The Impact of Coping Strategies on Suicide Attempts and Suicidal Ideation in Bipolar Disorder.

ABSTRACT: The stress coping strategies of patients with bipolar disorder (BD) may affect their suicide risk. We examined coping behaviors and impact of coping strategies and clinical characteristics on suicide attempts and lifetime suicidal ideation in patients with BD I, compared with a healthy control group. We recruited 185 euthymic patients with BD and 94 healthy controls. Participants completed the Coping Orientation to Problems Experienced Inventory. Suicide attempt prevalence in patients with BD was around 34%, and frequency of lifetime suicide ideation was around 60%. Binary logistic regression analysis revealed greater use of behavioral disengagement and religious coping strategies among patients with BD, compared with controls. Patients with previous suicide attempts presented a more severe illness course, notably early onset, with more depressive and mixed episodes and a more dysfunctional coping style than nonsuicidal patients. Behavioral interventions can target avoidant coping behavior, such as denial, especially in patients with suicide attempts.

Prenatal and Postnatal Attachment Among Turkish Mothers Diagnosed with a Mental Health Disorder.

The presence of a mental disorder in the mother is one of the key factors affecting attachment. The present study aimed to evaluate prenatal and postnatal attachment among mothers diagnosed with a mental health disorder by comparing them to a healthy group. The patient group included women who received follow-up care in a psychiatric clinic (74 pregnant and 75 postpartum), and the healthy group consisted of women who attended a follow-up polyclinic (118 pregnant and 82 postpartum). Data were collected using questionnaire forms, including the Prenatal Attachment Inventory and the Maternal Attachment Scale. Mothers diagnosed with a mental health disorder were determined to have lower attachment scores than the healthy group, both during the prenatal and postnatal periods. The literature suggests that mothers diagnosed with a mental health disorder showed low maternal attachment scores during pregnancy and/or the postnatal period. Psychiatric nurses should be involved in initiatives that may increase the prenatal and maternal attachment.

Use of Lithium in Severe Acute Manic Episodes: Retrospective Prescription Practice From a Tertiary Inpatient Unit.

OBJECTIVE: A retrospective chart review was performed to investigate the common preferences of clinicians for the pharmacological treatment of acute manic episodes, with particular regard to lithium use, and to assess the adherence of clinical practice to established guidelines. METHODS: Cases of manic episodes in patients admitted to Bakirköy Mazhar Osman Mental Health and Neurological Diseases Education and Research Hospital were retrospectively reviewed. Length of stay, medication data, serum levels, and adverse effects were evaluated for patients who received lithium therapy (N=98). RESULTS: On the first day of lithium treatment, 81 patients received 900 to 1200 mg of lithium. In total, 44 patients were discharged with the same dose as that given on the first day of treatment. With the exception of 1 patient, the dose was increased by 300 to 600 mg in the remaining patients within the first 10 days on the basis of serum drug concentrations. The mean serum concentrations of lithium in the first week were 0.67±0.17 mEq/L in patients with no dose increase, and 0.51±0.15 mEq/L in patients who did receive a dose increase. In total, 94 patients received at least 1 antipsychotic medication in addition to lithium. CONCLUSIONS: Clinicians attempted to maintain serum lithium levels above 0.60 mEq/L at the time of acute treatment initiation, consistent with established guidelines. Clinical practice in large inpatient settings may force clinicians to use lithium in combination with antipsychotics for the treatment of acute mania; the delayed action of lithium and the need for rapid stabilization may drive these practices.

The relationship between attachment styles and childhood trauma: a transgenerational perspective - a controlled study of patients with psychiatric disorders.

AIMS AND OBJECTIVES: This study had two aims. The first aim was to compare attachment styles and traumatic childhood experiences of women with psychiatric disorders and their children to a control group. The second aim was to determine the relationship between attachment styles and traumatic childhood experiences both in mothers and their children. BACKGROUND: According to attachment theories, trauma in an early relationship initiates a developmental cascade in which insecure attachments may occur. DESIGN: A cross-sectional, descriptive study which, employed a case-control design, was performed between May 2013-March 2014. METHODS: This study was conducted in 63 women with psychiatric disorders and their children. The control group consisted of 63 women without any psychiatric disorders and their children. Data were collected using questionnaire forms, including the Adult Attachment Style Scale and the Childhood Trauma Questionnaire for both mothers and children. Descriptive statistics, a Pearson correlation and comparative statistics were used to analyse data. RESULTS: The childhood trauma scores of both the women with psychiatric disorders and their children were higher than the control group scores. Compared to the control group, the mothers with psychiatric disorders and their children were found to have less secure attachment styles. It was determined that the mothers and children with insecure attachment were more likely to have been abused. CONCLUSION: These results point to a relationship between trauma in childhood and attachment style. They also suggest that this relationship may undergo intergenerational transfer. RELEVANCE TO CLINICAL PRACTICE: This study contributes to the existing literature on the relationship between childhood traumas and attachment. Psychiatric nurses should focus not only on psychiatric disorders but also on the difficulties a patient faces regarding being a parent.

Reproductive health in women with serious mental illnesses.

AIMS AND OBJECTIVES: To determine what problems female psychiatric patients have in terms of reproductive health. BACKGROUND: The reproductive health problems faced by female psychiatric patients are matters that have been neglected in the areas of both psychiatry and women's health. This study aims to make a contribution from Turkey to the literature in this neglected field. DESIGN: The study is descriptive and was conducted with 292 female patients treated in an acute inpatient psychiatric ward. METHODS: Data were collected through face-to-face interviews and a questionnaire based on the literature and prepared by the researchers which was designed to determine the kinds of reproductive health issues the patients were experiencing. RESULTS: It was found that compared with healthy women, the distinctive features of the participants in terms of sexuality were more negative; in particular, patients diagnosed with bipolar disorder were more likely to have been forced by their partners to have sex, they had suffered from rape or sexually transmitted diseases, the majority of those who had previous sexual experience had tried to use contraceptives but had been unable to continue using them, they were most likely to choose the method of withdrawal for contraception, their rates of pregnancy and abortion were high, they received less antenatal care, and they were more likely to have smoked during pregnancy. CONCLUSIONS: It was found that female patients with psychiatric disorders had more negative attributes with regard to marriage, sexuality, family planning, maternal characteristics and pregnancy, compared with a corresponding healthy population. RELEVANCE TO CLINICAL PRACTICE: The results of this study may be useful for nurses in the clinical field for calling an attention and raising an awareness of the reproductive health problems of women with psychiatric disorders, taking the necessary preventive measures, and developing damage-reducing strategies.