生杂志

Objective:To compare the suicidality risk in major depressive disorder (MDD)patients with and without anxious characteristics,and analyze the risk factors of suicidality in MDD patients. Methods:This was a secondary analysis of the data from the Diagnostic Assessment Service for people with Bipolar Disorders in China (DASP),which was initiated by the Chinese Society of Psychiatry (CSP),from September 1,2010 to February 28, 201 1. Based on the anxious module and suicide module of Mini International Neuropsychiatric Interview (M. I. N. I),1 172 MDD patients were classified as suffering from anxious MDD (n=728,62. 1%)and non-anxious MDD(n=444,37. 9%). Logistic regression was employed to examine the risk factors of suicidality in MDD pa-tients. Results:Among the anxious MDD patients,331 (45. 5%)of them had suicidality risk. And 54(12. 2%)of non-anxious MDD patients had suicidality risk. Compare to the non-anxious group,the anxious MDD patients had significantly higher suicidality risk (P<0. 00 1 ). Logistic regression analysis showed that more frequent depressive episodes (OR=2. 07 ),depressive episodes with psychotic symptoms (OR=2. 0 1 ),comorbid with anxious charac-teristics (OR=3. 18)or melancholic characteristics (OR=2. 90)were associated with suicidality risk in patients with MDD. Conclusion:It indicates that the anxious MDD patients may have higher suicidality risk than non-anx-ious MDD patients,and more frequent depressive episodes,depressive episodes with psychotic symptoms,comorbid with anxious characteristics or melancholic characteristics may be risk factors of suicidality in patients with MDD.

Autolesión no suicida en adolescentes peruanas: Una aproximación diagnóstica y psicopatológica / Non suicidal self-injury in Peruvian adolescents

Una aproximación diagnóstica y psicopatológica a la autolesión no suicida es planteada a partir de la recolección de datos de un grupo de diez adolescentes peruanas que sufrían esta patología. Se revisan las aproximaciones del DSM 5 a este diagnóstico, las que dan lugar a su configuración como una entidad que requiere mayor estudio para ser considerada como independiente de la sintomatología del trastorno límite de personalidad. Se formulan algunas tesis acerca de su psicopatología y las características que la singularizan frente a ese trastorno y la llamada conducta suicida. A partir de una formulación cognitivo-conductual, se examina el papel de esta sintomatología autolesiva como refuerzo automático y social, tanto en su vertiente positiva como la negativa. Ulteriormente se toman en cuenta las once creencias irracionales de Ellis como un instrumento para dilucidar la adaptación a la realidad de las pacientes que conformaron el grupo explorado. Finalmente se esbozan algunos alcances en torno a la terapia dialéctico-conductual de Linehan, mentalizing de Bateman y el uso del aripiprazol y los inhibidores selectivos de recaptación de serotonina (ISRS) en estos casos.

A psychopathological and diagnostic approach regarding non suicidal self-injury is proposed as a result of an exploratory study of a group of ten Peruvian adolescents suffering that condition. The DSM 5 status for this category is taken into account, as well as its relationship with entities like suicidal behavior and the borderline personality disorder diagnosis. On the basis of a cognitive-behavioral formulation, the meaning of this self damaging pathology in terms of automatic and social reinforcement, both positive and negative, is elucidated in order to clarify further developments. One of them being the use of Ellis’ irrational beliefs as a tool to evaluate the sense of reality of the patients. Some comments about Linehan’s dialectical behavioral psychotherapy, Bateman’s mentalizing and aripiprazole or selective serotonine reuptake inhibitors (SSRIs) in the treatment of these patients are proposed.

Conductas autolesivas no suicidas en la práctica clínica: Primera parte: conceptualización y diagnóstico / Non suicidal self injuries in clinical practice

Self-injurious acts are understood as transnosologic behaviors, which by their vital risk and psychopathological complexity require a specific medical diagnosis and treatment. Their management should be known by psychiatrists and other medical specialties. There are varied reasons that can trigger these maladaptive behaviors which are coming from the specific difficulties arising from the patient's mental state. It is essential to identify the presence of triggering or concomitant psychiatric disorders for the appropriate guiding of clinical management...

Las conductas autoagresivas pueden comprenderse como comportamientos transnosológicos que, por su riesgo vital y complejidad psicopatológica, requieren de un diagnóstico y manejo médico específicos. Este manejo debe ser conocido tanto por el médico psiquiatra como por facultativos de otras especialidades. Existen variadas motivaciones que pueden desencadenar conductas autolesivas, las que tienen su origen en dificultades específicas relacionadas con el estado mental del paciente. Resulta imperativo identificar la presencia de patologías psiquiátricas desencadenantes, o concomitantes, para orientar el apropiado manejo clínico...

Suicidality in Major Depressive Disorder : The Impact of Psychiatric Comorbidity / 신경정신의학

OBJECTIVES: Generally, major depressive disorder (MDD) with psychiatric comorbidities is associated with a high suicide rate. However, this relationship has not been studied much in Korea. In this study, we evaluated the suicidality in MDD with psychiatric comorbidities. METHODS: This study was performed on patients who visited the psychiatric department of three university hospitals in the Gyeongbuk area from March 2008 to September 2011. In total, 776 patients were evaluated with the Mini-International Neuropsychiatric Interview-Plus (MINI-Plus), and 288 with MDD were recruited for the study. Suicidality and suicidal risks were evaluated in the MINI-Plus questionnaire. RESULTS: MDD patients with comorbidities had a significantly higher suicidality and suicidal risk than patients with pure MDD. Suicidality was significantly higher in an anxiety disorder group with comorbidity than in the pure MDD group. As the total number of comorbidities got higher, the suicidality increased, and suicidal risks had significant differences depending on the total number of comorbidities. CONCLUSION: These results suggest that an MDD patient with comorbidities has a higher suicidality and suicidal risk. In clinical settings, comorbid MDD patients should be approached with more aggressive psychiatric intervention of their suicidal thoughts and actions.

Intramuscular ketamine in acute depression: a case report

In the pharmacological management of depression, antidepressant drugs take about two weeks for the onsetof their therapeutic action while electroconvulsive therapy though faster, is a cumbersome procedure requiringan anesthetist and many gadgets. Recent studies have shown that ketamine when given to severely depressedpatients in the dose of 0.5mg/ kg body weight as a slow intravenous infusion over 40 minutes brought aboutrapid and significant relief within a few hours to within a day. It was however a transitor y improvement whichlasted for up to a week. As the dose of ketamine administered was very small, it was now tried in theintramuscular route with similar rapid improvement of depressive symptoms in a 25 year old man. His case isreported here as it promises to be an easy tool for providing quick relief to severely depressed patients.

Antipsicóticos atípicos e comportamento suicida em pacientes esquizofrênicos ou esquizoafetivos: [revisão] / Atypical antipsychotics and suicidal behavior in esquizophrenic or schizo-affective patients: [review]

CONTEXTO: Os estudos a respeito da ação dos antipsicóticos atípicos no comportamento suicida são controversos e pouco explorados. OBJETIVOS: Análise discursiva da ação dos antipsicóticos atípicos no comportamento suicida de pacientes esquizofrênicos ou esquizoafetivos. MÉTODOS: Revisão de artigos nas bases de dados MEDLINE, LILACS e da Biblioteca Cochrane, entre o período de 1964 e 2009, usando as palavras-chave: "suicidal behavior" e/ou "suicide" e "atypical antipsychotics" e/ou "antipsychotics" e/ou "clozapine". RESULTADOS: As únicas evidências significativas positivas apontam para a clozapina, que apresenta uma relevância superior aos outros antipsicóticos de segunda geração na redução das taxas de autoextermínio. CONCLUSÕES: A clozapina é o único fármaco que pode alterar o comportamento suicida. Esse efeito não está associado à melhora clínica dos pacientes. Ela é a única droga aprovada pelo Food and Drug Administration (FDA) para prevenir suicídio em pacientes esquizofrênicos, mas os critérios para esse fim são incertos.

BACKGROUND: The literature concerning the net effect of atypical antipsychotic medication on suicidality is not consistent. OBJECTIVES: The empirical literature relating to the efficacy of pharmacological intervention with atypical antipsychotics in esquizophrenic or schizo-affective patients is comprehensively reviewed. METHODS: MEDLINE, LILACS and Cochrane Library were used to search for articles from 1964 to 2009 using these key-words: "suicidal behavior" e/ou "suicide" e "atypical antipsychotics" e/ou "antipsychotics" e/ou "clozapine". RESULTS: The strongest and perhaps unique evidence has been shown for clozapine, which seems to have a clinically relevant advantage over other second-generation antipsychotics for reducing suicidality temptation. DISCUSSION: Clozapine is the unique medication that modulates suicidal behavior. Its action is unknown but is not related do clinical improvement. It is the unique drug approved by Food and Drug Administration (FDA) to prevent suicide in esquizophrenic patients but the criteria for his use is uncertain.