Neurotic personality traits and associated dysfunctional attitudes as factors predisposing patients to suicidal ideations at the end of intensive psychotherapy. / Nerwicowe cechy osobowosci i zwiazane z nimi dysfunkcjonalne postawy pacjentów jako czynniki predysponujace do wystapienia mysli samobójczych pod koniec intensywnej psychoterapii.

OBJECTIVES: To determine the relationshipsbetween personality traits typical for neurotic disorders and dysfunctional attitudes declared by patients without suicidal ideations (SI) prior to treatment and SI at the end of an intensive psychotherapy with a predominant psychodynamic approach in the day hospital for neurotic, behavioral, or personality disorders. MATERIAL AND METHOD: KO "O" Symptom Checklist for assessing SI, Neurotic Personality Questionnaire KON-2006 for evaluation of neurotic personality characteristics and patients' attitudes, and a Life Questionnaire, all completed by a group of 680 patients of a day psychotherapy ward, treated for the first time. Statistical analysis encompassed 466 non-SI patients, 4% of whom had SI at the end of treatment. RESULTS: A number of attitudes have been identified in patients who were significantly predisposed to SI at the end of intensive psychotherapy: physical aggression towards relatives (p < 0.001), grandiose fantasies (p = 0.043), resignation tendencies (p = 0.022), resignation feeling associated with the experience of loss of life opportunities (p = 0.037), and being guided mainly by intuition (p = 0.035). It was also observed that declaring certain attitudes was significantly associated with less than average chance of SI at the end of treatment. CONCLUSIONS: In patients who declared these attitudes, there was a higher risk of SI at the end of the psychotherapy cycle than in the remaining patients (10-30% vs. 4%), which indicates the presence of specific dysfunctions of personality, in the case of which intensive psychotherapeutic work requires particular caution -it can trigger emotional stress leading to SI instances. It can be assumed that SI are the result of the reconstruction of defense mechanisms while working on insight, confrontation with the causes and consequences of the patients' own physical aggression towards the loved ones, the realization of the size of their grandiose thinking and the insight into its function, and the insight into the causes of resignation attitudes.

Progression of suicidal ideation to suicidal behavior from a perspective of selected suicidological models. / Progresja mysli samobójczych do zachowan samobójczych w swietle wybranych modeli suicydologicznych.

In clinical practice suicidal ideation (SI) is one of the most commonly encountered symptoms in patients with mental disorders. Such encounter calls for diligent evaluation of suicidal risk. Although the risk factors are widely known, accurate estimation of suicidal risk remains one of the most difficult and most important tasks that clinicians face - especially considering recently collected data showing increase in suicide prevalence in Poland. More thorough estimation of suicidal risk in patients with SI requires taking under consideration not only suicidal risk factors but also factors that are more specific for progression of SI to suicidal behaviors (SB). The review presented in this paper consists of a range of suicidological theories that allow to select a number of groups of factors and mechanisms that are most specific for progression of SI to SB. These groups include: (1) transgression of fear of causing harm and pain to oneself, as well as disintegration of other protective barriers such as (2) decline of social integration with others, feeling of being alienated or abandoned, decline of sense of belongingness, lack of social support, (3) resignation from family and social obligations, (4) dismissing cultural or religious norms, (5) rejection of life goals, values and aspirations that were appreciated earlier, (6) narrowing down in perceived alternatives for suicide, i.e., "tunnel vision", feelings of helplessness and powerlessness, (7) devising in details and accepting simple suicidal plan, especially when such plan is being consolidated through rehearsals and as if "automatized", (8) impulsiveness, (9) accumulation of aggression that may be vented out as suicide, and finally (10) accessibility of means to commit suicide.