Suicide prevention from a public health perspective. What makes life meaningful? The opinion of some suicidal patients

BACKGROUND AND AIM OF THE WORK: Suicide is a worldwide phenomenon, with a relevant number of victims. Moreover, repercussions of suicidality-across its entire spectrum-involve not only the individual but also survivors and communities, in a profound and lasting way. As such, suicidality represents a crucial public mental health concern, in which risk/protection factors' study represent a key issue. However, research primarily focused on suicidality risk factors. This study, moving from Frankl's first observations on "Meaning in Life" (MiL) as protective against suicidality, aimed to identify the main themes that suicidal patients identified as MiL carriers, or potential carriers, in their existences. METHODS: Qualitative study on 144 patients admitted to the Geneva University Hospital's emergency department for suicidal ideation (SI) and suicide attempt (SA).  Results: Interpersonal/affective relationships constituted the main theme (71.53%), with emphasis on family (39.80%), children/grandchildren (36.89%). Profession/education, intellectual/non-intellectual pleasures, and transcendental dimension also emerged. CONCLUSIONS: These aspects could be considered among a public health agenda's points for suicide prevention programs taking into account also protective factors promotion/support, including community's mental health resources. Reconnecting to introduction's historical part, our findings are consistent with Frankl's observations. Even if exposed to "absurd" and reluctant to deliberate on this, he seems approach Camus conceptualization who, confronted to the necessity of predictable and conform to recognizable personal patterns transcending chaos for a sense-giving perspective, invited to imagine that a meaning, even a "non-absolute meaning", may lie in apparent smallest things and that Sisyphus can have "the possibility to revolt by trying to be happy".

Meaning in life and demoralization: a mental-health reading perspective of suicidality in the time of COVID-19.

Consequences on mental health have been reported in general population, vulnerable individuals, psychiatric patients, and healthcare professionals. It is urgently necessary to study mental health issues in order to set priorities for public health policies and implement effective interventions. Suicidality is one of the most extreme outcomes of a mental health crisis. It is currently too early to know what the effect of COVID-19 will be on suicidality. However, authoritative commentary papers alert that most of the factors precipitating suicide are, and probably will be for a long time, present at several individual existence levels. A number of prevention measures and research considerations have been drawn up. A point of the latter, recommended by the International COVID-10 Suicide Prevention Research Collaboration, states that "the COVID-19 suicide research response should be truly multidisciplinary. This will foster research that addresses the different aspects and layers of risk and resilience.It will also foster research that informs prevention efforts by taking a range of perspectives" (Niederkrotenthaler et al., 2020). In this light, we would like to propose a reading perspective of suicidality that takes into account Meaning in Life (MiL) and demoralization. Both of the constructs were studied in heterogeneous populations with extreme life situations having led to a fracture between a "before" and an "after", and play a role in affecting suicidality, respectively as resilience and risk factors. In clinical practice, during these unprecedent times, we wish that this more inclusive approach could: 1) contribute to prevention, by delineating more individualized suicidal risk profiles in persons conventionally non-considered at risk but here exposed to an extremely uncommon experience, 2) enrich supportive/psychotherapeutic interventions, by broadening the panel of means to some aspects constitutive of the existential condition of a person who is brutally confronted with something unexpected, incomprehensible and, in some ways, still unpredictable.

Intimate Partner Homicide Suicide: a Mini-Review of the Literature (2012-2018).

RECENT FINDINGS: In homicide-suicide (HS), a perpetrator kills at least one victim and then commits suicide within a time frame, which is not consistently described in the literature. Most HS happen in an intimate partner relationship (HS-IP), but data about this phenomenon are still scant and poorly systematized. PURPOSE OF REVIEW: To assess the research papers published about HS-IP from 2012 to 2018 in Pubmed and Scopus. Article selection followed the PRISMA flow diagram. Information was extracted from the selected articles and tabulated. The 22 eligible articles focusing on different types of HS, including HS-IP, suggest that HS-IPs are predominantly committed by men, usually married, cohabiting, or recently separated from their partner, with a medium-low employment status; the victim is usually the current or former female partner. Heterogenity of HS makes it difficult to generalize the results. Implications emerge for the need to target domestic violence and firearm regulation.

Pathways to and Results of Psychiatric Consultation for Patients Referred from the Emergency Department. Are there Differences between Migrant and Native Patients?

The aim of this study was to compare migrants and native Italians on the pathways to care and results of psychiatric consultation (PC) in the emergency department (ED). Patients who were referred from the ED for psychiatric consultation (EDPC) at the Maggiore della Carità Hospital between March 2008 and March 2015 were recruited consecutively. Socio-demographic, clinical and consultation variables were recorded along with information about suicidal behaviours; migrants ( n = 379; 42.74% males, 57.26% females; age: 45.38 ± 16.95 years) were compared with native Italians ( n = 2942; 43.51% males, 56.49% females; age: 42.08 ± 15.89 years). Migrants were younger, more likely to be unemployed and less likely to be already under the care of a psychiatrist. Symptoms related to use of alcohol or substances were more frequent in migrants, especially female migrants. Migrants were less likely than native Italians to be referred for PC because of the presence of psychiatric symptoms, however they were more likely to be referred because of self-harming behaviour. Nonetheless, migrant status was not identified as a risk factor for suicidal behaviour in the multivariate analysis. The outcome of EDPC showed differences between migrants and natives. In absolute terms migrants were less likely to be admitted to a psychiatric ward after the EDPC than native Italians, while they were more likely to be monitored in the ED before being discharged or referred to outpatient care. In a high percentage of psychiatric examinations of migrants, no psychiatric symptoms were identified. Further studies are warranted to disentangle the meaning of these findings.

Marchiafava-Bignami Disease with frontal cortex involvement and late onset, long-lasting psychiatric symptoms: a case report.

AIMS: To describe the case and management of a patient with Marchiafava-Bignami Disease (MBD) with frontal cortical lesions, no specific symptom at first referral to the Emergency Room, and late onset of atypical psychiatric symptoms. METHODS: We report the case of a 44-year-old patient with a history of chronic alcohol abuse, eventually diagnosed with MBD. RESULTS: Magnetic Resonance showed lesions in the splenium and the body of corpus callosum and bilateral lesions of the frontal cortex. The patient showed late-onset atypical psychiatric symptoms which were drug resistant. DISCUSSION: The case we describe seems to support the existing few ones describing cortical involvement in MBD, which suggest that this is associated with a poorer prognosis. Psychiatric symptoms may be challenging to treat because of drug resistance. CONCLUSIONS: The involvement of psychiatrists together with neurologists and radiologists, with a consultation-liaison approach proved important for the achievement of diagnosis and of the most appropriate management and treatment for this patient.

Asenapine in clinical practice: preliminary results from a naturalistic observational study.

OBJECTIVE: Asenapine, a second-generation antipsychotic, seems to be an effective and tolerable alternative to other treatments for patients with manic or mixed episodes. The objective of our naturalistic observational study was to identify asenapine responders and remitters and to compare responders vs. non-responders and remitters vs. non-remitters, as far as clinical and socio-demographic features are concerned. MATERIALS AND METHODS: We recruited patients with diagnosis of manic episode in bipolar I (BD I) or schizoaffective disorder, with clinical indication to asenapine treatment. Patients' assessment was performed at baseline (T0), after 1 week (T1) and after 4 weeks (T2) of treatment, with the Young Mania Rating Scale (YMRS; T0,T1,T2) and Hamilton Rating Scale for Depression (HAM-D; T0, T2). According to YMRS scores, we classified patients as early improvers, treatment responders, and treatment remitters. RESULTS: A significant decrease was found in HAM-D scores from baseline to T2, with no significant difference between remitters and non-remitters or responders vs. non-responders.The YMRS score significantly improved from baseline to T2, with a significant difference between remitters and non-remitters, but not between responders and non-responders. No difference was found between responders and non-responders as far as socio-demographic and clinical variables, and questionnaire baseline scores are concerned. Remitters and non-remitters showed significant differences in baseline YMRS scores, which were lower in the first and in the type of current episode, which was more frequently moderate in the former than in the latter. CONCLUSIONS: Early improvers comprised 51% of subjects, responders comprised 91.9% and remitters comprised 59.4%. Elderly manic patients with neurological impairment and/or dementia may have poorer therapeutic outcomes. Our results suggest that: 1) decision regarding treatment discontinuation should be cautious in patients who fail to have an early response to asenapine; 2) different diagnosis (BDor schizoaffective disorder) does not seem to have a significant impact on asenapine efficacy; 3) remission with asenapine is more likely to happen for less severe manic episodes. Further naturalistic studies on larger samples are required to support our findings.