11 Aug Serious Infections Associated With Increased Risk of Suicide
Posted at 22:01h
in Author Interviews, Critical Care - Intensive Care - ICUs, Infections, JAMA, Mental Health Research
MedicalResearch.com Interview with:
Helene Lund-Sørensen BM
Department of Biomedical Sciences
Section of Cellular and Metabolic Research
University of Copenhagen
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Accumulating research has shown that inflammation and infections are associated with psychiatric diagnoses and interactions between infectious agents, known to affect the brain, and suicidal behavior have been reported.
We find an increased risk of death by suicide among individuals hospitalized with infections. The risk of suicide increased in a dose-response relationship with the number of hospitalizations with infections and with the number of days hospitalized with infections. We also examined the risk of suicide association with the time since the last hospitalization with infection and found that infection was linked to an elevated risk with the strongest effect after 1 and 2 years compared with those without infections.
Dr. Mima Becevic[/caption]
Mirna Becevic, PhD, MHA
Assistant Research Professor
University of Missouri - Department of Dermatology
Missouri Telehealth Network
MedicalResearch.com: What is the background for this study?
Response: Psychiatry is, by far, the biggest utilizer of telemedicine services on the Missouri Telehealth Network (MTN). MTN supports an average of 4000 tele-psychiatry appointments every month, and 10% of those are provided by the University of Missouri Department of Psychiatry. Since we are all aware of the ever-increasing demand for child and adolescent psychiatry, but also the stigma that goes along with it, we wanted to examine more closely the actual usage of those services at the University of Missouri.
Dr. Guang Yang[/caption]
Guang Yang, Ph.D.
Assistant Professor
NYU Langone School of Medicine
Alexandria Center for Life Sciences
New York, NY 10016
MedicalResearch.com: What is the background for this study? How common is the problem of long-lasting behavioral deficits after repeated anesthesia exposure in neonates?
Response: Each year, in the United States alone, more than 1 million children under 4 years of age undergo surgical procedures that require anesthesia. Many lines of evidence from animal studies have shown that prolonged or repeated exposure to general anesthesia during critical stages of brain development leads to long-lasting behavioral deficits later in life. The results from human studies are less clear, although some studies suggest a higher incidence of learning disabilities and attention-deficit and hyperactivity disorders in children repeatedly exposed to procedures requiring general anesthesia. To date, there has been no effective treatment to mitigate the potential neurotoxic effects of general anesthesia.
Dr. Brian Haas[/caption]
Brian W. Haas PhD
Department of Psychology
Interdisciplinary Neuroscience Graduate Program
University of Georgia, Athens, GA
MedicalResearch.com: What is the background for this study?
Response: A burgeoning body of evidence highlights the role of several key genes within the oxytocin signaling pathway linked to sociability. Although many studies strongly supports the role of OXTR in the phenotypic expression of sociability in humans, the roles of other oxytocin pathway genes, such asOXT, has received relatively little attention.
Dr. Luca Passamonti[/caption]
MedicalResearch.com Interview with:
Dr. Luca Passamonti MD
Department of Clinical Neurosciences
University of Cambridge
MedicalResearch.com: What is the background for this study?
Dr. Passamonti: We wanted to study if the brain of young people with two different forms of conduct disorder (CD) (https://en.wikipedia.org/wiki/Conduct_disorder), a neuropsychiatric disease associated with severe and persistent antisocial behaviors (weapon use, aggression, fire-setting, stealing, fraudulent behavior), was different from that of young peers with no such abnormal behaviors.
There is already evidence that conduct disorder may have a biological basis (i.e., reduced levels of cortisol under stress) and brain alterations but a whole “map” of the brain in conduct disorder studying cortical thickness was never been done before.
Dr. Alexandra Pitman[/caption]
Dr. Alexandra Pitman BA MSc(Econ) MBBS MRCPsych FHEA PhD
Honorary Research Associate & Consultant Psychiatrist, Division of Psychiatry
University College London
London
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Pitman: We conducted this study to settle a long-standing debate over whether bereavement by suicide is more stigmatising than bereavement due to other causes of sudden death. This is important because the more we understand about the stigma of suicide bereavement, the better equipped we are to design services to support this group. Providing support for people bereaved by suicide is one of five key messages in WHO suicide prevention strategy, and features prominently in the suicide prevention strategies of high income countries such as England, Wales, Northern Ireland, the US, and Australia. The evidence to date suggests that we lack effective interventions to address their known risk of suicide and mental health problems, constituting a failure to tackle an important public health problem.
Although suicide is commonly believed to be highly stigmatising for bereaved relatives and friends, qualitative work suggests that people bereaved by other causes of death also feel stigmatised by their loss. For example, a 
Dr. Katya Rubia[/caption]
Katya Rubia, PhD
Department of Child and Adolescent Psychiatry
Institute of Psychiatry, Psychology, and Neuroscience
King’s College London
London, England
MedicalResearch.com: What are the main findings?
Dr. Rubia: ADHD and OCD patients both suffer from poor inhibitory control and in both disorders this has been associated with structural and functional deficits in fronto-striatal networks. However, it is not clear to what extent the two disorders differ in their underlying neural substrates. This study therefore conducted a meta-analysis of all published whole brain structural and functional MRI studies of inhibitory control in both disorders.
MedicalResearch.com: What are the main findings?
Dr. Rubia: The main findings are that ADHD and OCD patients differ quite fundamentally in their structural and functional brain abnormalities. OCD patients have enlarged volume in basal ganglia and insula, while ADHD patients have reduced volumes in these regions. In fMRI, in the left hemisphere this was also observed for the left insula and putamen, which were increased in OCD and reduced in ADHD. In addition both disorders have different frontal deficits. OCD patients have deficits in rostro-dorsal medial frontal regions that are important for top-down control of affect while ADHD patients had reduced activation in lateral inferior frontal cortex, a key area of attention and cognitive control. The findings fit into the notion of fronto-striatal dysregulation in OCD where basal ganglia are overactive and poorly controlled by medial frontal regions and a delayed fronto-striatal maturation in ADHD where both lateral frontal regions and the basal ganglia/insula are smaller, and presumably less developed in structure and in function in ADHD.
Dr. Andrew Anglemyer[/caption]
Andrew Anglemyer, PhD MPH
Operations Research Department
U.S. Naval Postgraduate School
Monterey, CA 93943
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Anglemyer: Suicide prevention programs in the military are ubiquitous. We aimed to identify the trends in suicide for each service specifically and explore any nonclinical factors that may be associated with the chosen methods of suicide. The trends in suicide are similar to what others have found.
The differences in those rates between services are striking, though. Not only are most suicides in the active duty military among the Army personnel, but the suicide rate among Army personnel is the highest and has been every year since 2006. Additionally, among Army personnel and Marines who committed suicide, those with an infantry or special operations job classification were significantly more likely to use a firearm to commit suicide than those without those job classifications.
Mark de Jong, MD, Psychiatrist
Yulius Academy, Yulius Mental Health
Barendrecht, the Netherlands
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Compulsory psychiatric admission, defined as admission against the will of the patient, has a strong effect on psychiatric patients and their relatives, and can be traumatic. Compulsory admission also conflicts with human rights, principles of autonomy, shared decision making, and recovery focused care. We also see, that rates of compulsory admissions in several European countries are tending to rise. So, interventions that prevent patients from being compulsory admitted are urgently needed.
We reviewed and meta-analyzed all currently available RCTs, that were designed to reduce compulsory admission rates in adult psychiatric patients with severe mental illnesses in outpatients settings. We found, that advance statements, like crisis plans, showed a significant 23% risk reduction in compulsory admissions. In contrast, community treatment orders and interventions for compliance enhancement showed no significant risk reduction in compulsory admissions. Although RCTs on integrated treatment showed no statistically significant risk reduction, we found a potentially clinically relevant risk reduction of 29%.
Dr. Robert Ursano[/caption]
Robert J. Ursano, M.D.
Professor and Chair
Department of Psychiatry/ Director
Center for the Study of Traumatic Stress
Uniformed Services University of the Health Sciences
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Ursano: This study is part of STARRS-LS (Study to address risk and resilience in service members-longitudinal study). STARRS is a group of studies that address suicide risk in the US Army. Suicidal behavior includes suicide ideation, plans, attempts and completions. Understanding the transitions between these is an important goal.
One component of STARRS is the examination of data available on all soldiers who were in the Army 2004-2009. This study examines suicide attempts in soldiers serving 2004-2009 in order to understand the association with deployment and the timing of suicide attempts as well as their association with mental health problems. STARRS is directed to identifying the who, when and where of service member risk. Then interventions can better be developed for these soldiers.
Donghao Lu[/caption]
Donghao Lu MD, PhD candidate
Department of Medical Epidemiology & Biostatistics,
Karolinska Institutet
Stockholm
MedicalResearch.com: What is the background for this study? What are the main findings?
Dr. Lu: Psychiatric comorbidities are common among cancer patients. However, whether or not there is already increased risk of psychiatric disorders during the diagnostic workup leading to a cancer diagnosis was largely unknown.
We found that, among cancer patients, the risks for several common and potentially stress-related mental disorders, including depression, anxiety, substance abuse, somatoform/conversion disorder and stress reaction/adjustment disorder started to increase from ten months before cancer diagnosis, peaked during the first week after diagnosis, compared to cancer-free individuals in Sweden.
