Medication used in intentional drug overdose in Flanders 2008-2013.

BACKGROUND: Intentional drug overdose is the most common method of self-harm. As psychiatric disorders are very common in self-harm patients, the medication used to treat these disorders can become the means for the self-harm act. The present study aimed at investigating an association between the use of prescribed medication (analgesics and antipyretics, anti-epileptics, antipsychotics, antidepressants and psychostimulants) as a method of self-harm and prescription rates of this medication in Flanders. We investigated the possible effect of gender, alcohol use during the self-harm act and a history of self-harm. METHODS: Data from the multicenter study of self-harm in Flanders between 2008 and 2013 were used. The significance of differences in percentages was calculated by GEE and the strength by odds ratios (OR). RESULTS: There was an increase in the odds of using antidepressants (0.8%) and antipsychotics (2%) among females when the rate of prescription increases. Analgesics and antipyretics (39.3/1,000) and antidepressants (124.9/1,000) were the most commonly prescribed drugs among females. Antidepressants (63.9/1,000) and antipsychotics (26.5/1,000) were the most commonly prescribed drugs among males. Antidepressants and analgesics and antipyretics were the most frequently used medications for self-harm. Analgesics and antipyretics during the self-harm act were more common among first-timers, while repeaters more commonly overdosed using antipsychotics and antidepressants. CONCLUSION: These findings suggest that the availability of medication via prescriptions plays an important role in the choice of the medication ingested during the self-harm act. Precautions are necessary when prescribing medication, including restrictions on the number of prescriptions and the return of unused medication to pharmacies after cessation of treatment. These issues should be a focus of attention in the education and training of physicians and pharmacists.

The association between motives, perceived problems and current thoughts of self-harm following an episode of self-harm. A network analysis.

BACKGROUND: A history of self-harm is a major risk factor for suicide. Some patients are more likely than others to repeat suicidal behaviour after an episode of self-harm. Insight in the relation between current thoughts of self-harm, motives for the self-harm episode and perceived problems may improve prevention strategies. Network analysis allows to investigate the co-occurence of these factors and their association with each other. METHODS: Ising model based networks are estimated on data collected between 2007-2015 within the Multicentre Study of Self-harm in Flanders. Patients were interviewed within 24 hours after hospitalization by a trained professional on their motives for the episode of self-harm and their perceived problems. Additionally, they were asked whether they had current thoughts of self-harm. Network analyses are used to determine which motives and problems are uniquely related to current thoughts of self-harm, and which are most central in the network. RESULTS: Data were used of 6068 patients (2279 males and 3789 females). Four internal motives (wish to die, lost control, escape from situation, situation was unbearable), one external motive (show somebody how hopeless I was) and four perceived problems (psychiatric, loneliness, trauma, rejection) are directly related to current thoughts of self-harm. Of all motives and problems, the motive a wish to die is most strongly related to current thoughts of self-harm. However, external motives are more central in the network when compared to internal motives and perceived problems. LIMITATIONS: Data most probably refer to a selected group of self-harm patients as many individuals who self-harm do not come to the attention of hospital services. Patients might be reluctant to tell professionals they had current thoughts of self-harm. CONCLUSIONS: Many internal motives and problems are directly related to current thoughts of self-harm, but external motives are more central in the network. The clinically most important motive (wish to die) does not play a central role in the network.

Increase in Self-Injury as a Method of Self-Harm in Ghent, Belgium: 1987-2013.

BACKGROUND: Self-harm is a major health care problem and changes in its prevalence and characteristics can have important implications for suicide prevention. The objective was to describe trends in the epidemiology of self-harm based on emergency department (A&E departments) visits over a 26-year period in Ghent, Belgium. METHODS: We analyzed data on all self-harm presentations from the three large general hospitals in Ghent between 1987 and 2013. We investigated trends in prevalence (events by year per 100.000), methods and alcohol use. RESULTS: Rates of self-harm steadily decreased during the 26-year study period. In general female rates of self-harm were higher than male rates. The mean patient age was 35 years. The most commonly used method of self-harm was self-poisoning by means of an overdose of medication (80.8%), followed by cutting (10.2%) and hanging (4.2%). Psychotropics (including antidepressants, benzodiazepines, barbiturates and other tranquilizers) were the most frequently used drugs (74.5%). A proportional increase in the use of self-injurious methods in self-harm was highly significant, more specifically in the use of hanging, jumping from heights and the use of other violent methods such as the use of firearms, jumping before a moving object or other traffic related injury. CONCLUSION: This epidemiological study showed an increase in the use of high-lethality methods in self-harm which has important implications for suicide prevention. As restrictions in the availability of these methods are difficult or impossible to achieve, prevention programmes will have to emphasize the role of thorough psychosocial assessment and adequate follow-up care of self-harm patients.

Differential Neural Correlates of Set-Shifting in the Bingeing-Purging and Restrictive Subtypes of Anorexia Nervosa: An fMRI Study.

In this study, possible differences in the neural correlates of set-shifting abilities between the restrictive (AN-R) and bingeing/purging (AN-BP) subtypes of anorexia nervosa have been explored. Three groups of participants performed a set-shifting task during functional magnetic resonance imaging: patients with AN-R (N = 16), AN-BP (N = 13) and healthy control participants (N = 15). As in a typical set-shifting experiment, participants had to switch between two easy tasks (i.e. 'Is the presented number odd/even' or 'Is the presented number smaller/larger than 5'). The trials in which the task was repeated (repeat trials) were compared with trials in which the task was switched (switch trials). With regards to the level of task performance, no significant group differences could be established. However, when comparing switch specific brain activity across study groups, a stronger activation was found in the insula and the precuneus in AN-R when compared to AN-BP and HC. These results suggest that the both subtypes of AN might have different neurobiological correlates, and thus, might benefit from different treatment approaches. Copyright © 2016 John Wiley & Sons, Ltd and Eating Disorders Association.