Eleonora De Pisa

Temperament and Personality Dimensions in Suicidal and Nonsuicidal Psychiatric Inpatients

Background: Suicide is a serious public health problem. In the international literature there is evidence to support the notion that certain temperaments and personality traits are often associated with suicidal behavior. Sampling and Methods: In this study, 150 psychiatric inpatients were investigated using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego autoquestionnaire, the Minnesota Multiphasic Personality Inventory, 2nd edition (MMPI-2) and the Beck Hopelessness Scale and evaluated for suicide risk by means of the critical items of the Mini International Neuropsychiatric Interview. Results: Statistical analysis, including logistic regression analysis and multiple regression analysis, showed that suicide risk contributed to the prediction of hopelessness. Among the temperaments, only the hyperthymic temperament, as a protective factor, and the dysthymic/cyclothymic/anxious temperament contributed significantly to the prediction of hopelessness. Irritable temperament and social introversion were predictive factors for suicidal risk. Hopelessness and depression were associated with higher suicidal behavior and ideation, but, unexpectedly, depression as measured by the MMPI did not contribute significantly to the multiple regressions. Conclusions: The present study indicated that, although suicidal psychiatric patients have MMPI-2 profiles in the pathological range, they exhibit several differences from nonsuicidal patients. Patients at risk of suicide have specific temperaments as well as personality and defense mechanism profiles. They are more socially introverted, depressed and psychasthenic, and use hysterical and schizoid mechanisms more often. Generalizability of the findings was limited by the small sample size and the mix of bipolar disorder I, bipolar disorder II, major depressive disorder and psychotic disorder patients.

Completed suicide in schizophrenia: Evidence from a case-control study.

Suicide is the single major cause of death among patients with schizophrenia. Despite great efforts in the prevention of such deaths, suicide rates have remained alarming, pointing to the need for a better understanding of the phenomenon. The present sample comprised 20 male patients with schizophrenia who committed suicide and who were investigated retrospectively for a large number of characteristics. Controls were 20 living patients with schizophrenia. The results suggest that suicide attempts, hopelessness and self-devaluation were the three variables most strongly associated with completed suicide. However, a number of variables were identified which may constitute risk factors, some of which have not been identified in the past: agitation and motor restlessness (OR = 3.66; 95%CI = 0.95/14.02), self-devaluation (OR = 28.49; 95%CI = 3.15/257.40), hopelessness (OR = 51.00; 95%CI = 7.56-343.72), insomnia (OR = 12.66; 95%CI = 0.95/14.02), mental disintegration (OR = 3.66; 95%CI = 0.95/14.02), and suicide attempt (OR = 3.66; 95%CI = 1.40/114.41). Poor adherence to medications was also predictive of completed suicide in our sample of schizophrenia patients, primarily because the suicide victims showed very low adherence.

Periventricular white matter hyperintensities as predictors of suicide attempts in bipolar disorders and unipolar depression

The aim of this study was to evaluate whether deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVH) are associated with suicidal behavior in patients with major affective disorders. Subjects were 99 consecutively admitted inpatients (42 men; 57 women; mean age: 46.5 years [SD=15.2; Min./Max.=19/79]) with a diagnosis of major affective disorder (bipolar disorder type I, bipolar disorder type-II and unipolar major depressive disorder). 44.4% of the participants had made at least one previous suicide attempt. T2-weighted brain magnetic resonance images were rated for the presence and extension of WMH using the modified Fazekas scale. Patients were interviewed for clinical data on average 5 days after admission. Bivariate analyses, corrected for multiple-testing, and logistic regression analysis were used to test the association between suicide attempts and clinical variables. Attempters and nonattempters differed only in the presence of PVH--the former were more likely to have PVH. The logistic regression indicated that the presence of PVH was robustly associated with suicidal behaviors after controlling for age (OR: 8.08). In conclusion, neuroimaging measures may be markers of risk for suicidal attempts in patients with major affective disorders.

Suicide risk in depression and bipolar disorder: Do impulsiveness-aggressiveness and pharmacotherapy predict suicidal intent?

The aims of the present study were to examine clinical, personality, and sociodemographic predictors of suicide risk in a sample of inpatients affected by major affective disorders. The participants were 74 inpatients affected by major depressive disorder or bipolar disorder-I. Patients completed a semi-structured interview, the Beck Hopelessness Scale, the Aggression Questionnaire, the Barratt Impulsiveness Scale, and the Hamilton scales for depression and anxiety. Over 52% of the patients were high suicide risks. Those at risk reported more severe depressive-anxious symptomatology, more impulsivity and more hostility. Impulsivity, the use of antidepressants, anxiety/somatization, and the use of mood stabilizers (a negative predictor) resulted in accurate predicting of suicide intent. Impulsivity and antidepressant use were the strongest predictors even after controlling for several sociodemographic and clinical variables.

Quality of life and suicide risk in patients with diabetes mellitus

BACKGROUND Diabetes mellitus may have profound effects on physical and emotional health and quality of life. OBJECTIVE The authors evaluated the perceived quality of life and its association with suicide risk in Italian patients with diabetes mellitus. METHOD Authors evaluated 100 patients with type 1 and type 2 diabetes. Patients completed the Beck Hopelessness Scale, the Suicide Score Scale, the SF-36 Health Survey Questionnaire, and the General Self-Efficacy Scale. RESULTS Patients with diabetes showed greater hopelessness and suicide ideation than internal-medicine outpatients. Poor quality of life was related to low self-efficacy, high hopelessness, and suicidality. A stepwise multiple regression found that polytherapy and older age predicted suicidality. CONCLUSION It would be useful in future research to follow up patient samples to determine how many and which patients engage in fatal and nonfatal suicidal behavior and the relationship of these parameters with quality of life.

Neurocognition in schizophrenia: From prodrome to multi-episode illness

Individuals with schizophrenia present a neuropsychological deficit throughout the course of the disorder. Few studies have addressed the progression of the deficit since the prodromal phase of the disorder. This investigation explored neurocognition in accordance with the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Consensus recommendations. The aim of the study was to explore the presence of neurocognitive impairment in ultra-high-risk individuals and the stage of this impairment in samples at different phases of illness. Thirty-six individuals with a prodromal syndrome, 53 first-episode and 44 multi-episode schizophrenia patients were assessed to examine neuropsychological performance. ANCOVA analysis adjusted for possible confounder factors and planned contrasts with healthy controls were undertaken. The results revealed deficits in speed-of-processing, visual-learning and social-cognition in prodromal individuals, and of all other neuropsychological domains in both first-episode and multi-episode patients. Furthermore impairment was found in the first-episode and in the multi-episode group, respectively on working-memory and attention. Within the framework of the neurodevelopmental model of schizophrenia, our results suggest the presence of neuropsychological impairment before the onset of full-blown psychosis. Moreover, the deficits are larger in the more chronic groups, according to the theory of an ongoing neurodevelopmental alteration.

Surviving the suicides of significant others: a case study.

Psychological pain has been reported to be major contributing factor for completed suicide, and classical suicidology based its wisdom on this construct. In this paper we report the case of a patient whose family experienced a high number of suicides apparently due to an escalation of psychological pain in the family members after the successive suicides. We also briefly discuss the problem of helping survivors after the suicide of loved one.

White matter microstructure in ultra-high risk and first episode schizophrenia: A prospective study

There is increasing evidence of white matter (WM) pathology in schizophrenia, but its role at the very early stage of the disorder remains unclear. In an exploration of WM microstructure in ultra-high risk (UHR) subjects and first episode schizophrenia (FES), 34 FES, 27 UHR and 26 healthy control (HC) subjects underwent a magnetic resonance imaging (MRI) tract based spatial statistics (TBSS) investigation. Whole brain fractional anisotropy (FA), mean diffusivity (MD), radial (RD) and axial diffusivity (AD) values were extracted. UHR subjects who later developed psychosis showed lower FA compared with HC in the corpus callosum (CC), the left superior and inferior longitudinal fasciculus, the left inferior fronto-occipital fasciculs (IFO), and the forceps; RD was significantly higher in the CC, the forceps, the anterior thalamic radiation bilaterally, and the cingulum bundle. FES, compared to HC, showed a significant FA reduction of the CC, the superior and inferior longitudinal fasciculi bilaterally, the IFO bilaterally, the corona radiate bilaterally, and the forceps; while RD was found to be significantly increased in the left superior longitudinal fasciculus. UHR who later developed psychosis had WM abnormalities affecting brain pathways that are crucial for intra- and inter-hemispheric connections.

RISK-TAKING AND REASONS FOR LIVING IN NON-CLINICAL ITALIAN UNIVERSITY STUDENTS

The associations between risk-taking, hopelessness, and reasons for living were explored in a sample of 312 Italian students. Respondents completed the Physical Risk Assessment Inventory, the Physical Risk-Taking Behavior Inventory, the Beck Hopelessness Scale, and the Reasons for Living Inventory. Students with lower scores on the Reasons for Living Inventory and higher scores on the Beck Hopelessness Scale rated the risky activities as less risky and engaged in them more often. Women obtained higher scores on risk assessment, lower scores on personal risk-taking and higher scores on the Reasons for Living Inventory and most of its subscales. Men in general and people who take risks and perceive lower risk are more hopeless and relatively weak in reasons for living.

Response to intravenous antidepressant treatment by suicidal vs. nonsuicidal depressed patients

BACKGROUND As effects of suicidal status on antidepressant responses remain uncertain, we compared responses to treatment in suicidal and nonsuicidal depressed patients. METHODS We evaluated treatment response and covariates in 82 depressed patients diagnosed with DSM-IV major depressive (n=50) or bipolar disorders (n=32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment, using citalopram given intravenously and then orally, with or without a mood-stabilizer. Suicidal status was based on an intake score of > or = 3 on item-3 of the 17-item Hamilton Depression Rating Scale, verified by clinical assessment. Morbidity and clinical change were assessed with the remaining 16 items (HDRS(16)). RESULTS Suicidal (n=31) and nonsuicidal subjects (n=51) were similar in baseline ratings of depressive symptom-severity but were depressed longer and more likely to abuse substances. Suicidal ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS(16)) improved half as much as in nonsuicidal subjects (13.4 vs. 25.1 points), independent of diagnosis, initial illness-severity, and treatment, and half as many patients improved by > or = 20%. In multivariate modeling, only being suicidal predicted poor response. CONCLUSIONS Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.