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PubMed1979

Predictive scales for parasuicide repetition. Further results.

A six-item predictive scale for parasuicide repetition was retested on a second sample of Italian parasuicides. All the patients firstever admitted after a deliberate self-harm to the psychiatric department of a general hospital during the period April 1973-March 1976 were interviewed and followed-up after an interval of 1 year. The scale showed the same predictive power found in the first sample (1970-73) and gave a range of probability of repetition within 1 year of 15% at a score of 0 up to 44.8% at the scores 3, 4, 5, and 6. Moreover it discriminated between repeaters and non-repeaters at a significant level. Only two items (diagnosis of sociopathy and change of domicile in the last year) of the five items which discriminated repeaters from non-repeaters in the first study were still significantly associated with repetition, while four additional items (previous in-patient psychiatric treatment; previous parasuicide resulting in hospital admission; unemployment; criminal record) appeared as new discriminating factors. In spite of these changes the rate of repetition remained constant over the years at around 26%.

Follow-Up Studies↗
PubMed1979

Types of attempted suicide (parasuicide).

The clinical usefulness of a typology of parasuicide, reported in a previous paper, has been improved. A finer grained classification, using six instead of only three clusters, has proved itself to be clinically highly realistic. By a new method of cluster analysis which examines 80 attributes in each of 350 patients, the following types of parasuicide emerge: (1) operant, not alienated; (2) repeaters; (3) depressed with high life endangerment; (4) operant and alienated; (5) wristcutters; (6) undifferentiated. This more detailed typology may offer some advantages for clinical management and research.

Humans↗
PubMed2026

Risk of subsequent self-harm, suicide attempts and suicide following a first hospital-treated self-harm episode among young people: a population-based cohort study.

BACKGROUND: Self-harm in young people is associated with elevated risks for subsequent self-harm, suicide attempts and suicide, particularly during the first year. Yet the trajectory across sex, age and self-harm methods remains poorly understood. OBJECTIVE: To estimate risk for subsequent self-harm, suicide attempts and suicide following a first hospital-treated self-harm event in young people. METHODS: This study included 77 647 individuals (57.0% female) whose first hospital-treated (ie, within inpatient or outpatient specialised healthcare) self-harm episode occurred between ages 10-24 years during 1973-2019. We estimated cumulative incidence and incidence rate for subsequent self-harm, suicide attempts and suicide at 1 month, 3 months and 1 year following the initial episode. FINDINGS: Within 1 year, the cumulative incidence was 17.3% (95% CI 17.0 to17.5) for subsequent self-harm, 8.3% (8.1 to 8.5) for suicide attempt and 0.3% (0.2 to 0.3) for suicide. The highest risks occurred in the first month: 8.4% (8.2 to 8.6) for self-harm, 2.9% (2.8 to 3.0) for suicide attempt and 0.04% (0.03 to 0.05) for suicide. In the first month, the incidence rate of self-harm was 2.97 per 1000 person-days (2.90 to 3.05), falling to 0.55 (0.54 to 0.56) over the year. The suicide attempt rate declined from 0.98 (0.94 to 1.02) to 0.24 (0.24 to 0.25) and the suicide rate from 0.013 (0.009 to 0.019) to 0.007 (0.006 to 0.008). Males exhibited the highest suicide risk and females the highest attempts risk. First-month self-harm risk was greatest among males and children aged 10-12. CONCLUSIONS: The month following a self-harm episode is marked by an elevated risk of subsequent self-harm, suicide attempts and suicide, yet risk remains elevated over the full year. CLINICAL IMPLICATIONS: These findings underscore the need for both acute and sustained prevention efforts. Special attention should be given to males and children aged 10-12 presenting with self-harm of ambiguous intent, as their risk of repetition may otherwise go unrecognised.

Humans↗
PubMed1977

A typology of parasuicide.

Parasuicide is not a single syndrome. Subtypes at present recognized are based largely on clinically derived stereotypes. When considering a series of patients, the clinician is unable to handle more than a few attributes at a time. This paper describes the application of three very different clustering algorithms to a material of 350 treated parasuicide patients. Mathematically, three types emerge. Clinically, two of these are interpretable and make sense. The types established are: I (n = 107) a group not characterized by any of the variables we examined; this group is a puzzle, mainly because the reasons for the parasuicidal act are not clear. II (n = 132) a depressed, alienated group with high life-endangerment. III (n = III) a group whose act was highly operant: they felt alienated and were angry with others. These groups did not differ significantly on demographic variables. The usefulness of this typology, particularly for management, after-care and prevention, has now to be assessed.

Anger↗
PubMed1979

A comparison of social workers and psychiatrists in evaluating parasuicide.

Sixty parasuicide patients admitted to medical wards were assessed by social workers prior to routine psychiatric assessment. Both disciplines completed a rating schedule. The social workers' and psychiatrists' rating schedule responses were compared, and their decisions were examined against further information obtained by a research psychiatrist, which included standardized mental state assessment. Overall the results show that social workers can safely and reliably assess these patients, but they are more cautious. A management approach involving social workers assessors of parasuicide patients is discussed.

Humans↗
PubMed1979

Samaritan contact among 325 parasuicide patients.

With the aim of aiding primary prevention of parasuicide by Samaritans, a study of 325 parasuicide patients admitted to hospital was undertaken to discover the extent of knowledge about Samaritans, the proportion of patients who had contacted Samaritans and the reasons why the remainder had not done so. Ignorance about Samaritans was found in 28 per cent, such ignorance being significantly more common among teenagers than in other age groups. Only 1.4 per cent had sought help from Samaritans immediately before the present parasuicidal act, though a further 13 per cent had contacted Samaritans previously. Suggestions are made for future public education programmes about Samaritans.

Adolescent↗
PubMed1979

A biological approach to two forms of human self-injury.

One hundred cases of self-injury, comprising 39 self-cutters and 61 self-poisoners, were interviewed when they became able to describe the act: 83 in a casualty department, 17 in a hospital. Standardized recordings were made of their feeling state before and after the act, together with an account of the social circumstances under which it occurred. The information was obtained in a way which allowed comparison with existing animal data on self-injury, although comparisons were made between what is known of animal behavior in this area and human feelings as reported by these subjects. The results indicate similarities between what is known of animal self-injury and self-cutting in man in the form of the injury, in the social situation preceding the act, and in the agitation preceding it. Similarities also exist, but are less close, for the self-poisoners. The most obvious effect of the act is a reduction in tension; this may constitute its physiological value.

Adolescent↗
PubMed1977

Suicidal behavior as a form of communication in married couples.

Suicidal behavior, specifically threats of suicide and acts of self-injury and self-poisoning, are interpreted by suicidologists as acts of communication directed to some person important in the social life of the potential victim. Four groups of married couples were studied using a measure of their marital communication habits and an intensive personal interview. These groups included wives who (a) were volunteer workers in a suicide prevention center, (b) were experiencing marital problems but were not actively suicidal, (c) had called the suicide prevention center and made a verbal threat of suicide, and (d) had actually committed acts of self-injury or self-poisoning for which they received emergency room or hospital treatment. Analysis of the data revealed that the quality of interpersonal communication between spouses significantly deteriorated across the groups as the degree of suicidal behavior increased. Descriptive data are discussed for their relevance to clinicians who, if they correctly interpret the meaning of the "suicide attempt," may be in a position to facilitate its being a successful one.

Attitude↗
PubMed1979

Self-injury in the de Lange syndrome.

Self-injury, a common problem among retarded children is thought to be a behavioural manifestation of an organic disease and the usual treatment has been through drugs or physical restraint. Psychological treatment techniques were used to control such behaviour in a de Lange syndrome patient. The treatment was effective in producing clinically significant control of self-injurious behaviour.

Adolescent↗
PubMed1979

Speech skill levels and prevalence of maladaptive behaviors in autistic and mentally retarded children: a statistical study.

Forty-seven autistic and 128 mentally retarded children, ages 6 to 14, from a special school were assessed in terms of nine maladaptive behaviors and speech skill levels. The results indicated that the group of the mentally retarded children with withdrawal had significantly lower speech skill levels than the group of those without withdrawal, and the group of the autistic children with self-injury had significantly lower speech skill levels than the group of those without self-injury.

Adolescent↗
PubMed1978

Auto-mutilation in animals and its relevance to self-injury in man.

Self-mutilation in non-human mammals is a well-established, although not a widely known phenomenon, which has been reported under zoo and laboratory conditions. In macaque monkeys, laboratory rearing and isolation are important predisposing factors, and the more serious self-injury is initiated by some immediate stimulating event. It is commonly accompanied by behaviour normally shown by the animal in a fighting context. Lower mammals are also known to mutilate themselves under laboratory conditions after administration of drugs wich probably cause increased sympathetic activity. The implications of this behaviour for an understanding of states of self-injury in man are discussed.

Aggression↗
PubMed2025

Systematic Review of Symptoms of Catatonia in Autism Spectrum Disorder.

Catatonia is a complex neuropsychiatric syndrome characterized by disturbances in mood, motor function, behavior and speech. It is increasingly recognized in individuals with autism spectrum disorder (ASD), although its identification remains challenging due to the overlapping clinical features of the two conditions. Shared characteristics, such as echophenomena, mannerisms, social indifference and repetitive behaviors can obscure accurate diagnosis. Although reports suggest a significant prevalence of catatonia among individuals with ASD, the condition remains poorly understood and frequently under recognized, leading to substantial diagnostic and treatment challenges. A systematic review was conducted to characterize the symptoms of catatonia in individuals with ASD. The literature search included peer-reviewed journal articles published in English from 1980 onward, focusing on studies examining co-occurring catatonia and ASD. A qualitative framework analysis was implemented to evaluate 45 peer-reviewed studies, with findings interpreted in relation to, and extending beyond, the diagnostic criteria for catatonia outlined in the International Classification of Diseases, 11th revision (ICD-11). The objective was to identify symptom patterns extending beyond current diagnostic frameworks and to support improved clinical recognition and diagnostic precision in ASD populations. The review identified six primary symptom clusters associated with catatonia in individuals with ASD: (1) psychomotor activity, (2) speech disturbances, (3) changes in behavior/skills/functions, (4) mental health symptoms, (5) physiological symptoms, and (6) symptoms related to arousal and awareness. Notably, several symptoms observed within these clusters are not currently included in the ICD-11 diagnostic criteria for catatonia. These additional symptoms include tics, motor compliance, incoherent speech, self-injury, impaired cognition, and appetite changes, suggesting a broader clinical presentation of catatonia in ASD populations than is presently captured in existing diagnostic frameworks. The findings of this review highlight the significance of enhancing clinicians' awareness and understanding of how catatonia manifests in individuals with ASD. Most notably, six symptom clusters, psychomotor changes, speech disturbances, behavioral and functional regression, affective and psychiatric symptoms, physiological symptoms, and arousal/awareness disturbances, were observed. Several symptoms identified in this review are not included in the current diagnostic criteria, and their recognition may facilitate in earlier identification and timely intervention, potentially preventing the severe consequences of untreated catatonia in this population.

Humans↗