Archive for category Suicide

Depression Strongest Driver of Suicidal Thoughts in Soldiers, Vets


Current and former soldiers who seek treatment for post-traumatic stress disorder (PTSD) should be screened closely for major depression since the disorder is the single strongest driver of suicidal thinking, say authors of a new Canadian study.

Researchers evaluated 250 active duty Canadian Forces, RCMP members and veterans.  The study comes at a time when record numbers of suicides are being reported among American troops returning from Afghanistan and Iraq, and the number of suicides reported among Canadian forces last year reached its highest point since 1995.

In veterans suffering from post-traumatic stress disorder, about half also have symptoms of major depressive disorder during their lifetime, said the researchers.

But “the task of predicting which people may be at an increased risk of completing suicide is a complex and challenging care issue,” they said.

The study included 193 Canadian Forces vets, 55 active troops and two RCMP members referred to the Parkwood Hospital Operational Stress Injury Clinic in London, Ontario.

Soldiers and vets were screened for PTSD, major depression, anxiety disorders and alcohol abuse.  The depression questionnaire also included questions about suicidal thinking.

Study participants served an average of 15 years and had been deployed an average of three times. About one-fourth had been deployed to Afghanistan at least once. Ninety-two per cent were men.

Most met the criteria for “probable” PTSD, and almost three-fourths screened positive for probable major depression.

Overall, about one-fourth — 23 percent — said that they had experienced thoughts of self-harm, or that they would be better off dead, for several days over the prior two weeks.

Another 17 percent said they had those thoughts more than half of the days in the past two weeks; six percent reported feeling this way almost every day for the previous two weeks.

As found in other studies, the researchers showed that PTSD is linked to suicidal thoughts. But “what became the biggest predictor was, specifically, depression severity,” said Dr. Don Richardson, a consultant psychiatrist at the Operational Stress Injury Clinic and an adjunct professor in the department of psychiatry at Western University in London.

“It really stresses the importance that when you’re assessing someone for PTSD it’s also critical that you assess specifically for major depression,” Richardson said. “From our limited study, it was depression severity that was the most significant predictor of having suicidal ideation.”

The concern is that soldiers seeking treatment for military-related trauma might not receive aggressive therapy for depression. Instead, the focus might be more focused on PTSD and exposure therapy.

“There’s potentially a lot of people out there who are suffering who might not be aware that there are effective treatments, and that there are clinics available across Canada that specialize in military trauma,” said Richardson.

Source:  The Canadian Journal of Psychiatry

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Virtual Simulations Help Train Psychologists, Psychiatrists


Virtual Simulations Train Psychologists, PsychiatristsFollowing on the heels of flight simulation training, medical simulation and now virtual mental health simulations train health professionals by realistically mimicking patient symptoms.

New simulators mimic the symptoms of a patient with clinical psychological disorders, according to new research presented at the American Psychological Association’s 120th Annual Convention.

“As this technology continues to improve, it will have a significant impact on how clinical training is conducted in psychology and medicine,” said psychologist and virtual reality technology expert Albert “Skip” Rizzo, Ph.D.

Technological advances including artificial intelligence and expert systems allow a highly interactive interaction with simulators even allowing the simulators to carry on a conversation with real humans.

“This has set the stage for the ‘birth’ of intelligent virtual humans to be used in clinical training settings,” Rizzo said. He showed videos of clinical psychiatry trainees engaging with virtual patients called “Justin” and “Justina.”

Justin is a 16-year-old with a conduct disorder who is being forced by his family to participate in therapy. Justina, the second and more advanced iteration of this technology, is a sexual assault victim who was designed to have symptoms of post-traumatic stress disorder.

In an initial test, 15 psychiatry residents, of whom six were women, were asked to perform a 15-minute interaction with Justina.

Video of one such interaction shows a resident taking an initial history by asking a variety of questions. Programmed with speech recognition software, Justina responds to the questions and the resident is able to make a preliminary diagnosis.

Rizzo’s virtual reality laboratory is working on the next generation of virtual patients using information from this and related user tests, and will further modify the characters for military clinical training, which the U.S. Department of Defense is funding, he said.

Researchers are working to develop simulated or virtual veterans with depression and suicidal thoughts, for use in training clinicians and other military personnel how to recognize the risk for suicide or violence.

Over time, Rizzo hopes to create a comprehensive computer training module that has a diverse library of virtual patients with numerous “diagnoses” for use by psychiatric and psychology educators and trainees.

Currently, psychology and psychiatry students are trained by role-playing with other students or their supervisors to gain experience to treat patients. They then engage in supervised on-the-job training with real patients to complete their degrees.

“Unfortunately, we don’t have the luxury of live standardized ‘actor’ patients who are commonly used in medical programs, so we see this technology as offering a credible option for clinical psychology training,” he said.

“What’s so useful about this technology is novice clinicians can gain exposure to the presentation of a variety of clinical conditions in a safe and effective environment before interacting with actual patients. In addition, virtual patients are more versatile and can be available anytime, anywhere. All you need is a computer.”

Source: American Psychological Association

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Am I Anorexic?


Hi I’m 15, female, 5’2 and 87. I’m completely obsessed with food. It literally rules my life. I stay up all night thinking and planning what I will eat the next day. I love making food for others but I never eat it. I find it hard to eat over 400 calories a day. I am on my feet every minute I am awake, I never sit down. I workout and exercise also. Not as much as I should. I cancel plans with my friends because I’m afraid they will make me eat or I will be confronted with food. I have constant urges to throw up but I never have. I also self harm by cutting.
I cancel all plans with friends also because I hate being social. I’m a nice person, I just get nervous around other people. I hate staying the night at other peoples’ houses because I have certain routines that I do every day.

I’m constantly sad. Nothing makes me happy. Not even going on vacations or “fun” trips to the mall or amusement park. Being with friends doesn’t make me happy, it just makes me freak out. I constantly think people are judging me. What the heck is wrong with me?? Eating disorder? Anxiety? OCD? Depression? I’ve taken many online quizzes and I’ve scored high on all of the above disorders. I haven’t been to a doctor in over a year, I’m afraid they’ll force me to gain weight and eat. I have insomnia also. Please help. I feel suicidal all the time but I’ve never attempted. I feel like I’m constantly bothering people.

A. I am sorry that you are suffering. You asked about whether you have anxiety, OCD, depression, or an eating disorder. I cannot know with certainty. What fundamentally seems to be driving your behavior is anxiety and fear.

You also seem to lack self-esteem. You are constantly worried about what other people think of you. You worry that you are “bothering people” which may indicate that you consider yourself unimportant.

You are not functioning well. Your eating or sleeping patterns are unstable and you are experiencing significant mental health symptoms, all of which are disrupting your life. You need help. Receiving help at this time is especially imperative because you admitted that you are considering suicide. People often consider suicide when they feel as though they have no other option or they don’t know what to do.

I would advise you to see a mental health professional. You should also have a physical evaluation by a medical professional to determine what damage your body has sustained. Undergoing those evaluations will help to determine your psychological and physical health status.

Accessing professional mental health treatment is the wisest and most efficient approach to your problems. Asking for help may be difficult but force yourself to do it anyway. There are many people who have had very similar problems, received help and their life has significantly improved. If you are willing to seek professional help, then you can expect the same, positive outcome. There is a great deal of hope if you are willing to seek treatment. Please take care.

Dr. Kristina Randle

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Suicide Tied to Altered Sense of Self in Early Stages of Schizophrenia


Among patients having their first schizophrenia episode, a tendency for suicide is strongly linked to an altered sense of self — what some experts have labeled as a “self-disorder,” according to a study of 49 patients with schizophrenia.

Self-disorders are abnormal personal experiences. They are described as “subtle disturbances of the person’s spontaneous experience of himself or herself as a vital subject naturally immersed in the world,” said psychiatrist Dr. Elisabeth Haug of the division of mental health, Innlandet Hospital Trust, Ottestad, Norway.

For the study, the researchers evaluated the relationship between self-disorders and suicide in patients who had just been diagnosed with schizophrenia spectrum disorder, as suicide risk is especially great at this stage of the disease.

Researchers studied data from the Norwegian Thematically Organized Psychosis study, which used information from all mental health treatment facilities from two counties with a total population of 375,000 people.

Of the 49 adults who had been diagnosed over a 2-year period, 38 had schizophrenia , nine had schizoaffective disorder, and two had schizophreniform disorder.

All of the patients were evaluated with the Examination of Anomalous Self Experience (EASE) manual, a 57-item questionnaire that covers five factors of self-disorders: cognition and stream-of-consciousness, self-awareness and presence, bodily experiences, demarcation/transitivism, and existential reorientation.

An example question is “Have you ever felt as if thoughts in your head don’t really belong to you?” The questionnaire then asks for descriptions or examples from the patient rather than simple yes-or-no responses. Each EASE interview took 30-90 minutes.

The findings showed that patients with newly diagnosed schizophrenia spectrum disorder also had high levels of suicidality, self-disorders and high levels of depression.

“Our main finding is that of a clear association between current suicidality and (self-disorders), which appears to be mediated by depression,” said Haug and her colleagues.

This result “strongly support(s) the role of self-disorders in the development of suicidal ideation and behavior in this patient group.”

In an earlier study, other researchers found that individuals with self-disorders experience specific feelings of inferiority and solitude, which differ from normal feelings of low self-esteem or loneliness and represent “more fundamental feelings of being profoundly dissimilar to other people and thus unable to relate to others,” noted Haug.

Source: National Center for Biotechnology Information

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Close Friend’s Social Phobia Off The Charts


A close friend told me in March that she has had social phobia/anxiety for over 4 years. I was stunned by her revelation. She has always been reserved in general. She is in the medical profession with advanced degrees and is generally a pleasant, but very driven person. She had started some therapy due to becoming physically ill before some meetings, even if she knew the attendees. Since January, she has taken about 30 days of sick time, which isn’t a problem as far as work goes. This is unheard of for her! She travels a great deal with her work and last Saturday started to become unhinged. I drove over an hour to meet her since we now live a couple of hours apart. Saying she was distraught doesn’t do it justice. I literally held her for hours, getting her to a place where she could let it out. This went on all night at a hotel. The next day, she was more herself and we went our separate ways and I felt okay with that. I was prepared to follow her back to her city if need be.

On Monday morning, I get a call from her brother that she has taken scores of Adderall tablets. REALLY? She doesn’t have ADHD that I know of, but the RX had her name on it I’m told. There was a strangely written note and after reading it, I can’t say it’s a traditional suicide note. This is all so out of character and it’s nearly overwhelming. I have healthcare POA for her and she for me along with access to bank accounts and some other account types when she travels. I now have everything business-related under control, but I am now processing my own feelings about what was a very real attempt at ending her life. I feel empathy and love for my close friend, not anger. We have never let each other down. She is done with observation and will go to another place for at least a couple of weeks- by choice. Another first and I’m happy for that. Besides being supportive and meeting with her Psychiatrist soon, is there something I should or shouldn’t do? There was a situation for me in 2001 where I could have given up my survival skills also. It was a specific event that triggered that thought process in me and she helped get me through it. This is far different for her. I just want to be loving, supportive and empathetic, but I’ve never dealt with a suicide attempt of someone close to me. Any suggestions?

Thank you.

A. Your friend is fortunate to have someone in her life who cares so deeply about her well-being. There are several ways that you can assist your friend in this situation. You could offer to drive her to therapy appointments or attend the first several with her, if she allows or believes that it would be helpful. You could also encourage her to attend a support group for individuals who are experiencing severe anxiety.

Psychoeducation about severe anxiety may help you to better support your friend during this difficult time. The more you know about anxiety the better able you can empathize with her situation.

Finally, being able to empathize, love, care, and support your friend during this difficult time are some of the greatest gifts that you can offer. Focus on providing your emotional support and don’t feel obligated to offer psychological advice. Suicide is a very complex matter that requires the treatment of mental health professionals. Though friends and family mean well, they’re simply not trained to deal with the complexities of mental illness and suicide. I hope this helps. Please take care.

Dr. Kristina Randle

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