2.2 Suicidality

Question 1

Waar gaat artikel DeJong over?

DeJong et al. (2010)

Answer 1

Comparison between suicide attempters and suicide completers on symptoms of depression

Question 2

Results

Lethality

DeJong et al. (2010)

Answer 2

1. Individuals who completed suicide used more lethal methods, like shooting, compared to attempters
2. Attempters can be devided in two groups: high lethality or low lethality, based on severity of their attempts.

Question 3

Results

Demographics

DeJong et al. (2010)

Answer 3

Those who commited suicide were older and mainly male

No sign differences were found in relation to marital status.

Question 4

Results

Actions

DeJong et al. (2010)

Answer 4

• Attempters usually has a history of more suicide attempts and had been through inpatient psychiatric treatment.
• Completers were more likely to leave a suicide note and majority consumed drugs or alcohol prior to the act.

Question 5

Results

Stressful life events

DeJong et al. (2010)

Answer 5

Completers experienced more work related stress and financial problems preceding suicide.

Question 6

Waar gaat artikel Turecki over?

Turecki et al. (2016)

Answer 6

Onderzoek naar suicidal behaviour.

Variations in suicidal behaviour across age groups, gender, geographical and sociopolitical context, there is currently no reliable algorithm to predict suicide in clinical practice.

Question 7

Suicide and countries/culture

Turecki et al. (2016)

Answer 7

Suicide rates show differences between and within countries
- Due to economic status and cultural differences
- Cultural differences affect people more than their geographical location

Question 8

Which type of suicidal behaviour is more prevalent

Turecki et al. (2016)

Answer 8

More non-fatal suicidal behaviours than completed suicides.

Question 9

Among which group is suicide more prevalent?

Turecki et al. (2016)

Answer 9

Middel aged and elderly men in high income countries

Question 10

Among which group is suicidal ideation most prevalent?

Turecki et al. (2016)

Answer 10

Most occurs in adolescents and young adults

Question 11

Which rates are higher in men and which rates are higher in women?

Turecki et al. (2016)

Answer 11

Men = suicide death rates

Women = ideation and suicide attempts

Question 12

Population-level risk factors

Turecki et al. (2016)

Answer 12

1. Suicide infrequent in societies with strong cohesion, shared values, and moral opposition to suicide.
2. Bad economics (unemployement/lower income) associated with higher suicide rates, especially among men.
3. The way the media covers suicides also influences suicide rates.

Question 13

Individual risk factors for suicide

Turecki et al. (2016)

Answer 13

• Suicidal behaviours run in families.
• Herited impulsive aggression found to be a mediator for suicidal behaviour.
• Sexual orientation –> increased suicide risk (same sex, especially in men)
• Exposure to early nega life events (relationship between victim and abuser, frequency of abuse and type of abuse were moderators for lifetime suicide risk)
• Early nega life events could cause changes in genetic pathways, such as increased stress response (HPA-axis)
• Brain parasite Toxoplasma Gondii can alter neurotransmitter activity and increase vulnerability to suicide

Question 14

Individual risk factors in 3 categories

Turecki et al. (2016)

Answer 14

1. Distal or predisposing factors
2. Developmental or mediating factors
3. Proximal or precipitating factors

Question 15

Developmental or mediating risk factors

Turecki et al. (2016)

Answer 15

More prevalent in adolescents:
1. Impulsive aggression
2. Conduct disorder
3. Interpersonal conflict
4. Antisocial behaviour
5. Alcohol and substance abuse

More prevalent with increasing age:
1. Mood disorders
2. Harm avoidance

Question 16

Which type of disorders lead to highest risk suicidal behaviour?

Turecki et al. (2016)

Answer 16

Mood disorder with another disorder that:
1. Decrease restraint (beheersing), like antisocial disorders and substance misuse, or:
2. Increase distress, like PTSD or panic disorder

Question 17

Early negative life events can lead to:

Turecki et al. (2016)

Answer 17

Cognitive deficits (memory specificity and problem solving) –> contributes to suicidal ideation.

Question 18

PFC in adolescents

Turecki et al. (2016)

Answer 18

Could lead to more risktaking behaviour –> could lead to suicidality

Question 19

Proximal or precipitating risk factors

Turecki et al. (2016)

Answer 19

Risk of suicide is highest within the first year of disorders and is linked with feelings of hopelessness.

Schizophernia = also elevated risk suicide

Question 20

Main clinical predictors of suicide

Turecki et al. (2016)

Answer 20

1. Past suicide attempt and psychopathology
2. Young age
3. Presence of depressive symtoms
4. Male sex
5. Lack of positive symptoms
6. Education
7. Insight indivual has on their disorder
8. Cluster B personality disorders and eating disorders –> common die by suicide

Question 21

Link age and suicide

Turecki et al. (2016)

Answer 21

• Young age: substance misuse disorders and cluster B personality disorder
• Middle age: depression disorder, anxiety, alcohol and substance misuse
• Old age: psychopathology, especially MDD

Question 22

Somatic treatments

Turecki et al. (2016)

Answer 22

Like antidepressants, which reduces suicidal ideation in people ages above 25 years

Other somatic treatments:
- Lithium
- Ketamine
- Antipsychotics (olanzapine) for schizophrenics

Question 23

Psychotherapeutic interventions

Turecki et al. (2016)

Answer 23

• Dialectic behaviour therapy (encourage belief in individual ability to succeed)
• Mentalization-based therapy (thinking of actions as product of emotion and thoughts, to help understand the perception of others)
• CBT

Question 24

Conclusion

Turecki et al. (2016)

Answer 24

Various biological, psychological and social elements should be considered to understand suicide risk.

Recognizing warning signs like behaviour, mood and communication changes are essential for treatment.

Question 25

Waar gaat artikel Lönnqvist over?

Lönnqvist (2021)

Answer 25

Mood and anxiety disorders in suicide and suicide attepters

Question 26

Depressive disorder - suicide

Lönnqvist (2021)

Answer 26

More than 50% of depressed patients have suicidal ideation (depending on severity)

Question 27

Which factors could predict earlier suicidal events?

Lönnqvist (2021)

Answer 27

1. Onset of mood disorders and impulsive aggression in offspring
2. History of sexual abuse
3. Parental depression

Question 28

Which depressive symptom is most prevalent in predicting suicidal ideation?

Lönnqvist (2021)

Answer 28

Hopelessness

Along with feelings of:
- Guilt
- Low self-esteem
- Loss of interest

Question 29

Risk of suicide highst in:

Lönnqvist (2021)

niet in mannen deze keer

Answer 29

Former psychiatric inpatients and outpatients.

Lowest in depressed individuals in primary care.

Question 30

Depression in suicide victims have more of following symptoms:

Lönnqvist (2021)

Answer 30

• Weight or appetite loss
• Insomnia
• Feelings of guilt/worthlessness
• Thoughts of death and suicidal ideation (duh)

Question 31

Bipolar disorder en suicidal behaviour

Lönnqvist (2021)

Answer 31

Strong link between the two.

Bipolar disorder = highly heritable, majority of episodes coonsist of depression.

Suicide mortality rate of bipolar disorder is 15 times higher than in general population

Question 32

Bipolar disorder

Hopelessness

Lönnqvist (2021)

Answer 32

Predictor of suicidal behaviour during depressive phase.

Question 33

Bipolar disorder

Risk factors for suicidal behaviour but not suicide:

Lönnqvist (2021)

Answer 33

1. History of abuse
2. Extent of depressive symptoms and hopelessness
3. Early age at onset of bipolar disorder
4. Family history of suicide
5. Mixed affective states
6. Comorbid mental disorders like anxiety disorder

Question 34

Lithium

Lönnqvist (2021)

Answer 34

Should be prioritized in therapy for bipolar patients, including the ones ar tisk of suicidal behaviour.

It is important in relapse prevention.