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As a term of particular usefulness, "suicide" has become generic to the point of meaninglessness. When I am in the general-hospital setting, the truth of this statement is driven home for me when the question I inevitably ask upon...
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As a term of particular usefulness, "suicide" has become generic to the point of meaninglessness. When I am in the general-hospital setting, the truth of this statement is driven home for me when the question I inevitably ask upon hearing the term is, "What do you mean by 'suicide'?" In a typical week on the consultation psychiatry service, for example, I may encounter a remorseful teenager who regrets the impulsive overdose she hoped would get her boyfriend's attention; an elderly man who would rather forgo dialysis than carry on as a cardiac cripple unable to engage any longer in the physical activities that bring his life meaning and joy; and a depressed, middle-aged man with severe facial wounds that resulted from a carefully planned gunshot wound to his brain that only failed to kill him because the rifle kicked out of position at the "moment of truth." All three consultations were requested for an evaluation of "suicide," even though they are alike as an apple, orange, and banana.
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摘要 :
As a term of particular usefulness, "suicide" has become generic to the point of meaninglessness. When I am in the general-hospital setting, the truth of this statement is driven home for me when the question I inevitably ask upon...
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As a term of particular usefulness, "suicide" has become generic to the point of meaninglessness. When I am in the general-hospital setting, the truth of this statement is driven home for me when the question I inevitably ask upon hearing the term is, "What do you mean by 'suicide'?" In a typical week on the consultation psychiatry service, for example, I may encounter a remorseful teenager who regrets the impulsive overdose she hoped would get her boyfriend's attention; an elderly man who would rather forgo dialysis than carry on as a cardiac cripple unable to engage any longer in the physical activities that bring his life meaning and joy; and a depressed, middle-aged man with severe facial wounds that resulted from a carefully planned gunshot wound to his brain that only failed to kill him because the rifle kicked out of position at the "moment of truth." All three consultations were requested for an evaluation of "suicide," even though they are alike as an apple, orange, and banana.
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Depression in the workplace is a common, chronic, and often recurrent disorder with consequences spanning a continuum from mild, barely perceptible subclinical effects to disabling symptoms, affecting employees at all levels of en...
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Depression in the workplace is a common, chronic, and often recurrent disorder with consequences spanning a continuum from mild, barely perceptible subclinical effects to disabling symptoms, affecting employees at all levels of enterprise structure. In its various forms, the disorder contributes to excess absenteeism, decreased at-work productivity (presenteeism), compromise of individual employment status, disruption of work organization (ie, the collective vocational and social fabric of work), and a surfeit of direct (medical and indemnity) and indirect health care and disability costs. A plethora of facts and figures describing the personal, organizational, and societal consequences of depressive illness can be found in the articles to follow-all supportive of the assertion that depression is a costly and debilitating disorder from any perspective.
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Adoption and twin studies show that familial transmission of suicidal behavior is partly attributable to genetic factors. Transmission of suicidal behavior is mediated by transmission of impulsive aggression or neuroticism and neu...
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Adoption and twin studies show that familial transmission of suicidal behavior is partly attributable to genetic factors. Transmission of suicidal behavior is mediated by transmission of impulsive aggression or neuroticism and neurocognitive deficits. The most plausible explanations for nongenetic familial transmission are the intergenerational transmission of abuse and adverse familial environments. Bereavement and relationship disruption contribute to suicidal risk via the development of complicated grief, although long-term effects may be mediated by a complex chain of interrelated events. Imitation may contribute to suicidal risk, at least in attempted suicide. However, so-called family environmental factors often are related to risk factors that are heritable. Conversely, genetic factors exert their impact on depression and suicidal behavior via interaction with a stressful environment.
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Studies of the interaction of the serotonin transporter genotype and environment upon adult depression (G x E) have suggested a role for both childhood maltreatment and stressful life events. This paper deals with two main issues....
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Studies of the interaction of the serotonin transporter genotype and environment upon adult depression (G x E) have suggested a role for both childhood maltreatment and stressful life events. This paper deals with two main issues. First, do both contribute? Evidence that G x E with childhood maltreatment plays a role is much stronger than that for G x E with life events occurring close to onset, although that for G x E with life events occurring over a 5-year period before the presence of the recorded depression is stronger. However, non-genetic research shows that life events occurring so long before onset as 5 years have little or no relationship with adult depression once childhood maltreatment is taken into account, suggesting they serve as a marker for childhood maltreatment rather than making a direct contribution to G x E. Second, genetic research has dealt only with the presence of depression and taking account of course may radically change ideas about the point at which G x E occurs. Two findings from non-genetic research concerning childhood maltreatment are relevant. Childhood maltreatment is associated with a particularly high risk of an adult onset of depression taking a chronic course (i.e. lasting 12 months or more). Moreover such maltreatment makes a substantial direct contribution - i.e. its link with course is independent of all other childhood and adult risk factors. This is consistent with early changes in brain function associated with the polymorphism in the context of childhood maltreatment explaining the link of such maltreatment with adult chronic episodes. It also follows that restricting analysis to such episodes would increase current estimates of G x E.
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BACKGROUND: Suicidal ideation is likely to represent a phase preceding suicidal acts among most suicidal patients with major depressive disorder (MDD). Factors predicting reversal of the suicidal process are unknown. Our aim was t...
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BACKGROUND: Suicidal ideation is likely to represent a phase preceding suicidal acts among most suicidal patients with major depressive disorder (MDD). Factors predicting reversal of the suicidal process are unknown. Our aim was to test the hypothesis that a decline in suicidal ideation is preceded by a decline in hopelessness among patients with MDD. METHOD: Of the 269 Vantaa Depression Study patients with DSM-IV MDD, 103 patients scored >/=6 points at baseline on the Scale for Suicidal Ideation (SSI). Seventy of these patients were followed-up weekly either until they scored zero points on the SSI, or up to 26 weeks. RESULTS: The median duration for a decline of suicidal ideation to zero was 2.2 months after baseline. The level of baseline suicidal ideation, depressive symptoms, and the presence of any personality disorder predicted duration of suicidal ideation. A decline in both depression (BDI) and hopelessness (HS) independently predicted a decline in suicidal ideation. LIMITATIONS: Due to study design, we do not know if suicidal ideation relapsed after the first time the patient reached zero score in the SSI. CONCLUSIONS: Among patients with major depressive disorder having suicidal ideation, the decline in suicidal ideation is independently predicted by preceding declines in the levels of both depressive symptoms as well as hopelessness. The findings are consistent with possible causal roles of declines in depression and hopelessness in reversing the suicidal process.
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BACKGROUND: The population attributable fraction of hopelessness, depression and other risk factors for suicidal ideation and suicidal attempts in Asian population is unknown. Social support is often said to be a buffer against th...
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BACKGROUND: The population attributable fraction of hopelessness, depression and other risk factors for suicidal ideation and suicidal attempts in Asian population is unknown. Social support is often said to be a buffer against the effect of hopelessness and depression. METHODS: Suicidal ideation, suicidal attempts as well as demographic and psychometric data were delineated in a random and representative population sample of 2,219 Chinese people in Hong Kong. The population attributable fraction was used to determine the contribution of hopelessness, depression and other risk factors to suicidal ideation and attempts. RESULTS: Multivariate modelling shows that about 40% of suicidal ideation and attempts was attributable to depression and about 20% was attributable to hopelessness. Drug abuse and marital dissolution were also significant contributors to suicidality. The impact of hopelessness and depression was not affected by social support. LIMITATIONS: Suicidality was self-reported. CONCLUSIONS: Suicidal ideation and suicidal attempts were to a large extent attributable to depression and hopelessness, and, to a lesser extent, drug abuse and marital dissolution. Social support appeared to play little role as a buffer.
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The relationship between adolescent suicide attempts and death by suicide and psychosocial functioning of peers remains poorly understood, especially in the myriad ways that these suicidal behaviors might impact friends. This stud...
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The relationship between adolescent suicide attempts and death by suicide and psychosocial functioning of peers remains poorly understood, especially in the myriad ways that these suicidal behaviors might impact friends. This study explored the relationship between peer suicidal behavior and adolescent risk behavior using a large, nationally representative sample of adolescents (N = 5852). Results indicate that youth exposed to peer suicidal behavior are significantly more likely to have their own suicidal ideation and attempts, and to smoke cigarettes and marijuana, binge drink, be involved in a serious physical fight, and have inflicted injuries that require medical attention. These results highlight the need for professionals to be aware of these risks in friends of those who have attempted or died by suicide. Assessment and intervention for peers is appropriate and required for this at-risk group.
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rich k.l. & butts j.b. (2004) Journal of Advanced Nursing46(3), 270-283 Rational suicide: uncertain moral groundBackground. The ambiguities involving end-of-life issues, such as physician-assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. Aim. The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. Findings. Attitudes towards suicide have been controversial, varying from acceptance to non-acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. Conclusion. Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions....
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rich k.l. & butts j.b. (2004) Journal of Advanced Nursing46(3), 270-283 Rational suicide: uncertain moral groundBackground. The ambiguities involving end-of-life issues, such as physician-assisted suicide and voluntary stopping of eating and drinking, have caused a blurring of the definition of rational suicide and have prompted rich dialogue with moral deliberations that seem to be on disparate paths among bioethicists and other health care professionals. With the evolution of advanced medical technology extending life expectancy in older, disabled, and terminally ill people, rational suicide has become a critical issue of debate. Aim. The purpose of this article is to address the ethical positions supporting and opposing rational suicide and to consider whether coherence can be achieved through an ethic of care. Findings. Attitudes towards suicide have been controversial, varying from acceptance to non-acceptance depending on social, political and religious influences. Nursing attitudes are no different from general societal attitudes and, consequently, nurses are treading on uncertain moral ground. Conclusion. Nurses who have not reflected on the moral issues involved with rational suicide may be unprepared psychologically and professionally when working with patients who may be contemplating such actions.
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Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact o...
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Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact of suicidal ideation and hopelessness on treatment with nortriptyline (NT). The degree of suicidal ideation and hopelessness was assessed during the screen visit with the use of items #3 and #30 of the Hamilton Depression Rating Scale (HAM-D) in 89 patients with TRD who entered a 6-week open trial of NT. Forty of these patients also completed the Beck Hopelessness Index (BHI) during the screen visit. In separate logistic regressions, the scores from the BHI and the two HAM-D items were then tested as predictors of clinical response to the 6-week trial with NT, controlling for the severity of depression. More than half of patients reported thoughts or wishes of death to self and significant hopelessness. A greater degree of hopelessness before treatment in completers, reflected by the score on the HAM-D item #30, predicted response to NT. More than half of patients with prominent hopelessness who completed the trial responded. Patients with TRD are more likely than not to report prominent suicidal ideation and hopelessness. Furthermore, a full 6-week trial of NT, a relatively noradrenergic tricyclic antidepressant, may be particularly useful in patients who have failed to respond to several antidepressants and also report significant hopelessness.
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