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The rapid spread of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) throughout key regions of the United States in early 2020 placed a premium on timely, national surveillance of hospital patient censuses. To meet that need, the Centers for Disease Control and Prevention’s National Healthcare Safety Network (NHSN), the nation’s largest hospital surveillance system, launched a module for collecting hospital coronavirus disease 2019 (COVID-19) data. We present time-series estimates of the critical hospital capacity indicators from April 1 to July 14, 2020.
From March 27 to July 14, 2020, the NHSN collected daily data on hospital bed occupancy, number of hospitalized patients with COVID-19, and the availability and/or use of mechanical ventilators. Time series were constructed using multiple imputation and survey weighting to allow near–real-time daily national and state estimates to be computed.
During the pandemic’s April peak in the United States, among an estimated 431,000 total inpatients, 84,000 (19%) had COVID-19. Although the number of inpatients with COVID-19 decreased from April to July, the proportion of occupied inpatient beds increased steadily. COVID-19 hospitalizations increased from mid-June in the South and Southwest regions after stay-at-home restrictions were eased. The proportion of inpatients with COVID-19 on ventilators decreased from April to July.
The NHSN hospital capacity estimates served as important, near–real-time indicators of the pandemic’s magnitude, spread, and impact, providing quantitative guidance for the public health response. Use of the estimates detected the rise of hospitalizations in specific geographic regions in June after they declined from a peak in April. Patient outcomes appeared to improve from early April to mid-July.
This study examined specific risk factors discriminating psychiatric inpatients who were never suicidal from those who reported one or more suicide attempts, and compared characteristics discriminating first-time attempters from first-time and multiple repeaters (recent attempters with one or more previous attempts).
716 inpatients admitted to the Division of Psychiatry of a University Hospital were evaluated for their suicidal history, psychiatric diagnosis, current and past stressors, and other clinical and sociodemographic risk factors.
Of the 358 attempters, 86 were first-time attempters, 219 first-time repeaters, and 53 multiple repeaters. There were significant differences between the nonattempters and the attempters in sociodemographic variables, DSM-IV-TR diagnosis (attempters were diagnosed more frequently with eating disorders, and less frequently with DSM-IV Axis II disorders than nonattempters), and clinical history. First-time attempters had fewer lifespan stressors (M=1.86; SD=0.90) than repeaters (first-time repeaters: M=2.26 [SD=0.89]; multiple repeaters: M=2.28 [SD=1.13]). Furthermore, repeaters were more likely to have personality disorders (ORs=2.71-3.83), low social support (OR=4.96-6.88), and previous hospitalizations (ORs=37.23-556.69) than first-time attempters.
In repeaters, stressors may have a specific effect and a cumulative effect. They can predispose to attempts at an earlier age and, through a process of “kindling” start a “suicide career.” Alternately, an accumulation of stressors can produce a “last straw” effect. In repeaters hospitalization can be seen as another factor contributing to the kindling phenomenon, and brief intensive care in hospital settings must be weighed accurately for efficacy and for its possible negative effects.
The authors examined the association between tobacco smoking and suicidal ideation and planning in schoolchildren from 10 countries in Africa, the Americas, and the Western Pacific region.
Data were collected through the Global school-based Student Health Survey (GSHS), a collaborative surveillance project between the World Health Organization (WHO), the United Nations, UNICEF, UNESCO, UNAIDS, and the US Centers for Disease Control and Prevention (CDC). Suicidal ideation and planning, tobacco smoking, and drug and alcohol use were included in loglinear models to analyze, separately for each sex, higher order interactions among suicidality and regional and country differences.
Schoolchildren who reported suicidal ideation and/or suicidal planning had a higher risk of smoking cigarettes even after controlling for drug and alcohol misuse. Furthermore, analyses indicated higher order interactions between suicidal ideation and planning and countries belonging to different regions with different exposure to tobacco smoking among schoolchildren.
Future studies analyzing the mechanism and sequencing of the relationship among suicidal ideation and tobacco smoking should explore cultural factors.
It has frequently been suggested that low self-esteem and low self-worth are closely related to psychological and emotional problems, particularly depression. In a retrospective study of “prodromal” symptoms of obsessive-compulsive disorder (OCD), Fava et al. (1996) noted that low self-esteem was one of a number of symptoms (including depression) reported as preceding the onset of OCD. Low self-esteem could also have the effect of predisposing people to the development of psychological problems regardless of type as a general vulnerability factor.
In a preliminary investigation of the link between self-esteem and obsessional problems, patients with OCD (n = 34) were compared with patients with social phobia (n = 29), diagnosed according to DSM IV. Standardized measures of self-esteem and clinical symptomatology were also administered: the Beck Depression Inventory (BDI), the Assertiveness Schedule of Rathus, the State Trait Inventory Anxiety, Yale Brown Obsessive Compulsive Scale (Y-BOCS) and Self-Esteem Inventory of Coopersmith (SEI).
Indicated that the OCD group differed significantly from the social phobia group on generalized self-esteem assessments (p<0.001). Both groups showed a lower self-esteem but there was some evidence of OCD specific effects; depressive cognitions altered significantly self-esteem in OCD patients (p<0.001). Obsessionals were more likely than anxious controls to link their self-worth to other people and their relationships. They also regarded the possibility of causing harm as likely to result in other people making extreme negative and critical judgements of them. The implications for future research and for treatment of OCD are discussed.
The insight paradox posits that among patients with schizophrenia, better insight is associated with depressive symptoms. However, available studies are characterized by conflicting results.
First, we conducted a systematic review, a meta-analysis and a meta-regression based on 59 available correlational studies. Second, we examined a cross-sectional examination on 80 patients diagnosed with schizophrenia in stable phase of the illness. Measures of depressive dimension were based on the Calgary Depression Scale for Schizophrenia (CDSS) and Beck Depression Inventory (BDI), for insight the Scale to assess Unawareness of Mental Disorder (SUMD). Furthermore, we assessed self-stigma, self-esteem and psychotic symptoms to test mediating and moderating models (Preacher and Hayes models).
In the meta-analysis, global insight was associated weakly, but significantly with depression (effect size r=0.14), as were the insight into the mental disorder (r=0.14), insight into symptoms (r=0.14) and symptoms’ attributions (r=0.17). Whereas, insight into the social consequences of the disorder or into the need for treatment were not associated with symptoms of depression. Better cognitive insight was associated with higher levels of depression. Methodological and clinical factors moderated the magnitude of the association between insight and depression. Similar results were observed in the clinical sample, where self-stigma significantly mediated the association between insight and depression.
In conclusion, both literature and clinical findings indicate that better insight is associated with higher levels of depressive symptoms among patients with schizophrenia: interventions that are aimed at improving insight need to take into account the implications of these findings
Previous findings suggested that electrodermal hyporeactivity has a high sensitivity (up to 97%) and high raw specificity (up to 98%) for suicide.
To evaluate prevalence, sensitivity and specificity of electrodermal hyporeactivity for suicide and suicide attempt, with and without death intent and with violent method or not, in adult patients with a primary diagnosis of depression.
At each study site at least 100 patients with a primary diagnosis of depression, also in remission, will be recruited. Depressive symptomatology will be evaluated through the Montgomery-Asberg Depression Scale. Previous suicide attempts will be registered and the death intent of the worst attempt will be rated according to the first eight items of the Beck Suicide Intent Scale. The risk of suicide will be assessed according to rules and traditions at the centre. The EDOR Test (ElectroDermal Orienting Reactivity) will be performed. Two fingers are put on gold electrodes. Through headphones a moderately strong tone is presented now and then during the test. Sensors located within the electrodes are able to register the electrodermal response to those tones, measuring the skin conductance (i.e. electrodermal activity from sweat gland activity). Each patient will be followed up for one year for actions of intentional self-harm that require medical care and for suicide. The death intent will also be rated.
It is expected that the EDOR test detects a previously unknown neuropsychological dysfunction that is independent of the depressive state and can predict suicidality with a high sensitivity and specificity.
Official reports indicate that the overall prevalence of lifetime childhood maltreatment has been estimated to be 30% in population-based samples and the association between childhood trauma, suicide behaviors and psychiatric disorders was previously shown.
The objective of the current study was to assess the presence and severity of ‘male’ depressive symptoms and suicidal behaviors in psychiatric patients who reported history of child abuse and neglect on the Childhood Trauma Questionnaire (CTQ)
To study the association between childhood trauma, suicidal behaviors and non-typical depressive symptoms.
163 adult inpatients were enrolled in the current study and completed the Mini International Neuropsychiatric Interview, Gotland Scale of Male Depression, the Childhood Trauma Questionnaire and the Suicidal History Self-Rating Screening Scale.
The group with no or minimal history of child abuse and neglect (N = 98) was characterized by lower scores on all the dimensions of the CTQ and higher scores on minimization/denial than the group with moderate to severe history of child abuse and neglect (N = 64). Furthermore patients with moderate to severe history of child abuse and neglect were more often females (62.5%), reported more severe ‘male’ depressive symptoms (20.82±10.12, t160 = −3.675, p-value < 0.001) and higher SHSS scores (6.90±4.49, t160 = −2.68, p-value 0.01).
Our data highlight the association between several childhood trauma and ‘male’ depression in both male and female patients. Furthermore Childhood trauma may be a risk factor for suicide attempts. Further researches are needed to clarify this issue.
Anomalous experiences such as Basic Symptoms (BS) are considered to be the first subjective manifestation of the neurobiological substrate of schizophrenia. Recently it has been outlined indeed, how various aspects of the phenomenological basic self-disorders occurring in schizophrenia may correlate with neurocognitive disturbances.
The purpose of this study is to explore whether a low or high emotional motor resonance occurring in Schizophrenia Spectrum (SzSp) patients is related to patients' clinical features and to their anomalous subjective experiences as indexed by the Bonn Scale for the Assessment of Basic Symptoms (BSABS).
We employed a validated paradigm sensitive in evoking a congruent facial mimicry (measured by means of facial Electromyographic activity, EMG) through multimodal positive and negative emotional stimuli presentation.
Results showed that SzSp patients more resonating with negative emotional stimuli (i.e., Externalizersfor negative emotions), had significantly higher scores in BSABS Cluster 3 (Vulnerability) and more psychotic episodes than patients belonging to the Internalizers group. On the other hand, SzSp patients more resonating with positive emotional stimuli (i.e., Externalizers for positive emotions), scored higher in BSABS Cluster 5 (Interpersonal Irritation) than patients belonging to the Internalizers group.
Drawing upon a phenomenological-based perspective, we shed new light on the abnormal experiences characterizing SzSp conditions, explaining them in terms of a disruption of the normal self-perception conveyed by the more basic, automatic, low-level emotional motor mechanisms. The importance of adopting a trans-domain approach integrating findings from the phenomenological and the neurophysiological levels of analysis is further emphasized.
Therapeutic research on suicide was virtually unknown a decade ago, but recently a great deal of clinically important information has emerged. A landmark event was approval by the US FDA of antisuicidal effects of clozapine in schizophrenia patients in 2003. Interest in effects of psychotropic drug treatments on suicidal behavior was strongly stimulated by recent regulatory warnings of increased risk of suicidal thoughts or behaviors in juveniles and young adults treated with modern antidepressants. This presentation reviews recent research findings pertaining to effects of psychoactive drugs on suicide risk. Antipsychotics other than clozapine are not known to reduce suicidal risk. Lithium has compelling evidence of long-term effectiveness in reducing risks of suicide and attempts by as much as 80% among patients with bipolar disorders, a mix of major affective disorders, and possibly also recurrent major depressive disorder. It has long been recognized that some depressed patients experience increased agitation soon after exposure to antidepressants, and such reactions may increase suicidal risk. These effects usually can be anticipated and minimized by timely clinical interventions. The findings of beneficial effects of antidepressant treatment on suicidal ideation but not behavior, and of reduced risk of suicidal behaviors by lithium and clozapine, suggest differential pharmacologic effects on particular components of 'suicidality,' in that reduction of anger, aggression and impulsivity evidently can limit progression from suicidal ideation to acts. Effective suicide prevention requires focused assessment and supervision, especially early in clinical management of patients with major mood disorders, with appropriate pharmacological and psychosocial interventions.
The New Generation Antipsychotics (NGAs) are frequently used in People with Intellectual Disability (PWID), especially for treating aggressive behaviour. However there is very limited research to fully establish evidence-based approaches for their use in this population.
To evaluate the effectiveness of NGAs, in particular olanzapine and risperidone, in treating aggressive behaviour in PWID for who previous medication with First Generation Antipsychotics (FGAs) were not effective.
62 subjects with intellectual disability underwent to a two-arm, parallel group pragmatic trial of olanzapine and risperidone with balanced randomisation and blind assessment of outcomes after a switch from a treatment with FGAs. Psychiatric disorders were evaluated by Diagnostic Assessment for the Severely Handicapped (DASH). Aggressive behaviour was assessed by Overt Aggression Scale (OAS) and clinical outcome by Clinical Global Impression (CGI) Scale. Side effects were assessed with specific scales, laboratory and instrumental tests.
Both risperidone and olanzapine resulted to be more effective than FGas in reducing aggressive behavior and in treating concurrent psychiatric disorders. the degree of improvement in our sample was very high for OAS and CGI scores. Both compounds resulted to be well tolerated, with side-effects similar to those encountered in other patient populations.
Our findings seem to confirm previous literature on that olanzapine and risperidone can be effective in reducing aggressive behaviour in PWID. Although NGas have shown greater efficacy and safety than FGAs, there is still a need for controlled trial and more methodically researches to confirm their benefit.
The aim of the present study was to assess sociodemographic and clinical differences between BD patients, pure MDD patients, and MDD patients with cyclothymic temperament (MDD-CYC).
Participants were 281 adult inpatients (134 men and 147 women) consecutively admitted to the Department of Psychiatry of the Sant'Andrea University Hospital in Rome, Italy, between January 2008 and June 2010. The patients completed the Hamilton Scale for Depression (HAMD17), the Young Mania Rating Scale, the TEMPS-A (Temperament Evaluation of the Memphis, Pisa, Paris and San Diego - Autoquestionnaire) and the Beck Hopelessness Scale.
38.7% of the MDD patients met criteria to be included in the MDD-CYC group. Above 93% of the MDD-CYC reported suicidal ideation (27.6% suicide attempts) at the item 3 of the HAMD17.Furthermore, MDD-CYC patients reported higher hopelessness compered to other patients.
Our results are potentially limited by the small number of MDD-CYC patients included in the sample.
Our results support the clinical usefulness of the concept of soft bipolar spectrum. Patients with unipolar depression and cyclothymic temperament differ from pure MDD patients and BD patients in terms of temperamental profile and clinical variables.
Interferon-related depressive disorders are well known in literature. Despite this, few study have been able to identify reliable predictors of depression
Our aim was to examine the predictive value of several bio-psycho-social factors for the development of persistent clinically significant depression in patients affected by HCV treated with IFN. We also aimed at describing the clinical course, treatment and impact on quality of life of depression.
We conducted a cohort prospective study with assessments at baseline and at 4, 8, and 24 weeks with clinical interview and self-administered psychometric tests. We evaluated depressive symptoms with the Hamilton Depression Rating Scale, manic symptoms, anxiety, suicidal ideation, temperament, alexithymia and quality of life with other reliable instruments.
Preliminary results are available for 61 patients. Depressive symptoms increased significantly during IFN therapy to peak after 4 weeks. A third of patients still suffered clinically significant symptoms after six months. In a multivariate model, the onset of irritability (aOR= 6.5; p=0.03) and living alone (aOR= 7.4; p=0,06) predicted the persistence of depression after 6 months. The preliminary model displayed good levels of specificity and sensitivity.
Both psychological traits (irritability) and social factors (living alone) predicted the persistence of depression. These findings might prove useful to improve early detection of vulnerable patients and their mental health care in the real clinical world. Larger samples are however needed to confirm these findings.
Mood disorders (MD) are disabling conditions throughout the world associated with significant psychosocial impairment. Affective temperaments, as well as hopelessness, may play a significant role in the pathophysiology of MD. The present study was designed to characterize patients with MD for their prevalent affective temperament and level of hopelessness.
559 consecutive adult inpatients were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego- Autoquestionnaire version (TEMPS-A), the Gotland Scale for Male Depression (GSMD), the Beck Hopelessness Scale (BHS) and the Mini International Neuropsychiatric Interview (MINI).
Higher cyclothymia (27.7% vs. 20.0%, < 0.05) and irritable (34.7% vs. 22.9%, p < 0.05) temperaments were found in bipolar disorder-I (BD-I) patients compared to those with other Axis I diagnoses. Major depressive disorder (MDD) patients had lower hyperthymia than BD-I and BD-II (22.9% vs. 44.6% vs. 40.7% p < 0.05) and higher anxiety than patients with other Axis I diagnoses (52.1% vs. 22.3%, p < 0.05). Severe’male’ depression was more common in BD-II patients compared to BD-I and MDD, respectively (33.7% vs. 16.3% vs. 22.9% p < 0.05). BD-I and patients with other axis I diagnoses reported lower BHS≥9 scores (41.6% and 36.6% vs. 61.6% and 62.5%, p < 0.05) than those with BD-II and MDD.
MDD patients were more likely to have anxious prevalent temperament, higher hopelessness and lower hypethimic temperament while BD-I patients had more frequently cyclothymic and irritable temperaments than patients with other Axis I diagnoses. The implications of the present results were discussed.
Sex offenders are persons convicted for having committed one of a list of statutorily defined sexual offenses. According to the APA Task Force definition, sex offence is a purposeful behavior which involves at least another person, adult or not, in a sexual act with physical, verbal or an other form of coercion or manipulation. A sex offender seems to use the other as an object to achieve his own pleasure, careless of the victim's feelings and suffering. The growing number of sexual abuses and crimes is a social cproblem that claim psychiatric attention, and poses some questions: is this inhuman behavior pathological? are they just cruel, or their cruelty is a symptom of a complex disease? If they've some kind of disease, is there a common dimensional pattern? Answers to these questions open controversial discussions about their psychology, new perspective in treatment and management. The aim of the study is to assess the prevalence of Personality Disorders among sex offenders, referring to a population of convicted in a prison of Genoa, Italy.
Body- art is associated with an increased risk of self- harming behaviours and suicide attempts (SA) in adolescents, but there is no concluding evidence for adults yet.
We investigate the relationship between ‘body art’ (i.e. tattoos, piercings) and SA in adult patients.
All patients admitted to the Psychiatric Clinic of Genoa for a SA between October 2012 - January 2013 were enrolled. Age, gender, education, previous SA, psychiatric diagnosis were analyzed. The patients underwent first a clinical interview where the presence of body-art, type, number, location, time between its performance and previous or present SA were assessed along with its meaning for the patient, then SCID I & II.
44 patients were enrolled (24 females). Mean age 47 years. 26 had at least a tattoo, among them six females. Eight had at least one piercing, of whom six were females. 58,3% had a diagnosis of MDD, 41.6% of PD (BPD 72%;NPD 34%; OCPD 42%; PPD 23%). 75% of patients with more than one tattoo had a diagnosis in both axes and attempted suicide more than once. These results show that 40% of our sample has a tattoo and one third a piercing, which presence in the same-age American population is estimated to be 26%. However, these results have a limited statistical significance because of the small sample size.
These results suggest a particular mind-body bond which would correlate SA and body art in adult patients, while previous studies found such evidences only in the adolescent population.