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At present, suicidal patients are still hospitalized to reduce their risk of committing a life-threatening act. Yet suicide research, long dominated by the ambition to identify people at risk, shows that the prediction model is largely ineffective. The time has come for a paradigm shift to: give up categorizing patients according to their risk; recognize that hospitalization, if not accompanied by a well-defined purpose, can become iatrogenic; formulate achievable short-term objectives, guiding such hospitalizations on the basis of a reproducible empirical model and demonstrating its benefits beyond keeping the patient alive. Interventions aim thus to reduce distress, personalize care and promote the change required by the suicidal crisis., Competing Interests: Les auteurs n’ont déclaré aucun conflit d’intérêts en relation avec cet article.

Background: Following experts' recommendations for a phenomenological approach to suicidal behavior, this study opted to focus on the life-protecting beliefs and values expressed by people in acute suicidal crisis., Method: 61 adults hospitalized in psychiatric emergency for suicidal crises were assessed in terms of reasons for living (RFL) and suicidality. Multiple correspondence analysis was used to discern groups of patients based on their RFL profiles. Group differences on suicidality were further examined., Results: 4 groups of patients were observed, emerging from RFL differences in "Survival and Coping Beliefs", "Fear of Social Disapproval", "Responsibility to Family" and "Child-Related Concerns". Profiles varied by gender but not age. We further observed that "Survival and Coping Beliefs" and "Moral Objections" are weakened during an acute suicidal crisis., Conclusions: These findings underline the clinical utility of evaluating RFL during a suicidal crisis, and that RFL may be useful to personalize case formulation during an emergency intervention. They could further increase therapeutic communication by connecting the individual to key psychological resources. Longitudinal studies are necessary to evaluate how the different groups identified in this study may yield specific post-emergency trajectories connected to specific clinical needs.

People with personality disorders (PDs) are often admitted to psychiatric emergency services due to the frequent repetition of acute crises. This study drew on the ICD diagnostic records of 2,634 individuals with PDs who were admitted to a specialized inpatient psychiatric crisis unit over a 6-year period. Multiple logistic regressions and survival regressions were performed to examine whether PD categories, gender, and other individual, interpersonal, and precipitating factors were associated with readmission and time-to-readmission. The results showed a 16.1% readmission rate. Of these, 99.5% of readmissions occurred within 4 years following the first admission. Gender was the main factor associated with both readmission and time-to-readmission: while men were readmitted faster, more women in total were readmitted for a second psychiatric emergency hospitalization. Findings also indicated that readmission rate and time-to-readmission differed following the category of PD: readmission rate in a ratio of 1-2 (from 8% to 10% for dissocial and paranoid PD up to 19%-21% for impulsive and borderline PD), and time-to-readmission in a ratio of 1-5 (from 1 month for anankastic and dependent, to 5 months for impulsive, histrionic and anxious-avoidant PD). Limitations of this naturalistic study include a lack of self-reported measures and generalizability to less specialized emergency settings. Future research should include a prospective longitudinal design using standardized scalable measurement tools to improve the completeness and accuracy of the data concerning the psychological processes involved in risk and time-to-readmission after brief hospitalizations in emergency psychiatry. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Context Our team works in a psychiatric hospital unit at the University Hospitals of Geneva (Switzerland). We welcome there for 7 days people in crisis situations who have either suicidal thoughts or suicidal behavior. As factors precipitating the suicidal crisis, these people go through life events that are accompanied by intense interpersonal difficulties or that threaten the image they have of themselves. In our clinical population, approximately 35% of patients suffer from borderline personality disorder (BPD). In these patients, repeated crises and suicidal behavior lead to frequent and damaging relational and therapeutic ruptures. Our objective is to develop a specific approach to this clinical problem. Intervention We have developed a brief psychological intervention informed by mentalization-based treatment (MBT) in 4 stages: welcoming of the patient, affective mentalization of the crisis elements, formulation of the problem, work on discharge and the continuation of outpatient care. This intervention is suitable for a medical-nursing team. From a MBT point of view, the welcoming phase is mainly devoted to mirroring and affective regulation in order to reduce the intensity of psychic disorganization. It is then a question of activating the capacity to mentalize, namely curiosity about mental states, through work on the crisis narrative with an affective focus. We then work with people to construct a formulation of their problem in which they can assume a role. It is about making them "agents" of their crises. Then we can end the intervention by working on both the separation and a projection into the immediate future. The goal is then to extend the psychological work started in our unit at the level of an ambulatory network. The termination phase sees the attachment system reactivated and the reappearance of the difficulties hitherto outside the therapeutic space. Clinical implications MBT is effective for BPD, particularly in reducing suicidal gestures and the number of hospitalizations. We have adjusted its theoretical and clinical device for individuals hospitalized due to a suicidal crisis and who present various and comorbid psychopathological profiles. MBT allows the adaptation and evaluation of empirically based psychotherapeutic tools to different clinical settings but also to different clinical populations.

The capacity of working memory is limited and undergoes important developmental changes during childhood. One proposed reason for the expansion of working memory capacity during childhood is the emergence and increased efficiency of active maintenance mechanisms, such as that of refreshing. Refreshing is a proposed mechanism to keep information active in working memory by bringing memory items back into the focus of attention. One prevalent view is that the spontaneous use of refreshing emerges around the age of 7 and becomes more efficient during middle childhood and beyond. Using a novel approach to examine refreshing in children in Experiment 1, we show, against common conceptions, that simply giving free time in a basic working memory task does not lead to spontaneous refreshing in 9-12-year-old children. Instead, their focus of attention appears to linger on the last-presented memory item, even when ample time for refreshing is provided. Experimentally imposing the use of refreshing in Experiment 2, however, showed that children in this age range are able to switch their focus of attention away from the last-presented item in switch to another memory item. Thus, the current study uncovers that children in middle childhood do not always spontaneously switch attention away from the last-presented memory item to refresh the entire list, even though they are able to switch attention away from the last-presented memory item when instructed to do so. The theoretical implications of these findings are discussed., (© 2021 John Wiley & Sons Ltd.)

Suicide is a major mental health problem, particularly during youth, when it is the second leading cause of death. Since young people at risk of suicide are often cared for by the adult health system, we sought to identify the specificities and similarities between suicidal youths and adults in order to further inform the potential need for adaptations in taking care of suicidal youths. For this study, we used the following data: mental disorders, treatments, previous hospitalization, and reasons for current hospitalization, that were collected from November 2016 to October 2017 among people hospitalized for a suicidal crisis in a specialized psychiatric unit. First, we compared the data from the youth group with those from the adult group, and then we tried to determine if there were any associations between variables. Analyses showed that youths were more similar to adults than expected. In particular, we found comparable rates of personality disorders (especially borderline) and relapse, and similar profiles of reasons for hospitalization in suicidal crisis. Remarkably, among youth, neuroleptics appeared to be associated with fewer hospitalizations for behavioral than ideational reasons, but with more relapses. Results of this study suggest that young people could benefit from brief psychotherapeutic interventions implemented for adults.

Objectives: The in vivo inflammatory effects of the Bacillus anthracis cell wall are unknown. We therefore investigated these effects in rats and, for comparison, those of known inflammatory stimulants, Staphylococcus aureus cell wall or lipopolysaccharide (LPS)., Method and Results: Sprague-Dawley rats (n = 103) were challenged with increasing B. anthracis cell wall doses (10, 20, 40, 80, or 160 mg/kg) or diluent (control) as a bolus or 24-h infusion. The three highest bolus doses were lethal (20-64% lethality rates) as were the two highest infused doses (13% with each). Comparisons among lethal or nonlethal doses on other measured parameters were not significantly different, and these were combined for analysis. Over the 24 h after challenge initiation with lethal bolus or infusion, compared to controls, ten inflammatory cytokines and NO levels were increased and circulating neutrophils and platelets decreased (P

Objective: To investigate the role of neuronal nitric oxide synthase (NOS1) in murine polymicrobial peritonitis and sepsis., Design: Randomized experimental trial., Setting: Animal research facility., Subjects: B6129S NOS1+/+ and B6;129S4 NOS-/- mice., Interventions: NOS1+/+ and NOS1-/- animals underwent cecal ligation and puncture (CLP) or sham surgery and received the NOS1 inhibitor 7-nitroindazole (7-NI) or vehicle., Measurements and Main Results: After CLP, genetic deficiency and pharmacologic inhibition of NOS1 significantly increased risk of mortality [8.69 (3.27, 23.1), p<0.0001 and 1.71 (1.00, 2.92) p=0.05, hazard ratio of death (95% confidence interval) for NOS1-/- and 7-NI-treated NOS1+/+ respectively] compared with NOS1+/+ animals. In 7-NI-treated NOS1+/+ animals, there were increases (6 h) and then decreases (24 h), whereas in NOS-/- animals persistent increases in blood bacteria counts (p=0.04 for differing effects of 7-NI and NOS1-/-) were seen compared with NOS1(+/+) animals. After CLP, NOS1(-/-) had upregulation of inducible NOS and proinflammatory cytokines and greater increases in serum tumor necrosis factor-alpha and interleukin-6 levels compared with NOS1+/+ mice (all p<0.05). Following CLP, there were similar significant decreases in circulating leukocytes and lung lavage cells (p

The effects of fibroblast growth factor (FGF) and nerve growth factor (NGF) on DNA synthesis and insulin secretion were studied in 4-5-day cultures of the isolated neonatal rat islets. FGF (0.1 ng/ml) stimulated significantly the incorporation of 3H-thymidine into DNA of the isolated islets, but failed to change either insulin content in the islets or the rate of insulin secretion. NGF (0.1-1000 ng/ml) did not affect the above parameters. The responses of the islets of Langerhans to increasing concentrations of glucose and isobutylmethylxanthine were not modified after prolonged exposure to NGF. The role of FGF and NGF in the regulation of proliferation and secretory process in pancreatic islet cells is discussed.