Protective factors against suicidal acts in major depression:Reasons for living, Journal Club Presentation in the Dept of Psychiatric Nursing, Kothamangalam
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
This presentation is about geriatric Psychiatry awareness. it contains basic information about what is geriatric psychiatry, which are the main psychiatry disorder found in elderly and how to manage them?. it contains some detailed information about late life depression, delirium and dementia in geriatric population.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
A journal club article review prepared for the Psychiatry Residency of Texas Tech El Paso - Paper title: 'Psilocybin Produces Substantial & Sustained Decreases in Depression & Anxiety in Patients With Life-threatening Cancer: A Randomized Double-Blind Trial'
Cognitive Behavior Therapy (CBT) for Psychosiscitinfo
Presented by: Dawn I. Velligan, Ph.D.
Professor, Department of Psychiatry
Director, Division of Schizophrenia and Related Disorders
Meredith L. Draper, Ph.D.
Assistant Professor, Department of Psychiatry
University of Texas Health Science Center, San Antonio
The Gurū-Chelā Relationship Revisited: A Review of the Work of Indian Psychia...Université de Montréal
In a series of original and pathbreaking publications, Jaswant Singh Neki (1925-2015), a leading Indian Sikh scholar and psychiatrist (Sikhnet contributors, 2021; Wikipedia contributors, 2021), proposed the gurū-chelā (master-disciple) relationship to create a new paradigm for the therapeutic relationship, employing an accessible cultural idiom that Indian patients could understand and identify with (Neki, 1973, 1974, 1975, 1976, 1977, 1978, 1992). Contrasting his new Indian paradigm with the Western patient-therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change-seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, 1997). The gurū-chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki’s paradigm in India (Carstairs, 1980; Parkar, et al., 2001; Sethi & Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), among Indian trainees in the West and in their return to India (Ananth, 1981; Pande, 1968; Surya, 1966) and in Western psychiatric and psychotherapeutic cultures (Di Nicola, 1985a, 1985b, 1997), concluding with a synthesis of Neki’s gurū-chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
The association of neuropsychiatric disorders with cerebrovascular disease has been recognized by clinicians for over 100 years. Disease of the vascular system contribute greatly to the sum total of psychiatric disability, chiefly in the elderly population, mainly as a result of stroke, cerebrovascular accidents & subarachnoid haemorrhage.
A journal club article review prepared for the Psychiatry Residency of Texas Tech El Paso - Paper title: 'Psilocybin Produces Substantial & Sustained Decreases in Depression & Anxiety in Patients With Life-threatening Cancer: A Randomized Double-Blind Trial'
Cognitive Behavior Therapy (CBT) for Psychosiscitinfo
Presented by: Dawn I. Velligan, Ph.D.
Professor, Department of Psychiatry
Director, Division of Schizophrenia and Related Disorders
Meredith L. Draper, Ph.D.
Assistant Professor, Department of Psychiatry
University of Texas Health Science Center, San Antonio
The Gurū-Chelā Relationship Revisited: A Review of the Work of Indian Psychia...Université de Montréal
In a series of original and pathbreaking publications, Jaswant Singh Neki (1925-2015), a leading Indian Sikh scholar and psychiatrist (Sikhnet contributors, 2021; Wikipedia contributors, 2021), proposed the gurū-chelā (master-disciple) relationship to create a new paradigm for the therapeutic relationship, employing an accessible cultural idiom that Indian patients could understand and identify with (Neki, 1973, 1974, 1975, 1976, 1977, 1978, 1992). Contrasting his new Indian paradigm with the Western patient-therapist relationship, Neki explored both similarities and sharp contrasts between Western and Indian cultures. Neki argued (1974) that “both are voluntary associations wherein a master enables a change-seeker to dispel ignorance and the effects of undesirable social conditioning.” Using ideas adapted from Raymond Prince, one of the founders of Social and Cultural Psychiatry at McGill University, the author identifies the “I-centered assumptions” behind Western-based psychotherapy: based on the individual as the focus of therapy, using introspection and insight as key therapeutic methods, with personal independence as the goal of therapy (Di Nicola, 1985a, 1985b, 1997). The gurū-chelā relationship, by contrast, “encourages permanent dependency, since the guru assumes total responsibility for leading the chela toward self-mastery through the disciplines of persistence and silence,” and would be “most suited to cultures valuing self-discipline rather than self-expression, and creative harmony between individual and society” (Neki, 1974; emphasis added). The author will take stock of the impact of Neki’s paradigm in India (Carstairs, 1980; Parkar, et al., 2001; Sethi & Chaturvedi, 1985), in the Indian diaspora (Shridhar, 2008), among Indian trainees in the West and in their return to India (Ananth, 1981; Pande, 1968; Surya, 1966) and in Western psychiatric and psychotherapeutic cultures (Di Nicola, 1985a, 1985b, 1997), concluding with a synthesis of Neki’s gurū-chelā paradigm with contemporary trends in psychotherapy, psychiatry, and psychoanalysis.
Antipsychiatry Movement arose as a zeitgeist of the 1960s anti-establishment movements. It has in a way contributed to the development of psychiatry by pointing out its short comings.
Journal club - Disease progression in hemodynamically stable patients present...Farooq Khan
Critical appraisal of:
Glickman SW et al. Disease Progression in Hemodynamically Stable Patients Presenting to the Emergency Department With Sepsis. Acad Emerg Med. 2010 17:383-90
Interactive quiz on early goal-directed therapy, surviving sepsis guidelines and EBM topic of prognosis studies.
Journal Club: Telomere Length And Cortisol Reactivity In Children Of Depresse...Ashutosh Ratnam
Here's a Journal Club Presentation I made on the article 'Genetic Predisposition to Schizophrenia Associated with Increased Use of Cannabis' which appeared in the Sep 14 issue of Molecular Psychiatry. It examined and found a correlation between shortened telomere length in women and a risk for depression in their daughters.
ABSTRACT- Background: The occurrence of psychiatric disorders is more in the prisoners than in general population. Co-morbidity is seen to be an important and complex entity in clinical assessment of mental state competence (diminished mental capacity, temporary insanity and insanity) in the offenders at the time of the offence. It has a great role in determining all possible options in future treatment of violent offenders. Aim: This research article is focused on the co-morbid psychiatric diagnoses and the treatment outcomes in the mentally ill prisoners referred to the tertiary care mental health facility. Materials and Method: Total 100 mentally ill prisoners referred to the tertiary care psychiatric hospital during the study period (Jan 2015 - Dec 2015) was the sample size. It was a prospective study and the sampling method was of the purposive type. Results: Besides their primary diagnosis, the referred prisoners had more than one co-morbid psychiatric diagnosis in 46% of the cases. The most frequent co-occurring conditions were learning disabilities, personality disorders, and substance use disorders. The outcomes for the psychiatric conditions were positive as patients responded well to the line of management. Conclusion: The study provides valuable data to understand the mental health needs and the treatment gaps in this population so as to plan adequate services to tackle these issues. Key-words- Mentally ill prisoners, Psychiatric co-morbidities, Treatment outcomes, Substance use disorders, Personality disorders
Organizational Contex and Patient Safety: Is there a Role for Mindfulness?Heather Gilmartin
Presentation to review and define the concept of organizational context, present research on context and the relationship to healthcare associated infections, review the practice of mindfulness, discuss a role of mindfulness in patient safety.
A presentation on the newly introduced cross-cutting symptom measures in DSM5. I'd made this as part of my psychiatry residency, and the article describes why the need came about, the process of formulating and testing the new cross-cutting system and the repercussions this will have on psychiatric practice
Depresi dan bunuh diri sebagai masalah kesehatan mental yang lazim untuk pasien hemodialisis. Tujuan: Para penulis meneliti faktor-faktor demografi dan psikologis yang terkait dengan depresi pada pasien hemodialisis dan dijelaskan hubungan antara depresi, kecemasan, kelelahan, kualitas kesehatan yang berhubungan hidup yang buruk, dan meningkatkan risiko bunuh diri.
The National Mental Healthcare Act-2017 and its implication to current psychiatric care practice in India.
A webinar on the topic at Parul University, Vadodara, Gujrat India
History collection format in psychiatric Nursing (Courtesy Department of Psy...Mental Health Center
Psychiatric History collection format in general psychiatric unit adapted from the department of psychiatry, National Institute of Mental Health and Neuroscienses Bangalore.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
4. Background (Cont.)
• Previously hypothesized: a stress-
diathesis model for the expression of both
suicidal behavior and completed suicide.
• Stressors or trigger domains, are state
dependent
• A diathesis or threshold domain, which is
more trait dependent.
5. Background (Cont.)
• There are significant religious or
cultural modulators in suicidal
acts among people.
• Facilitating those modulators
would be an important clinical
strategy for reducing the risk for
suicidal acts
6. Objective
• Verify hypothesis
– Does number of reasons to live reduce the
proportionate intensity of suicidal acts?
– Why depressed patients want to want to live?
7. Method
• Examined the demographic and clinical
correlates of history of suicide attempts in
patients with major depression.
• Patients with or without history of
attempted suicides were compared.
8. Method (Cont.)
• Subjects
– were recruited from patients admitted to two
urban university psychiatric hospitals
– aged between 18 and 80 years
– met the DSM IV criteria for current major
depressive episode during the intake clinical
assessment, and
– were free of severe, unstable medical &
neurologic disorders
10. Method (Cont.)
7. St. Paul Ramsay Life Experience Scale &
Recent Life Changes Questionnaire (quantity
& severity of life events )
8. Comprehensive lifetime history of lifetime
suicidal acts
9. Scale for Suicide Ideation(current ideation)
10. Suicide Intent Scale (intent at the most lethal
and most recent suicide attempt)
11. Medical Lethality Scale (medical injury
resulting from suicidal acts)
11. Results
• Demographic features
– Age(p=0.16), Gender (p=0.41), education
(p=0.38), religion (p=0.16), Race (p=0.03) and
Marital status (p=0.55).
– Depressed non-Caucasians were significantly
less likely to have attempted suicide than
were the depressed Caucasians
– No difference in the distribution of unipolar
versus bipolar depression (Fishers two-tailed
p=0.59)- (SCID-P)
12. Results (Cont.)
• Clinical features
– Of the 84 patients, 45 had attempted suicide
and 39 had not
– The suicide attempters reported significantly
greater subjective depression (p=0.007),
hopelessness (p=0.009), and suicidal ideation
(p=0.0004), than the nonattempters.
– Details as follows
13. Results (Cont.)
Characteristi
cs
Attempters
Mean±SD
Non-
attempters
Mean±SD
Test value p value
Hamilton
Depression
Rating scale
28.9±8.2 30.5±7.9
0.93 0.35
St Paul
Ramsay Life
Experience
Scale
4.00±1.10 3.70±1.2 1.21 0.23
BPRS 38.4±7.0 39.2±7.4 0.50 0.62
Hopelessness
scale
12.2±5.8 8.8±5.5 2.66 0.009
BDI II 31.4±11.9 23.9±11.8 2.79 0.007
Scale for
suicidal
ideation
20.6±10.5 12.1±10.1 3.68 0.0004
14. Reasons for Living
Reason for
living
inventory
Attempters
Mean±SD
Non-
attempters
Mean±SD
Test value p value
Total score
138.6±43.4 181.0±40.1
4.22 0.0001
Factor-wise scores
Responsibility
toward family
21.1±8.9 26.9±6.6 3.40 0.001
Fear of social
disapproval
9.0±2.9 12.8±3.6 5.31 0.0001
Moral objections 9.7±5.8 14.8±6.7 3.79 0.0003
Survival and
coping beliefs
70.1±26.8 92.3±23.8 3.79 0.0003
Fear of suicide 21.3±6.4 24.5±7.5 2.02 0.05
Child related concern
All subjects 9.3±5.8 10.2±5.9 0.67 0.51
Subjects with
children
12.6±5.5 14.6±3.9 1.36 0.18
15. Results (Cont.)
• Correlation analysis
– Pearson correlation analysis:
– The total score for reasons for living was
significantly inversely correlated with the
scores for hopelessness (r=–0.58;p<0.0001),
suicidal ideation (r=–0.48;p<0.0001), and
subjective depression (r=–0.42;p<0.0005).
– Clinical suicidality was significantly inversely
correlated with reasons for living (canonical
correlation=–0.64, ; p<0.0001).
16. Discussion
• Findings are consistent with results in a study
of BPD
• A higher total score for reasons for living was
associated with less hopelessness(may
modulate the threshold for acting on suicidal
thoughts)
• Subjective perception of stressful life events
may be more germane to suicidal expression
than objective quantitative measures of such
events.
17. Discussion (Cont.)
• Chinese patients : depression, rather than
hopelessness, was related to suicidal intent
(Chiles JA, Strosahl KD, Ping ZY, Michael MC, Hall K, Jemelka R, & Senn B,
Reto C; 1998).
• Reasons for living, like hopelessness, may
reflect a cultural or environmental component
to determine the suicide threshold.
• Repeated exposure to depression, rather
than the duration of depression, may be an
additional risk factor for suicidal acts in
patients who experience suicidality when
depressed
18. • Religion (not differentiate;p=0.16); the
scores for moral objections to suicide
(differed stronglyp=0.0003).
• Greater moral objection to suicide
protected against higher-lethality suicidal
acts.
Reasons for living may be a more
sensitive indicator of enduring
moral/religious beliefs than is “religion of
origin” per se.
19. Recommendations
• Caution is required when generalizing the
results(the study group was small and
confined to patients with major
depression).
• Assessment of reasons for living should
be included in the evaluation of suicidal
patients.
• Treatment strategies that reduce clinical
suicidality, or that increase awareness of
reasons for living, may be complementary,
and they can be explored.
20. Critique
• The time range of the study was not told.
• Samples came from two different hospital,
however the distribution of the patient in them
wasn’t described
• The sample size was small, further more, the
process of case enrollment was not introduced
in detail
• This study used a series of scale with good
reliability and validity but the author didn’t give
message about the evaluating members & the
consistency of measurement (?)
21. Critique (Cont.)
• t-test and chi-square test were used when
comparing the subjects; (advanced
statistics method (such as logistics
regression) could be adopted ?)
• Every variables in table 1 were described
in the article except the marital status
variable.
• This paper had mentioned about
“ duration of depressive episodes ”,
however no data were shown in the table
for comparison.
22. Critique (Cont.)
• Focus on the
protective factors.
• The new discovery
• The method of this
study can be
replicated
Plus
• Representativeness
of samples
Minus
23. Further reading
• Joanne McLean, Margaret Maxwell,
Stephen Platt, Fiona Harris, Ruth Jepson
(2008). Risk and protective factors for
suicide and suicidal behavior: a literature
review. Available at
http://www.scotland.gov.uk/Resource/Doc/
251539/0073687.pdf cited on 28.04.2014