Electroconvulsive Therapy (ECT) and Suicide Prevention

Kellner, Charles H.; Li, Erin H.; Farber, Kate G.; Geduldig, Emma T.; Ahle, Gabriella M.

doi:10.1007/s40501-016-0067-8

Cited by 14 publications

(4 citation statements)

References 25 publications

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“…In support of the validity of the results of the present study, they are compatible with the findings from clinical trials of ECT among patients with mood disorder 9,31 . Most prominently, Kellner et al 9 showed that among depressed patients reporting suicidal thoughts or acts at baseline (a rating of 3 or 4 on the suicide item of the Hamilton Depression Rating Scale (HDRS)), these symptoms had resolved (a rating of 0 or 1 on the suicidality item of the HDRS) in 81% of the patients at the end of the course of ECT.…”

Section: Discussionsupporting

confidence: 90%

“…In support of the validity of the results of the present study, they are compatible with the findings from clinical trials of ECT among patients with mood disorder. 9,31 Most prominently, Kellner et al 9 showed that among depressed patients reporting suicidal thoughts or acts at baseline (a rating of 3 or 4 on the suicide item of the Hamilton Depression Rating Scale (HDRS)), these symptoms had resolved (a rating of 0 or 1 on the suicidality item of the HDRS) in 81% of the patients at the end of the course of ECT. The study by Prudic and Sackeim 32 also reported a decrease in suicidal ideation after ECT in 148 patients with unipolar or bipolar depression as measured by the suicide item of the Hamilton Depression Rating Scale, both for ECT responders (n = 76) and nonresponders (n = 72).…”

Section: Discussionmentioning

confidence: 99%

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Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Salagre

Rohde

Østergaard

2021

J ECT

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 99%

Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Salagre

Rohde

Østergaard

2021

J ECT

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“…Electroconvulsive therapy (ECT) may reduce suicidal ideation and intent in acutely depressed patients with mood and psychotic disorders 142 , however this has not been studied with suicide as a primary outcome. Reducing access to lethal means also remains relevant both in outpatient and inpatient settings 80,132 .…”

Section: Suicide Prevention During and After Psychiatric Hospital Adm...mentioning

confidence: 99%

Psychotic depression and suicide risk: a mixed methods study

Fredriksen¹

2022

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Background: The reasons behind suicide are multifactorial, complex, and poorly understood. Despite decades of research, suicide rates remain elevated both during hospitalization as well as shortly after discharge. Clinically relevant knowledge and tools for suicide risk assessments to guide decision-making processes in acute settings are needed. Objectives: The thesis objective was to examine and improve understanding of the complex relationship between psychotic depression and suicide behaviour. We also examined risk factors of clinical relevance in hospital settings, both during treatment, and after discharge. Methods: This research project used a sequential exploratory strategy, commencing with a qualitative part (paper 1-2), followed by a quantitative part (paper 3-4). In paper 1 and 2, we conducted qualitative interviews with nine patients diagnosed with psychotic depression as part of uni- or bipolar disorder. Papers 3 and 4 used data from the naturalistic prospective cohort study Suicidality in Psychiatric Emergency Admissions. In paper 3, we included all patients with depression (N= 1846) in a representative sample to identify risk factors for suicide using a cox regression analysis. Paper 4 investigated a mixed diagnostic sample of 7000 acutely admitted inpatients to identify imminent- and short-term risk factors for suicide. The findings from all four papers were combined into a secondary analysis, where we thematically synthesized the perspectives of patients’ experiences with the main findings from the prospective cohort study based on clinical assessment. Results thematic summarized: Our main finding was that psychotic symptoms in depression are associated with increased suicide risk, both short- and long-term (Paper 3). A possible mechanism to explain this association is the combination of intense emotional suffering and cognitive impairment which may motivate impulsive behaviour in psychotic depression (Papers 1 and 2). Depressed mood including overvalued ideas and delusions of self-blame and guilt predicted suicide the first following week after admission (Paper 4). The association of intense affective states with both imminent and long-term suicide risk factors was supported by patient experiences of sleeplessness and intense anxiety as warning signs for suicidal behaviour (Paper 1 and 2). In further support of this, depression severity assessed by the Health of the Nation Scale item 7 predicted suicide the first following week after admission (Paper 4). We found higher short-term suicide rates in patients diagnosed with psychotic depression as compared to those without psychotic symptoms at all follow-up points (Paper 3). A diagnosis of psychotic depression and depression severity assessed by MADRS depression scale as independent predictors of suicide provided knowledge on the long-term perspective (median 5.5 years follow-up). Also of clinical importance is our finding that self-report of suicidal ideation is not a good measure of imminent, short- or long-term suicide risk. Our qualitative findings indicate that shame, psychotically motivated paranoid ideation and impulsivity motivated underreporting of both suicidal ideation and psychotic symptoms in themselves. This may partly explain why, despite reporting less suicidal ideation/planning on admission, the suicide rate was higher for patients with psychotic symptoms on admission than for those without such symptoms (Paper 3). Although reported suicidal ideation was less relevant for clinical risk assessment, paper 3 and 4 identified male gender and recent suicide attempt as significant risk factors for completed suicide. The last main finding was that patients found both security measures and a treatment approach focusing on modifying psychotic experiences, intense anxiety and sleeplessness was helpful during hospitalization. Taking the time to talk to establish good patient relations is essential for optimal treatment conditions. Conclusions: The periods of acute inpatient treatment and immediately post- discharge are associated with the highest suicide risk. High symptom load as well as a diagnosis of psychotic depression, especially the presence of overvalued ideas and delusions of self-blame and guilt, appear to indicate especially high suicide risk regardless of time horizon. Identifying delusions and other psychotic symptoms is thus of the utmost importance. Psychosis- and depression-focused interventions and treatment approaches aiming specifically to reduce both psychotic and affective symptom load may act as a suicide prevention strategy for psychotic depressed patients. We found self-report of suicidal ideation of limited relevance when assessing suicide risk. Such assessments should thus always be combined with thorough clinical assessment by trained staff. This is especially true when assessing patients with psychotic depression, but especially given the frequent underreporting of psychotic symptoms, it remains important with any patient admitted for a depressive episode. Structured depression rating scales for clinician use may meaningfully contribute to suicide risk assessments. When assessing acute admission patients, we recommend paying particularly close attention to males, and patients with prior and recent suicide attempts.

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“…ECT[ 43 ] – Electroconvulsive therapy is associated with a rapid and robust antidepressant response as well as the rapid diminution in associated suicidal thoughts. May also be indicated for suicidal individuals during pregnancy or for those who have already failed to respond or tolerate trials of medications.…”

Section: Psychiatric Managementmentioning

confidence: 99%

Suicide: A Précis!

Naguy

Elbadry

Salem

2020

J Family Med Prim Care

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Background: Suicide remains a psychiatric emergency, tragedy, a public health burden, and for those aged 15-29, is the second leading cause of death globally. Stigma attached to psychiatric disorders and suicide means many people feel unable to seek help. Aim of Work: We highlighted confusing nosology, psychopathology, neurobiological underpinnings, typology, and, risk factor pertinent to suicide. A road-map to the clinical assessment and management of suicide has also been provided. Last, but not least, we tried to dispel the long-held myths about suicide. Methods: EMBASE, Ovid MEDLINE, PubMed, Scopus, Web of Science, and Cochrane Database of Systemic Reviews were searched for all relevant studies up to date of Jan, 2020. Results: Suicide is self-inflicted death with evidence (explicit/implicit) of intention to die. Suicide reflects many disparate determinants release/relief, response-to the disordered thinking, religious, revenge, rebirth, reunification or rational. 5-HT deficiency appears central to the neurobiology of suicide. Durkheim proposed 4 types of suicide (egoistic, altruistic, anomic, fatalistic). Risk factors for suicide entail both static and dynamic factors. Dynamic factors encompass both clinical and situational variables. Shneidman's concepts of perturbation and psychache are very crucial to consider when assessing the risk. Suicide rating scales are only ancillary with the Modified high-risk construct scale balances vectors of suicidality versus survivality. Myths germane to suicide abound that need to be demystified. Psychiatric management capitalizes on determining a setting for treatment and supervision, attending to patient's safety, as well as working to establish a cooperative and collaborative physician-patient relationship. This entails both psychosocial 'package' and somatic treatments and the best outcomes mandate well-keeled combined approaches. Pharmacologic interventions aim chiefly at acute symptomatic relief. Recently, heaps of data accrue speaking to the idea of ground-breaking 'anti-suicidal' agents that might alleviate suicidal ideation (SI) Conclusion: Suicide continues to be a complex public health problem of global calibre. It is variably tied to a myriad of risk factors underscoring likely etiological heterogeneity. That said, suicides can, at least partially, be prevented by restricting access to means of suicide, by training primary care physicians and health workers to identify people at risk as well as to assess and manage respective crises, provide adequate follow-up care and address the way this is portrayed in the media. A host of psychotherapeutic, pharmacological, or neuromodulatory treatments of mental disorders are readily available that can alter this acrimonious trajectory.

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Electroconvulsive Therapy (ECT) and Suicide Prevention

Cited by 14 publications

References 25 publications

Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Self-Harm and Suicide Attempts Preceding and Following Electroconvulsive Therapy

Psychotic depression and suicide risk: a mixed methods study

Suicide: A Précis!

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