Search Results (121)

Understanding the effectiveness of suicide prevention measures for high-risk locations can often be challenging as many rely, at least to some degree, on psychological processes (e.g., engaging with help-seeking behaviours). Establishing how these measures may influence decision-making during a suicide attempt could be helpful for understanding how and when they may be most effective at preventing deaths. In the present work, we consider how suicide prevention measures may influence “goal pursuit” as it unfolds. Drawing on findings from across the suicide prevention literature, we apply the descriptive framework outlined in GOAL Architecture to consider how different measures may shape perceptions of “distance”, “time”, and “rate of progress” and, in turn, could influence levels of motivational drive associated with specific acts (e.g., “accessing means for suicide”). This is discussed in relation to real-time decisions around accessing means for suicide, avoiding intervention by a third party, and engaging in help-seeking behaviours. As well as the psychological processes that could encourage or prevent an individual from disengaging from a suicide attempt, we also consider potential risks and the influence of person-level factors. Full article

Background/Objectives: Long-acting injectable antipsychotics (LAIs) represent a significant advancement in the treatment of schizophrenia (SCZ), particularly for improving adherence and long-term outcomes. This study aimed to assess the clinical outcomes of patients receiving atypical LAIs compared to those on various oral antipsychotics over a one-year follow-up in a naturalistic setting. Methods: Sixty patients with SCZ were subdivided in two groups, those receiving LAIs (n = 25) and those receiving oral antipsychotics (n = 35). The groups were comparable for age, gender, educational attainment, employment status, marital status, smoking habits, and baseline SCZ severity, with no differences in baseline chlorpromazine equivalent dosages. Results: Over the follow-up period, patients in the LAI group discontinued treatment less frequently (χ² = 4.72, p = 0.030), showed fewer suicide attempts (χ² = 5.63, p = 0.018), fewer hospitalizations (χ² = 4.95, p = 0.026), and fewer relapses (χ² = 6.61, p = 0.010). Significant differences also emerged on the Drug Attitude Inventory (DAI-10) scores (F = 8.76, p = 0.005) and Body Mass Index (BMI) values (F = 8.32, p = 0.007), with the LAI group showing more favorable outcomes. Conclusions: LAIs, compared to oral antipsychotics, may promote treatment adherence, as shown by decreased hospitalization; furthermore, their use is related with better outcomes, like fewer relapses and less suicide attempts in individuals with SCZ in real-world settings. Full article

Suicide in children is a major global health crisis, with profound impacts on families, friends, and society. Understanding ways to ameliorate the rate of suicide attempt (SA) is critical given that it is a key factor in predicting future suicide risk. SA is the deliberate act of causing physical injury to oneself with the intent of death. The incidence of SA may be influenced by physical activity (PA). PA includes bodily movement via skeletal muscles that results in energy expenditure and physical fitness. While there is evidence to suggest that PA improves dysregulation of the parasympathetic nervous system which underpins the physiology of suicidal behaviour, evaluating the impact of PA on SA in children is required. Objectives: This systematic review aims to determine the relationship between PA and SA in children to inform alternative preventative and interventional strategies. Methods: This systematic review was registered with PROSPERO: CRD42023389415. Eight electronic databases were systematically searched. References were transferred to Covidence software for title and abstract screening and full text review were performed based on eligibility criteria: (1) children aged 6–18 years old; (2) participated in PA (individual, group exercise, or team sports); and (3) examined SA as a dependent variable. The JBI Checklist was used to measure the quality and level of bias of included studies. Results: Of the 2322 studies identified, 21 were included in the final analysis of the review. Twenty studies were cross-sectional in design, and one implemented a prospective study design. Thirteen studies (61.9%) yielded statistically significant results, indicating that increased PA, particularly team sport, may be associated with reduced odds of SA. There was some evidence to suggest that certain intensities and frequencies of PA may be beneficial to some and detrimental to other subgroups. Conclusions: The results suggest that PA may reduce the risk of suicide attempts. Although PA may be associated with reduced SA in children, future research is required, which (1) uses standardised outcome variables; (2) adopts longitudinal and experimental study designs; (3) explores qualitative research to determine distinctive factors that influence participation in PA not captured by quantitative research; and (4) examines different target populations such as children with a broad range of mental health issues. Full article

Prostate cancer (PCa) is a highly heterogeneous disease, with castration-resistant prostate cancer (CRPC) and neuroendocrine prostate cancer (NEPC) representing its most aggressive and therapy-resistant forms. Emerging evidence indicates that lineage plasticity—driven by key transcription factors such as Octamer Binding Factor 4 (OCT4)—plays a crucial role in therapeutic resistance and disease progression. OCT4, in coordination with SOX2 and NANOG, acts as a master regulator of stemness and is frequently upregulated in prostate cancer stem cells (PCSCs). This upregulation contributes to tumor initiation, metastasis, and resistance to both androgen deprivation therapy (ADT) and chemotherapy. In this review, we explore the role of OCT4 in mediating lineage plasticity in prostate cancer, with particular emphasis on its involvement in treatment resistance and neuroendocrine differentiation. We also examine therapeutic strategies aimed at targeting OCT4 directly, such as microRNA-mediated suppression, small-molecule inhibitors, and suicide gene therapy, as well as indirect approaches that modulate OCT4 expression via FGFR and NF-κB signaling pathways. While these strategies offer promising avenues, challenges such as adaptive resistance and the intricate signaling networks within PCSCs remain significant hurdles. A deeper understanding of the molecular mechanisms underlying OCT4-driven plasticity may pave the way for novel therapeutic approaches and improved outcomes in advanced prostate cancer. Full article

Ketamine and esketamine are two closely related compounds with fast-acting antidepressant properties that have reshaped the treatment landscape for individuals with treatment-resistant depression (TRD). Originally developed as anesthetic agents, both have since demonstrated rapid and robust antidepressant effects in patients who have not responded to conventional treatments such as selective serotonin reuptake inhibitors (SSRIs) or cognitive behavioral therapy. This narrative review synthesizes evidence on their pharmacology, mechanisms of action, clinical efficacy, safety profiles, and regulatory considerations, with a particular focus on their neuroplastic effects. While ketamine is a racemic mixture composed of equal parts R- and S-enantiomers, esketamine consists solely of the S-enantiomer and has been approved for intranasal use by the FDA and EMA for TRD. These agents have been shown to produce symptom relief within hours of administration—an unprecedented effect in psychiatric pharmacology. This rapid onset is particularly valuable in managing suicidal ideation, offering potential lifesaving benefits in acute settings. Furthermore, ketamine and esketamine’s influence on synaptic plasticity, brain-derived neurotrophic factor (BDNF), and glutamate transmission provides insights into novel therapeutic targets beyond monoaminergic systems. This review incorporates recent real-world findings and peer-reviewed literature to contextualize the clinical use of these agents in modern psychiatry, bridging experimental research with practical application. Full article

Background: Chronotype reflects individual variations in daily activity and sleep patterns, influenced by underlying circadian rhythms. While chronotype is often reduced to the morningness–eveningness spectrum, recent evidence suggests more diverse circadian typologies. Chronotype is linked to mental health, frequently associated with psychiatric disorders such as depression and suicide. This study aims to examine differences among six chronotypes (as defined by Single-Item Chronotyping) in mental health outcomes, including depression, anxiety, interpersonal relations, general functioning, suicidal behavior, and suicide acceptance. Methods: The study sample consisted of 306 young adults. Chronotype was determined using the Polish version of Single-Item Chronotyping (SIC). Mental health was assessed with the 30-item General Health Questionnaire (GHQ-30), which evaluates three dimensions: depression and anxiety, interpersonal relations, and general functioning. The Suicide Behavior Questionnaire (SBQ-R) measured past and potential future suicidal tendencies, while the Suicide Acceptance Questionnaire (SAQ) assessed attitudes toward the act of suicide. Results: The “daytime sleepy” and “moderately active” chronotypes were identified as at higher risk for mental health issues. These types exhibited greater levels of depression and anxiety, more general dysfunction, and a higher risk of suicidal behavior. The “daytime sleepy” type also experienced more interpersonal relationship difficulties compared to the “daytime active” type. Conclusions: Recognizing the “daytime sleepy” and “moderately active” types as risk factors highlights the importance of considering chronotype in mental health assessments. The SIC provides a concise method for monitoring circadian rhythm changes during treatment, facilitating tailored interventions such as modifying treatment schedules or lifestyle adjustments in alignment with an individual’s circadian rhythm. Full article

Work-related stress is a major contributing factor to the relatively high number of deaths from suicide and other mental disorders among those who work in the construction industry. Despite the knowledge that unmanaged stress can manifest as depression and ultimately trigger thoughts of suicide or even the act itself, workers’ mental health is often neglected. This study aims to identify the risk factors that are at the root of the workers’ mental health challenges, as well as the strategies that can be initiated to overcome or at least mitigate them. To accomplish this, a systematic literature review was conducted using the PRISMA method, and 132 relevant publications that met the pre-defined inclusion criteria were selected for further analysis. From the data analysis, 45 risk factors were identified and classified into five categories based on the literature and the definition of stressors. The most frequently cited mental health risk factors were revealed to be gender inequality (diversity and equity category), poor working conditions (health-related category), work overload (job demand category), poor work–life balance (organizational category), and lack of social support (personal category). Thirty-two (32) intervention strategies were identified and divided into primary, secondary, and tertiary types. It was evident from the findings that combining all three types of interventions is the most effective way to improve the mental health of the construction workforce. The findings from this study provide valuable insights for policymakers and regulatory agencies who develop and implement policies aimed at improving mental health and occupational safety in the construction industry. Full article

Background/Objective: To address the growing demand for mental health services, Nova Scotia Health introduced the Rapid Access Stabilization Program (RASP) through its Mental Health and Addictions Program (MHAP) in April 2023. RASP is designed to help reduce long wait times, frequent emergency department visits, and admissions to provide early intervention for individuals experiencing mental health problems. The RASP focuses on rapid access and early mental health intervention, aiming to prevent the worsening of patients’ symptoms, improve access to psychiatric care, and reduce service pressures on programs like the Community Mental Health Program (CMHP), which provide more extended, ongoing mental health support. This study compared participants’ sociodemographic and clinical profiles in the RASP and the CMHP. Methods: Data were collected from 1392 participants accessing mental health support either through the RASP or CMHP. A comparative analysis of sociodemographic factors (e.g., age, education, and income) and clinical characteristics (e.g., depression, anxiety, resilience, and substance use) was conducted. Chi-square tests and independent sample t-tests were used to evaluate the mean differences between the groups. Results: Significant sociodemographic and clinical differences emerged between the RASP and CMHP participants. The RASP group was older (M = 40.10 vs. 34.52 years) and more socioeconomically stable, with higher rates of employment (55.3% vs. 47.9%) and homeownership (36.5% vs. 17.7%). In contrast, the CMHP group had higher unemployment (25.7% vs. 16.5%) and lower income levels, with 47.5% earning <CAD 29,590 compared to 30.3% in the RASP group. Clinical profiles differed markedly: depression was more prevalent in the RASP (48.2% vs. 19.3%), whereas the CMHP had higher rates of psychosis (10.6% vs. 2.5%) and substance use disorder (7.8% vs. 1.9%). The RASP participants exhibited higher anxiety (GAD-7: M = 14.17 vs. 11.81) and depression symptoms (PHQ-9: M = 16.62 vs. 14.20) but lower resilience (BRS: M = 2.47 vs. 2.77). The CMHP participants had more adverse childhood experiences (ACE: M = 3.92 vs. 3.16) and lower suicidal intent (81.4% vs. 99.4% had no intention to act). Conclusions: The findings highlighted the unique profiles between the RASP and CMHP participants, suggesting the need for program-specific interventions. While the CMHP participants may benefit from integrated social support and trauma-informed care, the RASP participants may require cognitive behavioral therapy and resilience-building interventions. Tailoring mental health services to meet these unique needs could enhance program effectiveness and patient outcomes across both groups. Full article

This auto-theoretical essay examines the philosophical and historical underpinnings of suicide through a critical analysis of the author’s own suicide note, employing psychoanalytic theory and post-colonial critique. Through historical investigation, the author traces how the concept of suicide, coined in 1642 by Sir Thomas Browne, emerged alongside new configurations of selfhood that were fundamentally shaped by colonial encounters, particularly the “discovery” of America and the rise in modern liberal thought. The analysis reveals how suicide’s conceptual structure is inextricably linked to Western modernity’s founding ruptures, where the capacity for self-destruction became a marker of Western subjectivity while being denied to colonized and enslaved peoples. The author concludes that suicide, far from being a purely personal act, is fundamentally structured by colonial history and white supremacy, functioning as a form of “white enjoyment” that attempts to resolve the metaphysical ruptures at the heart of Western consciousness. Full article

Background: Suicide is a global public health issue, particularly in low- and middle-income countries and among vulnerable groups such as adolescents. Despite increasing research efforts, understanding the psychosocial factors associated with suicidal behavior remains a challenge. This study examines family and personal histories of suicidal behavior, exposure to violence, empathy, and perceived social support in adolescents who have received healthcare services in Ecuador. Methods: A cross-sectional study was conducted with 438 adolescents aged 12 to 18 years. Participants were classified into suicide attempt survivors (AS, n = 58) and non-attempters (NAS, n = 380). A characterization questionnaire was applied (prior hospitalization for suicide attempt, family history, and survivor condition), the Alexian Brother Urge to Self-Injure scale, the Plutchik Suicide Risk Scale, the Multidimensional Scale of Perceived Social Support, and the Cognitive and Affective Empathy Test. Results: Adolescents with a history of suicide attempts exhibited higher levels of self-injurious behavior impulse (OR = 8.90, CI 95% [4.28–18.52], p < 0.001), Gravity attempt (OR = 8.162, CI 95% [4.34–15.37], p < 0.001), and suicide risk (OR = 2.90, CI 95% [1.42–5.94], p = 0.006). A significant association was found between suicide attempts and exposure to domestic (p = 0.000), school (p = 0.000), and sexual violence (p = 0.000). A family history of suicide attempts increased the likelihood of suicidal behavior in adolescents (OR = 2.40, CI 95% [1.12–5.16], p = 0.022). In contrast, perceived family support acted as a potential protective factor (OR = 0.36, CI 95% [0.15–0.91], p = 0.055). Conclusions: These findings highlight the need for prevention strategies that address social and developmental factors. Full article

Background—Aggressive solid tumors are commonly characterized by both basic intracellular pH and acidic extracellular pH, which increase cell survival and proliferation. As carbonic anhydrases IX/XII are involved in this pH regulation, their inhibition is an appealing approach in cancer therapy, avoiding cancer cell survival and proliferation. Substituted coumarins are selective non-classical CA IX and CA XII inhibitors. Methods—In this study, new 7-hydroxycoumarinamides were synthesized and assayed for CA inhibition and antiproliferative activity. Results—All of the coumarinamides showed human CA IX and CA XII selective inhibition over the off-target CA I and CA II isoforms. Coumarin acts as a suicide inhibitor because its heterocyclic ring can be hydrolyzed by CA esterase activity to give the corresponding 2-hydroxycinnamic acid derivative which blocks the entrance of the active site. The 2-hydroxycinnamic acid derivatives deriving from the most potent and selective coumarinamides were docked into CA IX and XII to better understand the activity and selectivity against the two CA isoforms. The most active coumarinamides also produced a decrease of A549 cell proliferation and were able to arrest cells at the G1/S checkpoint. Conclusions—These results may open new perspectives for developing coumarin-based CA IX/XII inhibitors. Full article

Background/Objectives: Suicide accounts for 1.4% of global deaths, and the slow-acting nature of traditional treatments for suicide risk underscores the need for alternatives. Psychedelic therapies may rapidly reduce suicide risk. This systematic review evaluates impact of psychedelic therapies on suicide-related outcomes. Methods: A systematic search of MEDLINE, Embase, PsycINFO, and ClinicalTrials.gov was conducted up to November 2024. Results: Four randomized controlled trials (RCTs) evaluated suicidality as a secondary outcome or safety measure, showing significant reductions in suicidal ideation with psilocybin (three studies) and MDMA-assisted therapy (MDMA-AT; one study). Effect sizes, measured by Cohen’s d, ranged from =0.52 to 1.25 (p = 0.01 to 0.005), with no safety issues reported. Five additional RCTs assessed suicidality as a safety measure, showing reductions in suicidal ideation with psilocybin (two studies) and MDMA-AT (three studies; p = 0.02 to 0.04). Among 24 non-randomized and cross-sectional studies, results were mixed. Psilocybin (three studies) reduced suicidal ideation, with odds ratios (OR) of 0.40–0.75. MDMA-AT (five studies in PTSD patients) had a pooled effect size of d = 0.61 (95% CI: 0.32–0.89). LSD (six studies) showed increased odds of suicidality, with odds ratios ranging from 1.15 to 2.08. Studies involving DMT (two studies) and multiple psychedelics (three studies) showed mixed results, with DMT studies not showing significant effects on suicidality and studies involving multiple psychedelics showing varying outcomes, some reporting reductions in suicidal ideation and others showing no significant change. Conclusions: The effect of psychedelic therapies on suicide-related outcomes remains inconclusive, highlighting the need for further trials to clarify safety and therapeutic mechanisms. Full article

Suicide in Italy represents a serious public health problem, with significant data highlighting the urgency for prevention interventions. According to the epidemiological data, in the two-year period 2020–2021, 7422 suicides were recorded, representing an increase compared to previous years. Suicide is the most extreme self-harm. The contributing factors that surround this event are multiple, typically in conditions of serious distress or psychological distress, in particular in people suffering from serious psychiatric and/or mental disorders, such as depression. The role of the forensic pathologist in the context of suicide is crucial for ascertaining the contributing factors of death and for understanding the circumstances that lead to the suicidal act. Forensic medicine plays a crucial role in the analysis and understanding of suicides, addressing both the legal and medical implications. The aim of this study was to accurately describe the phenomenon of suicide in Italy. The accuracy of the review was very important in paying attention to the large difference in how the phenomenon manifests itself in the male population compared to the female population. The different ages at which suicide is committed were highlighted. The geographical difference between the North and the South and between the more urbanized areas compared to the rural areas where suicide is committed was analyzed. This scientific work also aimed to explore how forensic pathologists contribute to the resolution of complex forensic investigations. Psychological autopsy is an investigative method used primarily in cases of violent or questionable death, with the aim of understanding the psychological and social circumstances that led to an individual’s death. This practice is distinct from forensic autopsy, which focuses on the physical analysis of the body to determine the cause of death. The role of forensic pathologists in investigating suicide cases is crucial, as they not only determine the cause of death but also analyze the psychological implications that may have led to the extreme act. The main objective of a forensic pathologist in these cases is to gather and interpret evidence that can help understand the psychological and social context that influenced the decision to commit suicide, identifying any warning signs and underlying motivations and factors that may have contributed to the suicide. This approach provides valuable information for prevention, enhancing the understanding of the psychological mechanisms behind suicide and supporting targeted interventions in the future. The manuscripts also have an explanatory purpose and may have a therapeutic role in helping surviving relatives understand suicide. Knowledge of the messages contained in suicide notes could be useful for suicide prevention programs. Full article

Background: Nowadays, exotoxic substance intake is among the most frequently employed methods of suicide. Self-poisoning is quite common among psychiatric patients treated in hospitals. Psychotropic drugs used for suicide include phenothiazines. Promazine hydrochloride (Talofen©) is an alpha-lytic phenothiazine neuroleptic with a high affinity for histaminergic H1 receptors and a low affinity for dopaminergic D2, serotoninergic 5-HT, alpha1-adrenergic, and muscarinic receptors, which may explain its potent sedative effect. The most common adverse effects include extrapyramidal syndromes, weight gain, orthostatic hypotension, QTc prolongation, convulsions, delirium, and psychosis. Rare adverse events include the potential occurrence of autoimmune syndromes and vasculitis. Methods: We report herein the delayed death of a 59-year-old woman due to cardiocirculatory arrest on an arrhythmic basis in the context of vasculitis of the small pulmonary vessels and prolongation of the QTc interval secondary to voluntary acute intoxication with promazine hydrochloride. Results: The incident occurred in a psychiatric patient with a history of prior self-harming acts. Histological investigations revealed wavy fibers in the heart, a lymphocytic granulocyte infiltrate in the walls of small- and medium-caliber vessels, and spotty perivascular deposition of histiocyte-macrophage cells in the lungs. Immunophenotypic investigations showed the prevalence of CD15+ and T-CD3+ elements, thus identifying a small vessel vasculitis. These findings were consistent with the literature regarding adverse events following the intake of promazine hydrochloride, although vasculitis is rare. Conclusions: Thus, while QTc lengthening and arrhythmic incidents are widely reported events associated with promazine hydrochloride use, the development of a rare condition such as pulmonary vasculitis undoubtedly played a synergistic and decisive stressogenic role in the genesis of the cardiac event, leading to irreversible functional arrest. Full article

Background/Objectives: Bipolar disorder (BD) and obsessive-compulsive disorder (OCD) often coexist, presenting significant challenges in treatment. OCD comorbidity in BD is associated with severe clinical features such as increased suicidality and impaired functioning. While selective serotonin reuptake inhibitors (SSRIs) are effective for OCD, they may increase manic shifts in BD patients. The use of long-acting injectable (LAI) antipsychotics such as monthly aripiprazole (ARI-LAI) and monthly paliperidone (PP-LAI) has been proposed as a promising alternative for BD treatment, while their efficacy and safety in BD-OCD remain understudied. This study investigated the effectiveness and tolerability of ARI-LAI and PP-LAI as adjunctive therapies in this population. Methods: 27 BD-OCD patients were treated with ARI-LAI or PP-LAI, alongside mood stabilizers (MS) (lithium or sodium valproate), over a 24 week period. Clinical and psychopathological assessments were performed at baseline and regular intervals using the Yale-Brown Obsessive Compulsive Scale and the Hamilton Depression Rating Scale. Safety and tolerability were evaluated using the UKU Side Effect Rating Scale. Results: Both treatments led to significant reductions in obsessive-compulsive symptoms and mood stabilization without manic episodes. ARI-LAI showed superior tolerability in terms of body weight gain compared to PP-LAI, with no significant differences in overall efficacy between the groups. Conclusions: This study is the first that investigated the efficacy and safety of adjunctive PP-LAI and ARI-LAI in this population highlighting their potential as effective and well-tolerated options for managing BD-OCD. Further studies are needed to confirm these results and refine treatment strategies for this complex population. Full article