A Novel Brief Therapy for Patients Who Attempt Suicide: A 24-months Follow-Up Randomized Controlled Study of the Attempted Suicide Short Intervention Program (ASSIP)

Background

Attempted suicide is the main risk factor for suicide and repeated suicide attempts. However, the evidence for follow-up treatments reducing suicidal behavior in these patients is limited. The objective of the present study was to evaluate the efficacy of the Attempted Suicide Short Intervention Program (ASSIP) in reducing suicidal behavior. ASSIP is a novel brief therapy based on a patient-centered model of suicidal behavior, with an emphasis on early therapeutic alliance.

Methods and Findings

Patients who had recently attempted suicide were randomly allocated to treatment as usual (n= 60) or treatment as usual plus ASSIP (n = 60). ASSIP participants received three therapy sessions followed by regular contact through personalized letters over 24 months. Participants considered to be at high risk of suicide were included, 63% were diagnosed with an affective disorder, and 50% had a history of prior suicide attempts. Clinical exclusion criteria were habitual self-harm, serious cognitive impairment, and psychotic disorder. Study participants completed a set of psychosocial and clinical questionnaires every 6 months over a 24-month follow-up period.

The study represents a real-world clinical setting at an outpatient clinic of a university hospital of psychiatry. The primary outcome measure was repeat suicide attempts during the 24-month follow-up period. Secondary outcome measures were suicidal ideation, depression, and health-care utilization. Furthermore, effects of prior suicide attempts, depression at baseline, diagnosis, and therapeutic alliance on outcome were investigated.

During the 24-month follow-up period, five repeat suicide attempts were recorded in the ASSIP group and 41 attempts in the control group. The rates of participants reattempting suicide at least once were 8.3% (n = 5) and 26.7% (n = 16). ASSIP was associated with an approximately 80% reduced risk of participants making at least one repeat suicide attempt (Wald χ²₁ = 13.1, 95% CI 12.4–13.7, p < 0.001). ASSIP participants spent 72% fewer days in the hospital during follow-up (ASSIP: 29 d; control group: 105 d; W = 94.5, p = 0.038). Higher scores of patient-rated therapeutic alliance in the ASSIP group were associated with a lower rate of repeat suicide attempts. Prior suicide attempts, depression, and a diagnosis of personality disorder at baseline did not significantly affect outcome. Participants with a diagnosis of borderline personality disorder (n = 20) had more previous suicide attempts and a higher number of reattempts.

Key study limitations were missing data and dropout rates. Although both were generally low, they increased during follow-up. At 24 months, the group difference in dropout rate was significant: ASSIP, 7% (n = 4); control, 22% (n = 13). A further limitation is that we do not have detailed information of the co-active follow-up treatment apart from participant self-reports every 6 months on the setting and the duration of the co-active treatment.

Conclusions

ASSIP, a manual-based brief therapy for patients who have recently attempted suicide, administered in addition to the usual clinical treatment, was efficacious in reducing suicidal behavior in a real-world clinical setting. ASSIP fulfills the need for an easy-to-administer low-cost intervention. Large pragmatic trials will be needed to conclusively establish the efficacy of ASSIP and replicate our findings in other clinical settings.

Below:  Survival curves.

Suicide-attempt-free survival of participants who attempted suicide at least once during the 24-month follow-up period. (A) All participants (n = 120). (B) Participants without BPD (n = 100).

Full article at:   http://goo.gl/yxeVwr

By:  

Anja Gysin-Maillart, Konrad Michel 
Outpatient Department, University Hospital of Psychiatry, University of Bern, Bern, Switzerland

Simon Schwab, Leila Soravia 

Translational Research Center, University Hospital of Psychiatry, University of Bern, Bern, Switzerland

Millie Megert 

Psychiatric Department, General Hospital, Thun, Switzerland

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Empathy Impairments in Intimate Partner Violence Perpetrators with Antisocial and Borderline Traits: A Key Factor in the Risk of Recidivism

Antisocial, borderline, and narcissistic personality traits have been described as characteristics of intimate partner violence (IPV) perpetrators. Furthermore, deficits in cognitive empathy and impairments in emotional decoding processes may at least partially explain conduct disorders and social dysfunction in general. However, previous research has not explored potential associations between empathy deficits and the aforementioned traits or whether they are reflected in recidivism in IPV perpetrators. 

Accordingly, the main aim of this study was to explore associations between empathy deficits, antisocial, borderline, and narcissistic traits and the risk of recidivism in this population. 

The sample consisted of 144 IPV perpetrators (mean age = 41 years). High antisocial and borderline personality traits in this sample were associated with a high risk of recidivism, these relationships being moderated by poor empathy skills. Moreover, in IPV perpetrators with both antisocial and borderline personality traits, the risk of recidivism was higher than in those with only one of these traits. In contrast, narcissistic traits were unrelated to the risk of recidivism and impairments in empathy. 

The results of our study highlight the importance of empathy deficits and may help professionals to develop specific intervention programs focusing on improving empathy skills in antisocial and borderline IPV perpetrators.

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By:  Romero-Martínez Á, Lila M, Moya-Albiol L.

University of Valencia, Spain

Violence Vict. 2016 Jan 29.

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Psychotic-Like Experiences and Nonsuidical Self-Injury in England: Results from a National Survey

Background

Little is known about the association between psychotic-like experiences (PLEs) and nonsuicidal self-injury (NSSI) in the general adult population. Thus, the aim of this study was to examine the association using nationally-representative data from England.

Methods

Data from the 2007 Adult Psychiatric Morbidity Survey was analyzed. The sample consisted of 7403 adults aged ≥16 years. Five forms of PLEs (mania/hypomania, thought control, paranoia, strange experience, auditory hallucination) were assessed with the Psychosis Screening Questionnaire. The association between PLEs and NSSI was assessed by multivariable logistic regression. Hierarchical models were constructed to evaluate the influence of alcohol and drug dependence, common mental disorders, and borderline personality disorder symptoms on this association.

Results

The prevalence of NSSI was 4.7% (female 5.2% and male 4.2%), while the figures among those with and without any PLEs were 19.2% and 3.9% respectively. In a regression model adjusted for sociodemographic factors and stressful life events, most types of PLE were significantly associated with NSSI: paranoia (OR 3.57; 95%CI 1.96–6.52), thought control (OR 2.45; 95%CI 1.05–5.74), strange experience (OR 3.13; 95%CI 1.99–4.93), auditory hallucination (OR 4.03; 95%CI 1.56–10.42), and any PLE (OR 2.78; 95%CI 1.88–4.11). The inclusion of borderline personality disorder symptoms in the models had a strong influence on the association between PLEs and NSSI as evidenced by a large attenuation in the ORs for PLEs, with only paranoia continuing to be significantly associated with NSSI. Substance dependence and common mental disorders had little influence on the association between PLEs and NSSI.

Conclusions

Borderline personality disorder symptoms may be an important factor in the link between PLEs and NSSI. Future studies on PLEs and NSSI should take these symptoms into account.

Below:  Prevalence of nonsuicidal self-injury by the presence of psychotic-like experience. Abbreviation: PLE Psychotic-like experience. Bars denote 95% confidence intervals. Prevalence figures are based on weighted sample.

Full article at:   http://goo.gl/w0BF2U

By:   

Ai Koyanagi, Josep Maria Haro

Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain

Ai Koyanagi, Josep Maria Haro

Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, (CIBERSAM), Madrid, Spain

Andrew Stickley

The Stockholm Centre for Health and Social Change (SCOHOST), Södertörn University, Huddinge, Sweden

Andrew Stickley

Department of Human Ecology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

 

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Gender Differences in Recovery Consequences among Heroin Dependent Patients After Compulsory Treatment Programs

Studies on recovery patterns and how baseline factors influence recovery consequences among heroin dependent patients have shown mixed results. This study is aimed at describing the gender differences in long-term recovery patterns and exploring the predictors of negative recovery consequences by gender among heroin dependent patients in Shanghai, China. 

At baseline, this study recruited 503 heroin dependent patients discharged from Shanghai compulsory rehabilitation facilities in 2007 and 2008. In this cohort study, the baseline data was then linked with participants’ 5-year follow-up data from official records. Generalized Estimating Equations (GEE) were used to compare males with females in terms of the presence of negative consequences (incarceration, or readmission to compulsory treatment, or both), in the subsequent 5-years after their discharge from compulsory treatment. Ordinary least squares (OLS) regression was used to explore factors associated to the time length of negative consequences in 5 years after the discharge for males and females separately. 

Our findings indicate that female heroin dependent patients tend to have less negative recovery outcomes than male patients. Male patients with a life-time history of poly drug use and female patients with borderline personality disorder are especially at risk of incarceration and readmission into compulsory treatment programs.

Below:  Natural history of heroin dependent patients who discharged from the compulsory treatment program in Shanghai, China

Below:  Percentage of male and female participants who having negative consequences in 5 years after the discharge from compulsory treatment

Full article at:   http://goo.gl/FJ9edp

By:   Jiang Haifeng,1 Liang Di,2 Du Jiang,1 Sun Haiming,1 Chen Zhikang,1 Fu Liming,3 and Zhao Mina,1

¹Shanghai Mental Health Center, Shanghai Jiao Tong University School of medicine, 600 South Wanping Road, Shanghai 200030, PR China

²UCLA Fielding School of Public Health, Department of Health Policy and Management, 650 Charles Young Dr. S., 31-269 CHS Box 951772, Los Angeles, CA, 90095-1772, USA

³Council of Shanghai Ziqiang Social Services, 158 Hanzhong Road, Shanghai 200070, PR China

^aEmail: moc.liamg@oahznimrd

 

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Reducing Adverse Polypharmacy in Patients with Borderline Personality Disorder: An Empirical Case Study

Objective:

Polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden. Reduction in polypharmacy could be conceptualized as a high priority in the treatment of borderline personality disorder. This case aims to demonstrate that potential.

Method:

This case report presents outcomes data for an individual with borderline personality disorder during the course of an extended psychiatric hospitalization. Symptomatic change is based on the Patient Health Questionnaire Somatic, Anxiety, and Depression Symptoms scales and World Health Organization 5-Item Well-Being Index. Change in polypharmacy is presented both in terms of absolute number and complexity of the medication regimen. Clinical outcomes data are provided at 2, 12, and 24 weeks postdischarge.

Results:

During a 56-day hospitalization, the patient demonstrated clinical improvement across clinical domains—all occurred within the context of reduced number (43%) and complexity (40%) of her medication regimen. Symptomatic improvement was sustained up to 6 months postdischarge.

Conclusions:

Despite good intentions, polypharmacy can be associated with iatrogenic harm and contribute to functional impairment, especially in the context of borderline personality disorder, in which symptomatic fluctuations are part of the illness itself. A reduction in the patient’s high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself. Additional measures of medication risk and liability have the potential to become markers of clinical effectiveness.

Clinical Points

• Despite good intentions, polypharmacy is common and especially challenging in the context of borderline personality disorder in light of impulsivity and self-harm associated with the disorder, risk of adverse drug-drug interactions, and financial burden.
• A reduction in patients’ high-risk polypharmacy during treatment represents a noteworthy treatment outcome in and of itself and might be conceptualized as a marker of clinical effectiveness.

Table 1.

Ms A’s Medications at Admission and Discharge

Admission	Indication	Discharge	Indication
Venlafaxine 75 mg: 3 by mouth in the morning and 2 by mouth at bedtime	Antidepressant
Lamotrigine 200 mg by mouth in the morning	Mood stabilizer	Lamotrigine 200 mg at bedtime	Mood stabilizer
Mirtazapine 30 mg by mouth at bedtime	Antidepressant	Mirtazapine 30 mg at bedtime	Antidepressant
Clonazepam 1 mg by mouth in the morning and at bedtime	Antianxiety	Hydroxyzine 25 mg every 8 h as needed	Antianxiety
Ziprasidone 80 mg by mouth in the morning and at bedtime	Antipsychotic	Ziprasidone 80 mg twice daily	Antipsychotic
Zolpidem 10 mg by mouth daily as needed for anxiety	Hypnotic
Metformin hydrochloride 1,000 mg by mouth twice daily	Diabetes	Metformin hydrochloride 1,000 mg in the morning and 500 mg at bedtime	Diabetes
Atorvastatin 40 mg by mouth at bedtime	High cholesterol
Esomeprazole 40 mg by mouth at bedtime	Gastroesophageal reflux disease	Esomeprazole 40 mg daily	Gastroesophageal reflux disease
Lithium carbonate 600 mg by mouth twice daily	Mood stabilizer	Lithium carbonate 600 mg twice daily	Mood stabilizer
Buspirone 7.5 mg by mouth twice daily	Antianxiety	Buspirone 7.5 mg twice daily	Antianxiety
Levothyroxine 50 mcg by mouth in the morning	Hypothyroid	Levothyroxine 100 mcg daily	Hypothyroid
Amphetamine/dextroamphetamine 25 mg by mouth in the morning and 20 mg at noon	Stimulant
Multivitamin: 1 by mouth daily	General health
Baby aspirin: 1 by mouth daily	Cardiovasular
Quinine sulfate: 2 tablets by mouth at bedtime	Leg cramps
Cetirizine 10 mg by mouth in the morning	Antihistamine
Atropine/diphenoxylate: 1 by mouth twice daily	Irritable bowel syndrome
Bismuth subsalicylate over-the-counter by mouth twice daily	Irritable bowel syndrome
Insulin glargine 45 IU subcutaneous twice daily	Diabetes	Insulin glargine 47 units subcutaneous in the morning and at bedtime	Diabetes
Insulin lispro sliding scale	Diabetes	Insulin lispro sliding scale	Diabetes
		Ferrous sulfate 324 mg daily	Anemia
		Pregabalin 50 mg twice daily	Paresthesia

Full article at: http://goo.gl/ubG1uX

By:   Alok Madan, PhD, MPH, John M. Oldham, MD, Sylvia Gonzalez, MD, and J. Christopher Fowler, PhD

The Menninger Clinic and Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, Texas.

Corresponding author.

Corresponding author: Alok Madan, PhD, MPH, The Menninger Clinic, 12301 S Main St, Houston, TX 77035 (Email: ude.regninnem@nadama).

 

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Preserved Error-Monitoring in Borderline Personality Disorder Patients with and without Non-Suicidal Self-Injury Behaviors

Background

The presence of non-suicidal self-injury acts in Borderline Personality Disorder (BPD) is very prevalent. These behaviors are a public health concern and have become a poorly understood phenomenon in the community. It has been proposed that the commission of non-suicidal self-injury might be related to a failure in the brain network regulating executive functions. Previous studies have shown that BPD patients present an impairment in their capacity to monitor actions and conflicts associated with the performance of certain actions, which suppose an important aspect of cognitive control.

Method

We used Event Related Potentials to examine the behavioral and electrophysiological indexes associated with the error monitoring in two BPD outpatients groups (17 patients each) differentiated according to the presence or absence of non-suicidal self-injury behaviors. We also examined 17 age- and intelligence- matched healthy control participants.

Results

The three groups did not show significant differences in event-related potentials associated with errors (Error-Related Negativity and Pe) nor in theta power increase following errors.

Conclusions

This is the first study investigating the behavioral and electrophysiological error monitoring indexes in BPD patients characterized by their history of non-suicidal self-injury behaviors. Our results show that error monitoring is preserved in BPD patients and suggest that non-suicidal self-injury acts are not related to a dysfunction in the cognitive control mechanisms.

Below:  Grand average of response-locked ERPs at Fz, Cz, Pz and EOG electrodes for controls, SI-BPD and NI-BPD individuals. Correct trials are depicted in blue solid lines, and choice/stop-error trials in red lines. Data were low-pass filtered at 12 Hz for illustration purposes.

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By:  

Daniel Vega, Àngel Soto, Joan Ribas

Department of Psychiatry and Mental Health, Consorci Sanitari de l'Anoia, Igualada, Barcelona, Spain

Daniel Vega, Rafael Torrubia

Unitat de Psicologia Mèdica, Departament de Psiquiatria i Medicina Legal & Institut de Neurociències, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain

Daniel Vega, Adrià Vilà-Balló, Julià Amengual, Antoni Rodríguez-Fornells, Josep Marco-Pallarés

Cognition and Brain Plasticity Group, Bellvitge Biomedical Research Institute- IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain

Antoni Rodríguez-Fornells, Josep Marco-Pallarés

Department of Basic Psychology-Campus Bellvitge, University of Barcelona, L’Hospitalet de Llobregat, Barcelona, Spain

Antoni Rodríguez-Fornells

Catalan Institution for Research and Advanced Studies (ICREA), Barcelona, Spain

Josep Marco-Pallarés

Institut de Recerca en Cervell, Cognició i Conducta, IR3C, University of Barcelona, Barcelona, Spain

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Profiles of Psychiatric Disorders among Heroin Dependent Individuals in Changsha, China

The strong comorbidity of psychiatric and substance use disorders is well documented outside of China, however it has not been studied extensively among drug using individuals in China. This study evaluated patterns of co-occurring psychiatric and substance use disorders among heroin dependent individuals in Changsha, China.

Participants were 1002 individuals consecutively admitted between March 10 and October 30, 2008 into two compulsory and one voluntary drug rehabilitation centers in Changsha. The Structured Clinical Interview for DSM-IV-TR Axis I Disorders-Patient Edition (SCID-I/P) and the Structured Clinical Interview for DSM-IV-TR Axis II personality Disorders (SCID-II) were used.

Mental health disorders were highly prevalent among study participants: 29.6% had at least one lifetime DSM-IV Axis I and 19.5% had at least one current (past month) Axis I mental health disorder. Antisocial (40.7%) and Borderline (22.6%) Personality Disorders were most prevalent DSM-IV Axis II lifetime diagnoses and a mood disorder (19.1%) was the most prevalent Axis I lifetime disorder; 57.8% had other substance use disorder in addition to opioid dependence. Study results indicate that females in compulsory settings have lower socio-economic status than males in compulsory settings, and that males in compulsory settings have higher rates of co-morbidities, including personality, mood disorders, substance use co-morbidities, and lower socio-economic status than males in the voluntary setting.

The study findings suggest an urgent need to expand and improve diagnostic and treatment capabilities in compulsory rehabilitation settings in China and a need for additional services and interventions specific for female rehabilitants.

Full article at: http://goo.gl/zyAgVd

By: Mei Yang,a,b Yanhui Liao,a Qiang Wang,c Marek C. Chawarski,d,** and Wei Haoa,*

^aMental Health Institute, Technology Institute of Psychiatry and Key Laboratory of Psychiatry of Hunan Province, Second Xiangya Hospital, Central South University, Changsha, China

^bDepartment of Social Medicine and Health Management, School of Public Health, Central South University, Changsha, China

^cDepartment of Psychiatry, West China Hospital, Sichuan University, Chengdu, China

^dDepartment of Psychiatry, Yale School of Medicine, New Haven, USA

   

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Patterns of Use of Other Drugs among Those with Alcohol Dependence: Associations with Drinking Behavior & Psychopathology

Alcohol dependence (AD) presents with substantial clinical heterogeneity, including concurrent use of non-alcohol drugs. Here, we examine specific patterns of concurrent non-alcohol substance use during the previous year among a nationally representative sample of adults with DSM-IV AD, and estimate their population prevalence in the U.S. We then evaluate alcohol use behavior and comorbid psychopathology among respondents with AD according to their patterns of concurrent non-alcohol substance use.

These analyses utilized data from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. Latent class analyses classified respondents with AD into four clinically meaningful patterns of concurrent substance use: (1) use of alcohol only; (2) use of alcohol and tobacco only; (3) use of alcohol, tobacco and cannabis; and (4) use of alcohol, tobacco, cannabis, cocaine, and other illicit drug(s).

Among AD respondents, the most prevalent pattern was the use of alcohol and tobacco only (weighted percentage, 32.4%), followed by the use of alcohol only (weighted percentage, 27.5%). AD respondents who used alcohol, tobacco, cannabis, cocaine, and other illicit drug(s) (weighted percentage, 25.3%) manifested the most severe pattern of alcohol consumption, and had significant overrepresentations of major depression, panic, and other anxiety disorders as well as paranoid, schizotypal, borderline, antisocial, and histrionic personality disorders compared with those who used alcohol alone.

Specific patterns of concurrent substance use convey important information regarding the clinical presentation and prognosis for AD. In particular, concurrent use of illicit drugs over the past year by AD individuals was associated with greater severity and comorbid psychopathology. These data suggest the need for pragmatic trials of AD interventions that take into account patterns of substance use behavior in addition to an AD diagnosis.

Via: http://ht.ly/Ss5hU   Purchase full article at: http://goo.gl/9G0K02

By:  Moss HB1, Goldstein RB1, Chen CM2, Yi HY2.

• 1National Institute on Alcohol Abuse and Alcoholism, Bethesda, MD 20892, USA.
• 2Alcohol Epidemiologic Data System, CSR Incorporated, Arlington, VA 22201, USA.
• 
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Borderline Personality Disorder and Military Sexual Trauma: Analysis of Previous Traumatization and Current Psychiatric Presentation

Military sexual trauma (MST) increases vulnerability for posttraumatic stress disorder (PTSD). Sexual trauma is also associated with increased risk for developing borderline personality disorder (BPD). Research has also documented a significant link between PTSD and BPD; however, there is a paucity of information examining this relationship among veterans with MST-related PTSD. In particular, we sought to examine whether comorbid BPD-PTSD compared with veterans with PTSD and no BPD resulted in increased PTSD and depression symptomatology. We also examined psychiatric, previous sexual trauma, and demographic factors to determine what-if any-factors were associated with comorbid BPD diagnosis. Using data from a recently conducted randomized clinical trial, we examined electronic medical records of the local Veterans Affairs Medical Center. 

Data from 90 veterans with MST-related PTSD were obtained. More than 22% of the sample had a historical diagnosis of BPD. Participants were administered measures to assess psychiatric symptomatology (PTSD and depression), trauma-related negative cognitions (NCs), and previous sexual traumatization (e.g., childhood and civilian sexual exposure). An analysis of variance was conducted, which found that veterans with comorbid MST-related PTSD and BPD had significantly greater PTSD criterion B (avoidance) symptoms, depressive symptomatology, and NC scores than participants without comorbid BPD. 

In addition, a binary stepwise logistic regression found that veterans' BPD was also positively associated with NCs about self and the world; however, self-blame, depression, PTSD, sociodemographic variables (e.g., gender, age), and previous sexual traumatizations were not significant predictors. Implications are discussed with regard to clinical care and future research directions.

Via:  http://ht.ly/Sa16K 

By: Williams R1, Holliday R1, Clem M2, Anderson E2, Morris EE3, Surís A4.

• 1Veterans Affairs North Texas Health Care System, Dallas, USA University of Texas Southwestern Medical Center, Dallas, USA.
• 2University of Texas Southwestern Medical Center, Dallas, USA.
• 3Veterans Affairs North Texas Health Care System, Dallas, USA.
• 4Veterans Affairs North Texas Health Care System, Dallas, USA University of Texas Southwestern Medical Center, Dallas, USA