| 1. |
- Nilsson, Anna Maria, et al.
(författare)
-
Application of an accident approach to the study of acute suicidal episodes through repeated in-depth interviews
- 2023
-
Ingår i: Death Studies. - Philadelphia, PA : Informa UK Limited. - 0748-1187 .- 1091-7683. ; 47:1, s. 75-83
-
Tidskriftsartikel (refereegranskat)abstract
- We modified an accident analysis model for the study of acute suicidal episodes (ASEs). Our aim was to use this model (SCREAM, Suicidal Cognitions' Reliability and Error Analysis Method) as a lens to understand the worst-ever ASEs of nine patients who took part in repeated in-depth interviews. Guided by the theory of SCREAM including four predetermined categories, nine themes were identified. ASEs were triggered by interactions with the interpersonal and physical environment and spiraled into a state of lost control. Timing and the availability of promoters and barriers in the environment were salient features. Findings may aid person-centered safety planning.
|
|
| 2. |
- Nilsson, Anna Maria, et al.
(författare)
-
The Meaning of Mental Imagery in Acute Suicidal Episodes : A Qualitative Exploration of Lived Experiences
- 2023
-
Ingår i: Omega. - Thousand Oaks, CA : Sage Publications. - 0030-2228 .- 1541-3764.
-
Tidskriftsartikel (refereegranskat)abstract
- Clinical assessment of suicidal ideation focuses on cognitions in the form of verbal thoughts. However, cognitions also take the shape of mental imagery. The aim of this qualitative study was to explore the meaning of mental imagery in acute suicidal episodes (ASEs). Eight persons with severe previous ASEs participated in repeated in-depth interviews and in the semi-structured Suicidal Cognitions Interview. Textual data from both sources underwent content analysis. All participants experienced suicide-related imagery during ASEs. Analysis resulted in two themes. (1) Suicide-approaching imagery: intrusive looming images that contributed to loss of control, flashforwards that clarified the suicidal solution, or desirable but unattainable images. (2) Suicide preventive imagery: death-alienating, life-affirming, or potentially helpful images. The meaning of mental imagery in ASEs is suggested to be understood in relation to the context of the individual ASE. A narrative approach is encouraged, as is an increased clinical focus on mental imagery in general. © The Author(s) 2023.
|
|
| 3. |
|
|
| 4. |
- Bangirana, P, et al.
(författare)
-
Cognition, behaviour and academic skills after cognitive rehabilitation in Ugandan children surviving severe malaria: a randomised trial
- 2011
-
Ingår i: BMC NEUROLOGY. - 1471-2377. ; 11
-
Tidskriftsartikel (refereegranskat)abstract
- Background Infection with severe malaria in African children is associated with not only a high mortality but also a high risk of cognitive deficits. There is evidence that interventions done a few years after the illness are effective but nothing is known about those done immediately after the illness. We designed a study in which children who had suffered from severe malaria three months earlier were enrolled into a cognitive intervention program and assessed for the immediate benefit in cognitive, academic and behavioral outcomes. Methods This parallel group randomised study was carried out in Kampala City, Uganda between February 2008 and October 2010. Sixty-one Ugandan children aged 5 to 12 years with severe malaria were assessed for cognition (using the Kaufman Assessment Battery for Children, second edition and the Test of Variables of Attention), academic skills (Wide Range Achievement Test, third edition) and psychopathologic behaviour (Child Behaviour Checklist) three months after an episode of severe malaria. Twenty-eight were randomised to sixteen sessions of computerised cognitive rehabilitation training lasting eight weeks and 33 to a non-treatment group. Post-intervention assessments were done a month after conclusion of the intervention. Analysis of covariance was used to detect any differences between the two groups after post-intervention assessment, adjusting for age, sex, weight for age z score, quality of the home environment, time between admission and post-intervention testing and pre-intervention score. The primary outcome was improvement in attention scores for the intervention group. This trial is registered with Current Controlled Trials, number ISRCTN53183087. Results Significant intervention effects were observed in the intervention group for learning mean score (SE), [93.89 (4.00) vs 106.38 (4.32), P = 0.04] but for working memory the intervention group performed poorly [27.42 (0.66) vs 25.34 (0.73), P = 0.04]. No effect was observed in the other cognitive outcomes or in any of the academic or behavioural measures. Conclusions In this pilot study, our computerised cognitive training program three months after severe malaria had an immediate effect on cognitive outcomes but did not affect academic skills or behaviour. Larger trials with follow-up after a few years are needed to investigate whether the observed benefits are sustained.
|
|
| 5. |
|
|
| 6. |
- Bergqvist, Erik, et al.
(författare)
-
Health care utilisation two years prior to suicide in Sweden: a retrospective explorative study based on medical records
- 2022
-
Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 22:1
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Previous literature has suggested that identifying putative differences in health care seeking patterns before death by suicide depending on age and gender may facilitate more targeted suicide preventive approaches. The aim of this study is to map health care utilisation among individuals in the two years prior to suicide in Sweden in 2015 and to examine possible age and gender differences. Methods Design: A retrospective explorative study with a medical record review covering the two years preceding suicide. Setting: All health care units located in 20 of Sweden's 21 regions. Participants: All individuals residing in participating regions who died by suicide during 2015 (n = 949). Results Almost 74% were in contact with a health care provider during the 3 months prior to suicide, and 60% within 4 weeks. Overall health care utilisation during the last month of life did not differ between age groups. However, a higher proportion of younger individuals (< 65 years) were in contact with psychiatric services, and a higher proportion of older individuals (>= 65 years) were in contact with primary and specialised somatic health care. The proportion of women with any type of health care contact during the observation period was larger than the corresponding proportion of men, although no gender difference was found among primary and specialised somatic health care users within four weeks and three months respectively prior to suicide. Conclusion Care utilisation before suicide varied by gender and age. Female suicide decedents seem to utilise health care to a larger extent than male decedents in the two years preceding death, except for the non-psychiatric services in closer proximity to death. Older adults seem to predominantly use non-psychiatric services, while younger individuals seek psychiatric services to a larger extent.
|
|
| 7. |
- Doering, Sabrina, et al.
(författare)
-
Anxiety symptoms preceding suicide: A Swedish nationwide record review.
- 2024
-
Ingår i: Journal of Affective Disorders. - 0165-0327 .- 1573-2517. ; 355, s. 317-324
-
Tidskriftsartikel (refereegranskat)abstract
- The literature on the relationship between anxiety and suicidal behaviors is limited and findings are mixed. This study sought to determine whether physicians noted anxiety symptoms and suicidality in their patients in the weeks and months before suicide.Data were derived from a nationwide medical record review of confirmed suicides in Sweden in 2015. Individuals with at least one documented physician consultation in any health care setting during 12months before suicide (N=956) were included. Clinical characteristics were compared between decedents with and without a notation of anxiety symptoms. Odds ratios were calculated to estimate associations between anxiety symptoms and suicidality in relation to suicide proximity.Anxiety symptoms were noted in half of individuals 1week before suicide. Patients with anxiety were characterized by high rates of depressive symptoms, ongoing substance use issues, sleeping difficulties, and fatigue. After adjustment for mood disorders, the odds of having a notation of elevated suicide risk 1week before death were doubled in persons with anxiety symptoms. Associations were similar across time periods (12months - 1week). Two-thirds had been prescribed antidepressants at time of death.Data were based on physicians' notations which likely resulted in underreporting of anxiety depending on medical specialty. Records were not available for all decedents.Anxiety symptoms were common in the final week before suicide and were accompanied by increases in documented elevated suicide risk. Our findings can inform psychiatrists, non-psychiatric specialists, and GPs who meet and assess persons with anxiety symptoms.
|
|
| 8. |
- Ehnvall, Anna, 1964
(författare)
-
Life-charting patients with treatment-refractory affective disorder
- 2004
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Introduction:In treatment-refractory affective illness there are several hypothesis to suggest alterations in the neurobiological systems in relation to illness course. The underlying mechanisms have been scantily investigated. The sensitisation hypothesis suggests a sensitisation process over time for affective disorder the affective illness course shows a tendency towards more frequent, deeper, and less stress related episodes over time. There are reasons to believe that these alterations in biological systems are a result of the wear-and-tear of the affective illness itself, a change from homeostasis to allostasis. By means of the Life-charting method, a graphical method to visualise the illness course in relation to stress and treatments over a lifetime, these hypothesis can be further analysed. Earlier Life-charting research has exclusively focussed on illness course per se, or in relation to stressing life events and treatment. Childhood experiences and its impact on later vulnerability for psychopathology have been emphasized earlier. The Life-charting method can help shed light on this vulnerability in relation to illness course. Aims:The current study was undertaken to explore the Life charting method in measuring illness course in 38 treatment refractory affective disorder patients in relation to the Sensitisation hypothesis, the HPA axis, monoamine metabolites in cerebrospinal fluid as well as experience of parental rearing. Subjects:The patients were consecutively admitted over a three-year period, to a Treatment Refractory Affective Disorder Program at the Sahlgrenska University Hospital at Mölndal, Sweden.Results: Our results partially support the sensitisation hypothesis of affective disorders in demonstrating this phenomenon in more than half of our affectively recurring patients. However, a substantial minority clearly were non-sensitisers showing a stable but more malignant illness course.We found cerebrospinal fluid (CSF) concentrations of the noradrenalin metabolite, 3-methoxy-4-hydroxyphenylglycol (MHPG), to be positively related to the accumulated burden of mood swings (defined as time spent in illness depth of episodes) over a lifetime, irrespective of age, gender, uni- or bipolarity, and current severity of depression. Thus, the involvement of noradrenalin turnover in the long-term burden of affective illness is a likely reality. These results point towards a shift in the biological set-points from homeostasis to allostasis.Also, the HPA axis, determined by the CRH challenge test, seemed to shift to a new biological set-point, an allostatic shift, as the individual experienced three or more illness episodes.We found that a patient with severe treatment refractory affective illness who perceived himself/herself as not wanted by his/her parents in childhood can be expected to have a more malignant illness course, as compared to a similar patient who instead perceived himself or herself as wanted during childhood.Conclusions: In conclusion, the life-charting method is useful in investigating psychological and biological variables in relation to illness course. Our findings support the hypothesis of altered neurobiological systems in relation to illness course in patients suffering from treatment refractory affective disorders. Furthermore, our findings also point towards a more malignant illness course in individuals with a more negative perception of parental rearing.
|
|
| 9. |
|
|
| 10. |
|
|
