Repetición de conductas suicidas en urgencias psiquiátricas en pacientes sin intentos previos, index y repetidores: un estudio prospectivo / Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: a prospective study

INTRODUCCIÓN: La incidencia de la repetición de conductas suicidas no ha variado en los últimos años. Es necesario aportar evidencias sobre la incidencia de la conducta suicida en población psiquiátrica y su seguimiento. MATERIAL Y MÉTODO: Estudio multicéntrico caso-control, prospectivo. La muestra se compuso de 440 pacientes atendidos en los servicios de urgencias de psiquiatría. Se aplicó la Escala de acontecimientos vitales adversos de Brugha y la Escala Columbia de cribado del riesgo suicida. La muestra se dividió en tres grupos: pacientes sin intentos de suicidio previos, pacientes index y pacientes con más de un intento. A los dos años se revisaron las historias clínicas de dichos pacientes analizando la presencia de conducta suicida. RESULTADOS: El 49,1% (n=216) repitieron atención en urgencias de psiquiatría en el periodo de seguimiento. El 2,7% fallecieron por suicidio. Se ha encontrado un perfil diferencial entre los tres grupos estudiados. El grupo de los repetidores fue el que más atenciones recibió con relación a conductas suicidas (11,0%; χ2=30,3; g.l.=2; p < 0,001). El 6,1% (n=10) de los pacientes que nunca habían tenido un intento realizaron su primer intento, y el 21,7% (n=60) del resto de la muestra lo repitieron. El mayor riesgo de intento fue en los 30días siguientes a la atención en urgencias. Pasado ese tiempo, la distribución del riesgo varía en cada grupo. Tres ítems de la Escala Columbia predicen las conductas suicidas. CONCLUSIONES: Es necesario valorar el riesgo de conductas suicidas en todos los pacientes que acuden a urgencias de psiquiatría y durante su seguimiento. Este debería ser más intenso en los primeros meses para quienes no tienen intentos previos, y a más largo plazo para quienes ya lo han intentado

INTRODUCTION: There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD: A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS: A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS: The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide

Suicidal behaviour recurrence in psychiatric emergency departments of patients without a prior suicide attempt, index and reattempters: A prospective study. / Repetición de conductas suicidas en urgencias psiquiátricas en pacientes sin intentos previos, index y repetidores: un estudio prospectivo.

INTRODUCTION: There has been little change in the incidence of suicidal behaviour and reattempts in recent years. Evidence is needed on the incidence of suicidal behaviour in the psychiatric population and its follow-up. MATERIAL AND METHOD: A prospective multi-centre case-control study. The sample covered the cases of 440 patients seen as psychiatric emergencies. For this purpose, we used the Vital Adverse Event Scale by Brugha and screening with the Columbia Scale. The sample was divided into three groups: patients without prior suicide attempts, patients with an index attempt and patients with more than one attempt. At two years, the clinical histories of these patients were reviewed, assessing for suicidal behaviour. RESULTS: A total of 49.1% (n=216) of the patients required urgent psychiatric care during the follow-up period, and 2.7% eventually committed suicide. The data shows a differential profile between the three groups analysed. Among them, the group of reattempters required the highest number of interventions regarding suicide behaviour (11.0%; χ2=30.3; d.f.=2; P<.001). Eventually, 6.1% of the patients without prior suicide attempts tried to commit suicide for the first time, and 21.7% (n=60) of the remaining sample repeated their prior attempts. The highest risk of attempt was in the thirty days following the urgent intervention. After this period, risk distribution varied for each group. Three items from the Columbia Scale predict suicide behaviour. CONCLUSIONS: The results show the need for assessing suicidal behaviour for all patients who receive psychiatric urgent care, including during the follow-up period. A more thorough control should be performed during the first months for patients without prior suicide attempts, and longer periods for those patients who have already tried to commit suicide.

Repeated suicide attempts: a follow-up study.

INTRODUCTION: There is a strong association between those who re-attempt a suicide attempt and those who complete it. Therefore, follow-up on the interventions carried out for suicidal patients is essential. This study investigated the sociodemographic and clinical profiles of individuals admitted as psychiatric emergencies after a suicide attempt according to sex, determined the prevalence of re-attempts in a period of six months, compared the profiles of patients who engaged in repeated suicide attempts to those who did not, and evaluated predictive variables for repeated suicide attempts. METHODOLOGY: A total of 207 patients (122 women and 85 men) who went to the psychiatric emergency room for a suicide attempt (January-October 2015) were interviewed, and their clinical histories were reviewed at 6 months. RESULTS: Lethal suicidal behaviour was lower in women. Fourteen percent of the sample (n=29) repeated a suicide attempt in the following 6 months, and 2 people died by suicide; 3 died from other causes. The patients admitted to the Psychiatric Hospitalization Unit presented with more re-attempts (X2=4.1; d.f.=1; p=0.043). In the multivariate analysis, of all the variables analysed, the only one associated with repeated suicide attempts was having been in mental health treatment upon inclusion into the study (OR=3.504, p=0.009, CI95%: 1.361-9.018). In the follow-up period, the percentage of patients who engaged in mental health treatment increased 21.7%. CONCLUSIONS: The risk of recurrence after being treated for a suicide attempt psychiatric emergency is high in the months following an attempt, and it is necessary to improve prevention and intervention programmes aimed at improving these figures.

La repetición del intento de suicidio: un estudio de seguimiento / Repeated suicide attempts: a follow-up study

Introducción. Existe una fuerte asociación entre quienes repiten un intento de suicidio (IS) y quienes lo consuman. Por ello el seguimiento de la intervención de estos pacientes es fundamental. En este estudio: se establece el perfil sociodemográfico y clínico de personas atendidas en urgencias psiquiátricas por un IS, en función del sexo; se determina la prevalencia de reintentos en un periodo de seis meses; se compara el perfil de los pacientes que repiten o no el IS; y se evalúan variables predictoras de la repetición. Metodología. Se entrevistó a 207 pacientes (122 mujeres y 85 hombres) que acudieron a urgencias psiquiátricas por un IS (enero-octubre de 2015), y se revisó su historia clínica a los 6 meses. Resultados. Las mujeres presentaron una menor letalidad en la conducta suicida. Un 14% de la muestra (n=29) repitió un IS en los 6 meses siguientes y 2 personas fallecieron por suicidio; 3 fallecieron por otras causas. Los pacientes ingresados en la Unidad de Hospitalización Psiquiátrica presentaron más reintentos (X2=4,1; g.l.=1; p=0,043). En el análisis multivariable, de todas las variables analizadas, la única asociada a la repetición del intento fue encontrarse en tratamiento en salud mental al incluirse en el estudio (OR=3,504; p=,009; I.C.95%=1,361-9,018). En el periodo de seguimiento se incrementó un 21,7% los pacientes tratados en salud mental. Conclusiones. El riesgo de repetición tras ser tratado en urgencias psiquiátricas por IS es crítico los meses posteriores, siendo necesario mejorar los programas de prevención e intervención destinados a mejorar estas cifras

Introduction. There is a strong association between those who re-attempt a suicide attempt and those who complete it. Therefore, follow-up on the interventions car-ried out for suicidal patients is essential. This study investigated the sociodemographic and clinical profiles of individuals admitted as psychiatric emergencies after a suicide attempt according to sex, determined the prevalence of re-attempts in a period of six months, compared the profiles of patients who engaged in repeated suicide attempts to those who did not, and evaluated predictive variables for repeated suicide attempts. Methodology. A total of 207 patients (122 women and 85 men) who went to the psychiatric emergency room for a suicide attempt (January-October 2015) were interviewed, and their clinical histories were reviewed at 6 months. Results. Lethal suicidal behaviour was lower in women. Fourteen percent of the sample (n=29) repeated a suicide attempt in the following 6 months, and 2 people died by suicide; 3 died from other causes. The patients admitted to the Psychiatric Hospitalization Unit presented with more re-attempts (X2=4.1; d.f.=1; p=0.043). In the multivariate analysis, of all the variables analysed, the only one associated with repeated suicide attempts was having been in mental health treatment upon inclusion into the study (OR=3.504, p=0.009, CI95%: 1.361-9.018). In the follow-up period, the percentage of patients who engaged in mental health treatment increased 21.7%.Conclusions. The risk of recurrence after being treated for a suicide attempt psychiatric emergency is high in the months following an attempt, and it is necessary to improve prevention and intervention programmes aimed at improving these figures

Comparación entre los Intentos de Suicidio Leves, Graves y las Muertes por Suicidio en Navarra / Comparison between mild and serious suicide attempts and suicide deaths in Navarre Region

Este trabajo compara personas fallecidas por suicidio con personas que realizaron algún intento (leves o graves), identificando factores asociados a cada grupo. En el estudio se utilizan dos muestras en las que se recogieron variables sociodemográficas y clínicas de las personas fallecidas por suicidio en Navarra (2010-2013, n = 180) y de personas atendidas en urgencias de psiquiatría por un intento de suicidio (enero-octubre 2015, n = 207). Los resultados indican que un método de suicidio no violento, no estar jubilado y la ausencia de intentos de suicidio previos se asocian a quienes realizan intentos leves. Ser hombre, la ausencia de atenciones previas en urgencias de psiquiatría y el haber nacido en España se asocian a los fallecidos por suicidio. Se concluye que las diferencias encontradas entre los fallecidos y los intentos de suicidio subrayan la necesidad de abordajes diferenciados en la prevención de la repetición de la conducta suicida

This paper compares people who committed suicide with people who made some (mild or severe) attempt, identifying factors associated with each group. This study uses two samples in which sociodemographic and clinical variables of people dying by suicide in Navarre (2010-2013, n = 180) and people attending psychiatry emergencies for an attempted suicide (January-October 2015, n = 207) were collected. The results show that a non-violent method of suicide, not being retired, and the absence of previous suicide attempts are associated with those who perform mild attempts. Being a male, the absence of previous attendances in psychiatry emergencies and being born in Spain are associated with those who have committed suicide. It is concluded that the differences between the deceased and suicide attempts underline the need for differentiated approaches in preventing the recurrence of suicidal behavior

[Proposal for a neuropsychological cognitive evaluation battery for detecting and distinguishing between mild cognitive impairment and dementias]. / Propuesta de una bateria neuropsicologica de evaluacion cognitiva para detectar y discriminar deterioro cognitivo leve y demencias.

The early and etiological diagnosis of dementia syndrome in the clinical practice remains the neuropsychological assessment through the study of the cognitive profile of the patient and the qualitative and quantitative analysis of the functions, both impaired and preserved. In this article, we describe a neuropsychological battery of cognitive evaluation to detect mild cognitive impairment in any of its clinical forms and dementia; as well as discriminate between the main profiles of dementia syndrome, based on its topographic and etiological classification (frontotemporal, temporoparietal, subcortical, cortico-subcortical and multifocal). This battery is implemented in the neuropsychological assessment specialized surgery from Navarra Hospital Center Neurology Service. Not only the tests that form the assessment protocol are presented, but also the theoretical models that are considered more appropriate for their interpretation.

TITLE: Propuesta de una bateria neuropsicologica de evaluacion cognitiva para detectar y discriminar deterioro cognitivo leve y demencias.El diagnostico precoz y etiologico del sindrome demencial en la practica clinica sigue siendo la evaluacion neuropsicologica mediante el estudio del perfil cognitivo del paciente y el analisis cualitativo y cuantitativo de las funciones, tanto deficitarias como preservadas. En este articulo se describe una bateria neuropsicologica de evaluacion cognitiva para detectar deterioro cognitivo leve en cualquiera de sus formas clinicas y demencia, y para discriminar entre los principales perfiles del sindrome demencial en funcion de su clasificacion topografica y etiologia (frontotemporales, temporoparietales, subcorticales, corticosubcorticales y multifocales). Esta bateria se implementa en la consulta especializada de evaluacion neuropsicologica del Servicio de Neurologia del Complejo Hospitalario de Navarra. Se exponen no solo las pruebas que componen el protocolo de evaluacion, sino los modelos teoricos que se consideran mas apropiados para su interpretacion.

Propuesta de una batería neuropsicológica de evaluación cognitiva para detectar y discriminar deterioro cognitivo leve y demencias / Proposal for a neuropsychological cognitive evaluation battery for detecting and distinguishing between mild cognitive impairment and dementias

El diagnóstico precoz y etiológico del síndrome demencial en la práctica clínica sigue siendo la evaluación neuropsicológica mediante el estudio del perfil cognitivo del paciente y el análisis cualitativo y cuantitativo de las funciones, tanto deficitarias como preservadas. En este artículo se describe una batería neuropsicológica de evaluación cognitiva para detectar deterioro cognitivo leve en cualquiera de sus formas clínicas y demencia, y para discriminar entre los principales perfiles del síndrome demencial en función de su clasificación topográfica y etiología (frontotemporales, temporoparietales, subcorticales, corticosubcorticales y multifocales). Esta batería se implementa en la consulta especializada de evaluación neuropsicológica del Servicio de Neurología del Complejo Hospitalario de Navarra. Se exponen no sólo las pruebas que componen el protocolo de evaluación, sino los modelos teóricos que se consideran más apropiados para su interpretación (AU)

The early and etiological diagnosis of dementia syndrome in the clinical practice remains the neuropsychological assessment through the study of the cognitive profile of the patient and the qualitative and quantitative analysis of the functions, both impaired and preserved. In this article, we describe a neuropsychological battery of cognitive evaluation to detect mild cognitive impairment in any of its clinical forms and dementia; as well as discriminate between the main profiles of dementia syndrome, based on its topographic and etiological classification (frontotemporal, temporoparietal, subcortical, cortico-subcortical and multifocal). This battery is implemented in the neuropsychological assessment specialized surgery from Navarra Hospital Center Neurology Service. Not only the tests that form the assessment protocol are presented, but also the theoretical models that are considered more appropriate for their interpretation (AU)