Determinants of mental and physical health-related quality of life among patients hospitalized for suicidal behavior

The current study was interested in exploring the clinical factors related to mental and physical health-related quality of life among patients hospitalized for suicidal behavior. A multicenter cross-sectional study was designed to compare data obtained form 246 patients hospitalized for suicide behavior. Results suggest that mental health-related quality of life was negatively associated with hopelessness while physical health-related quality of life was negatively associated with age, medical disease and the number of previous suicide attempts and positively associated with employment. Findings are discussed in the context of theoretical evidence and clinical implications.Fil: Grendas, Leandro Nicolás. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital Dr. Braulio A. Moyano; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Rojas, Sasha. University of Arkansas for Medical Sciences; Estados UnidosFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Lado, Gisela. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal ; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Patients hospitalized for suicidal ideation and suicide attempt in a mental health hospital: clinico-demographical features and 6-month follow-up

Introducción: El suicidio es un problema de alto impacto para la salud pública. En la Argentina son pocos los estudios publicados sobre suicidio e intento de suicidio. Objetivo: Determinar el porcentaje de internaciones motivadas por intento o ideación suicida en un Hospital de Salud Mental de la Ciudad de Buenos Aires, describir las características clínico-demográficas de estas pacientes y analizar la frecuencia de eventos desfavorables en el seguimiento a 6 meses. Métodos: En el presente estudio se emplean los datos basales y de seguimiento de un estudio analítico, observacional, de cohorte prospectivo. Resultados: Los datos basales muestran que de la totalidad de pacientes que ingresaron al Servicio de Guardia, el 27% lo hizo por ideación o intento de suicidio. Los diagnósticos más frecuentes fueron: trastorno límite de la personalidad (41%), trastorno depresivo mayor (38%), trastorno bipolar (20%) y esquizofrenia (16%). El método utilizado con más frecuencia en el intento de suicidio fue la sobreingesta medicamentosa. En la mitad de las pacientes, el proceso suicida se desarrolló en menos de 10 minutos. Los datos del seguimiento muestran que el 22% de las pacientes presentó un nuevo intento de suicidio y el 34% tuvo una reinternación a 6 meses. Conclusiones: En conjunto, estos resultados describen las características de las pacientes suicidas asistidas en un Hospital de Salud Mental, muestran la baja eficacia de las intervenciones y plantean la necesidad de diseñar nuevas estrategias para el manejo de las mismas.Background: Suicide is an issue of high public health impact. In Argentina there are few published studies on suicide and suicide attempt. Objective: To determine the percentage of hospitalizations caused by suicidal attempt or suicidal ideation in a Mental Health Hospital of the City of Buenos Aires, describe the clinical and demographic characteristics of these patients and to analyze the frequency of adverse events at a 6-month follow-up. Methods: In the present study, baseline and follow-up data of an analytical, observational, prospective cohort study are used. Results: Baseline data show that of all patients who entered the Emergency Department, 27% did so for ideation or suicide attempt. The most frequent diagnoses were: borderline personality disorder (41%), major depressive disorder (38%), bipolar disorder (20%) and schizophrenia (16%). The method most commonly used during the suicide attempt was drug poisoning. In half of the patients, the suicidal process was developed in less than 10 minutes. Monitoring data show that 22% of patients had a new attempted suicide and 34% had a readmission in a 6-month period. Conclusions: Together, these results describe the characteristics of suicide patients admitted to a Mental Health Hospital and show the low efficacy of interventions and the need to devise new strategies for the management of suicidal patients.Fil: Teti, Germán Leandro. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Rebok, Federico. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Grendas, Leandro Nicolás. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; ArgentinaFil: Fógola, Agustina. Universidad de Buenos Aires. Facultad de Medicina; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Cátedra de Farmacología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital “Dr. Braulio A. Moyano”; Argentin

An evaluation of endurance and combined endurance and resistance training on fitness and C-reactive protein

PURPOSE: This study was designed to determine whether endurance or endurance + resistance training would influence circulating C-reactive protein (CRP) levels and if these changes are related to alterations in aerobic fitness and/or body composition. METHODS: Fifty eight healthy young adults aged 18-24 yrs (78% female) were assigned to one of three groups: 1) endurance training (E) (n=18), 2) endurance + resistance training (ER) (n=11), or 3) active control (AC) (n=29). The E group completed 15 weeks of endurance training for either a half marathon (n=6) or full marathon (n=12). The ER group performed 15 weeks of periodized resistance training in addition to the half marathon (n=3) or full marathon (n=8) training. The AC group continued the same exercise routine that they had used prior to becoming a study participant. Pre and post measures included: a 1.5 mile run, 8 rep max (8 RMs; ER group only) on the bench and leg presses, height, weight, waist and hip circumference, DXA, and plasma CRP (ELISA). RESULTS: At baseline, no significant differences were observed between groups. In the E group only, estimated VO2 max significantly increased 12.45% from 38.9 ± 3.8 ml/min/kg to 43.8 ± 7.5 ml/min/kg (mean ± SD) (P \u3c 0.05) and total percent body fat decreased significantly 1.7% from 29.4% ± 8.3 to 27.7 ± 8.8 (mean ± SD) (P \u3c 0.05). In the ER group only, plasma CRP concentrations decreased, but not significantly from 1.59 ± 1.2 mg/L to 0.99 ± 0.5 mg/L (mean ± SD) (P = 0.16). All other measures for the ER group did not change significantly. In addition, while the E and AC groups remained in the average risk category for CRP levels (1-3 mg/L) at the post intervention time point, the ER group entered the low risk category (\u3c 1 mg/L) with an average CRP concentration of 0.99 mg/L. CONCLUSIONS: Combined endurance and resistance training may be an effective modality for reducing plasma CRP in young adults. However, improvements in aerobic capacity and total percent body fat do not appear to affect changes in CRP. FUNDING: Louisiana State Universit

Social epigenetics: a science of social science?

Epigenetics has considerable potential to transform social science by embedding mutually regulative reciprocal connections between biological and social processes within the human activities it studies. This paper highlights common epigenetic methods and outlines practical considerations in the design of ‘social epigenetics’ research addressing the identification of biomolecular pathways, statistical inference of causality, conceptualization of the environment as a biochemical event, heritability of epigenetic alterations and intergenerational accountability, and concept of time implied by attempts to capture complex, non‐linear gene‐environment interactions. Finally, we reflect on the social epigenome as a conceptual space and try to identify barriers to translation, and practical and ethical issues raised by epigenetics research. In order for social epigenetics and social science to contribute to the emergence of this putative ‘science of social science’ and to capture meaningful human experience they will both need to change significantly

How lipids may affect risk for suicidal behavior

Suicide and nonfatal suicidal behaviors are major causes of mortality and morbidity worldwide. Variability in rates of suicide and suicidal behaviors within and between countries has been attributed to population and individual risk factors, including economic status and cultural differences, both of which can have suicide risk effects mediated through a variety of factors, of which perhaps the least understood is the role of diet. We therefore review the scientific literature concerning two major dietary lipid classes, cholesterol and polyunsaturated fatty acids (PUFAs), that have been associated with higher risk of suicide attempts and suicide. We consider potential mechanistic intermediates including serotonin transporters and receptors, toll-like receptors (TLRs), nuclear factor kappa-light-chain-enhancer of activated B cells (NFκB), and peroxisome proliferator activated receptors (PPARs). Based on this review, we describe a theoretical model linking cholesterol and PUFA status to suicide risk, taking into account the effects of cholesterol-lowering interventions on PUFA balance, membrane lipid microdomains (rafts) as a nexus of interaction between cholesterol and omega-3 PUFAs, and downstream effects on serotonergic neurotransmission and specific inflammatory pathways.Fil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Mann, John. Columbia University. Department of Psychiatry. New York State Psychiatric Institute; Estados UnidosFil: Sublette, M. Elizabeth. Columbia University. Department of Psychiatry. New York State Psychiatric Institute; Estados Unido

Association between religiosity and depression varies with age and sex among adults in South America: Evidence from the CESCAS I study

Prior studies have suggest that religiosity mitigates symptoms of depression. However, population-based data in South America are limited. This study determines the prevalence of religiosity and explores its association with depression in four cities of the Southern cone of Latin-America. In the CESCAS I study 7524 participants aged between 35 and 74 years old were recruited between 2011 and 2012 from randomly selected samples in 4 cities (Bariloche and Marcos Paz, Argentina; Temuco, Chile; and Pando-Barros Blancos, Uruguay). Religiosity was assessed with a questionnaire from the Hispanic Community Health Study/Study of Latinos. Two dimensions were used: 1) recognition as belonging to a religion; and 2) frequency of participation in religious activities. Depression was measured using the PHQ-9. Prevalence of religiosity was described by sociodemographic characteristics. Association between religiosity and depression was examined through logistic regression models controlling for sex, age and other potential confounders. Weekly religious activities were reported by 32.3% (95% CI: 30.1, 33.6) of participants. Prevalence of major depressive episode (MDE) was 14.6% (95% CI: 13.6, 15.6). After controlling for confounders, older women (≥65 years) who reported religious affiliation had 70% lower likelihood of having MDE (OR: 0.3; 95% CI, 0.1, 0.8). Moreover, in this group, women participating in religious activities more than once per week compared with "never" had 50% lower likelihood of having a MDE (OR: 0.5; 95% CI: 0.3, 0.9). No association between religious activities and depression was found in men. Religiosity is highly prevalent among adults in four cities of South America. Our study found an inverse association between religiosity and depression only in women, stronger in olders. Although longitudinal studies are necessary to determine the true nature of these relationships, religiosity may be a relevant factor that health care providers could take into account when exploring depression in their patients.Fil: Santero, Marilina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Prado, Carolina. Instituto de Efectividad Clínica y Sanitaria; ArgentinaFil: Hernández Vásquez, Akram. Universidad San Ignacio de Loyola; PerúFil: Irazola, Vilma. Instituto de Efectividad Clínica y Sanitaria; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Towards the clinical implementation of pharmacogenetics in bipolar disorder.

BackgroundBipolar disorder (BD) is a psychiatric illness defined by pathological alterations between the mood states of mania and depression, causing disability, imposing healthcare costs and elevating the risk of suicide. Although effective treatments for BD exist, variability in outcomes leads to a large number of treatment failures, typically followed by a trial and error process of medication switches that can take years. Pharmacogenetic testing (PGT), by tailoring drug choice to an individual, may personalize and expedite treatment so as to identify more rapidly medications well suited to individual BD patients.DiscussionA number of associations have been made in BD between medication response phenotypes and specific genetic markers. However, to date clinical adoption of PGT has been limited, often citing questions that must be answered before it can be widely utilized. These include: What are the requirements of supporting evidence? How large is a clinically relevant effect? What degree of specificity and sensitivity are required? Does a given marker influence decision making and have clinical utility? In many cases, the answers to these questions remain unknown, and ultimately, the question of whether PGT is valid and useful must be determined empirically. Towards this aim, we have reviewed the literature and selected drug-genotype associations with the strongest evidence for utility in BD.SummaryBased upon these findings, we propose a preliminary panel for use in PGT, and a method by which the results of a PGT panel can be integrated for clinical interpretation. Finally, we argue that based on the sufficiency of accumulated evidence, PGT implementation studies are now warranted. We propose and discuss the design for a randomized clinical trial to test the use of PGT in the treatment of BD

Differential Impact of Child Sexual Abuse and Family History of Suicidal Behavior in High-Risk Suicidal Patients

The current study aimed to compare suicide-related variables as a function of 1) family history of suicidal behavior and 2) child sexual abuse among patients hospitalized for a suicide attempt or active suicidal ideation. Family history of suicidal behavior and child sexual abuse were examined independently and in combination as a diathesis for a high-risk suicidal phenotype. A multicenter cross-sectional study was designed to compare data obtained from 292 patients hospitalized for suicidal behavior. Demographic and clinical variables were compared among Group 1 (patients who reported both family history of suicidal behavior and child sexual abuse), Group 2 (patients who reported only family history of suicidal behavior), Group 3 (patients who reported only child sexual abuse), and Group 4 (patients who did not report family history of suicidal behavior or childhood sexual abuse). A multinomial logistic regression was used to examine suicide-related variables associated with each group and to compare differences between groups. Group 1 and 3 endorsed a higher number of previous suicide attempts and were more likely to be younger at the first suicide attempt compared to Group 4. Group differences remained after adjustment in a multinomial regression model. The current findings suggest that child sexual abuse may be more strongly related to suicide risk among high risk patients than family history of suicidal behavior.Fil: Grendas, Leandro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad de Buenos Aires. Hospital General de Agudos "Dr. Teodoro Álvarez"; ArgentinaFil: Rojas, Sasha M.. University of Arkansas for Medical Sciences; Estados UnidosFil: Rodante, Demián E.. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Puppo, Soledad. Universidad de Buenos Aires. Facultad de Medicina. Hospital de Clínicas General San Martín; ArgentinaFil: Vidjen, Patricia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Portela, Alicia. Gobierno de la Ciudad de Buenos Aires. Hospital Municipal "José Tiburcio Borda"; ArgentinaFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Gobierno de la Ciudad Autonoma de Buenos Aires. Hospital Neuropsiquiatrico Braulio Aurelio Moyano.; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentin

A randomized 3-month, parallel-group, controlled trial of CALMA m-health app as an adjunct to therapy to reduce suicidal and non-suicidal self-injurious behaviors in adolescents: study protocol

Background: Suicidal and non-suicidal self-injurious behaviors are among the leading causes of death and injury in adolescents and youth worldwide. Mobile app development could help people at risk and provide resources to deliver evidence-based interventions. There is no specific application for adolescents and young people available in Spanish. Our group developed CALMA, the first interactive mobile application with the user in Spanish, which provides tools based on Dialectical Behavioral Therapy to manage a crisis of suicidal or non-suicidal self-directed violence with the aim of preventing suicide in adolescents and youth. Methods: To test the effectiveness, safety and level of engagement of the CALMA app in people aged 10 to 19 who are treated in mental health services of two public hospitals, we will conduct a parallel-group, two-arm randomized controlled trial. Participants will be assessed face-to-face and via video call at four timepoints: day-0 (baseline), day-30, day-60, and day-90. A total of 29 participants per group will be included. Change in the frequency of suicidal and non-suicidal self-injurious behaviors will be compared between groups, as well as the level of emotional dysregulation, level of app engagement and time of psychiatric admission during the follow-up period. Discussion: This study is particularly relevant to young people given their widespread use of mobile technology, while there are currently no available smartphone app-based self-guided psychological strategies in Spanish that attempt to reduce suicidal behavior in adolescents who are assisted in the public health sector from low and middle-income countries in Latin America.Fil: Rodante, Demián. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Chiapella, Luciana Carla. Universidad Nacional de Rosario. Facultad de Ciencias Bioquímicas y Farmacéuticas; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - Rosario; ArgentinaFil: Olivera Fedi, Ramiro. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Papavero, Eliana Belen. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; ArgentinaFil: Lavoie, Kim L.. Université du Québec a Montreal; CanadáFil: Daray, Federico Manuel. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Farmacologia; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Cambios en la conceptualización de la conducta suicida a lo largo de la historia: desde la antigüedad hasta el DSM-5

El suicidio es una conducta universal y específica del hombre que ha estado presente a lo largo de toda la historia de la humanidad. Sin embargo, a través de las épocas han variado las consideraciones sociales que se han tenido acerca del mismo: la aceptación o el castigo. Estos cambios dependieron fundamentalmente de la influencia de distintos factores culturales. En el presente artículo, se realiza una revisión sobre como los paradigmas imperantes en cada época produjeron cambios en la conceptualización del suicidio.</p