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Completed suicide (CS) is a leading cause of death worldwide and its rates are available for most developed countries. On the other hand, attempted suicide (AS) is a risk factor for CS but there are limited data on its rates in various countries. In constructing a ratio for AS/CS rates, most would agree that for CS, the denominator should be the annual suicide rate (per 100 000). As for the ratio's numerator (AS) per 100 000, there are three possible calculations: (1) annual prevalence from population surveys, (2) annual prevalence from national clinical registers or (3) lifetime prevalence from population surveys. We think that the first possibility would probably be the best choice but, unfortunately, surveys providing the annual prevalence of AS are lacking for most countries. Annual prevalence from national registers is also lacking for most countries and is contaminated by under-reporting. Therefore, in this editorial, we are left with only the last option, a ratio for lifetime prevalence of AS (per 100 000) divided by annual rate of CS (per 100 000). This ratio for AS/CS rates appears to differ substantially across countries worldwide but presents no big regional differences other than two remarkable exceptions, one per continent. In Europe, Spain and France had greater ratios (174.4 and 152.5, respectively) than Italy (64.1). In Asia/Pacific, New Zealand has a higher ratio (345.9) compared with China (75.8) and Japan (76.9). The ratio for AS/CS rates could be a good index for implementing evidence-informed decision-making regarding suicidal behaviour (SB) among health service managers, and for helping them in the allocation of health resources for the prevention of SB. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Chronic cocaine use is associated with some executive deficits. We assessed executive functions using ecologically valid tests in chronic cocaine users. OBJECTIVES: To investigate the relationship between executive deficits and three measures of severity of cocaine use: years of use, quantity used, and frequency of use. METHODS: Twenty-four cocaine users were compared with twenty-seven community controls. We used Student's t-test and Chi-squared to compare means and categorical variables, respectively. Linear regression analyses for the adjusted comparative analysis between cases and controls, and severity of cocaine use among cocaine users were performed. RESULTS: Chronic cocaine users performed worse on measures of attention and working memory (Forward and Backward Digit Span, p<.001), set-shifting abilities (difference score between the Trail Making B and A, TMB-A, p=.006), cognitive test of mental flexibility and response inhibition (Rule Shift Cards) (p<.001), and prefrontal functioning (Wisconsin Card Sorting Test, WCST, p=.023) than controls. Years of cocaine use were associated with deficits in the Backward Digit Span (p=.041; CI 95%: -.760 to -.002), the TMB-A (p=.026; CI 95%: .687 to 9.761), the Zoo Map (p=.034; CI 95%: -.480 to -.021), and the Rule Shift Cards (p=.006; CI 95%: -.836 to -.164), among others. Quantity of cocaine use was associated with executive deficits measured by the Forward Digit Span (p=.007; CI 95%: -.727 to -.133), the TMB-A (p=.021; CI 95%: 5.304-57.945), and the number of perseverative errors in the WSCT (p=.002; CI 95%: -10.654 to -2.800). Frequency of cocaine was associated with deficits in the Backward Digit Span (p=.042; CI 95%: -1.548 to -.030). CONCLUSIONS: Chronic use of cocaine is associated with executive deficits, which may influence patients' functionality, prognosis, and therapeutic failure. [ABSTRACT FROM AUTHOR]

Background. Recent studies have suggested that genetic predisposition to suicidal behavior may be independent of the risk of suicide associated to mental disorders, such as affective disorders, schizophrenia or alcohol dependence. Given the suicidal behavior heterogeneity and its hereditary complexity, the need to find demonstrable intermediate phenotypes that may make it possible to establish links between genes and suicide behaviors (endophenotypes) seems to be necessary. The main objective is to review which are the candidate endophenotypes of suicidal behaviors. Methods. We carried out a non-systematic review of all published literature in English, French and Spanish in MEDLINE. The search terms were endophenotypes and suicide behaviors. Conclusions. The main candidate endophenotypes of suicidal behaviors are neuropsychological (decisionmaking, executive functions), personality traits (impulsivity, aggressiveness, and neuroticism), neurochemistry (5-HIAA in CNS) and neuroimaging (fMRI of cerebral amygdala or PET of prefrontal cortex metabolism). [ABSTRACT FROM AUTHOR]

Introduction: Narrative therapy in psychotic patients shows recovery as an adaptative process: the personal recovery journey. Myths have always brought cultural and institutional cohesion and bind all human beings in any era or country. Hero's Journey is a myth that appeals to any person who faces life challenges. The hero is an example of courage, strength, and resilience who resist setbacks and obstacles and in doing so experiences an identity transformation. The victory of the heroine is the victory of all mankind. When he returns from the journey he shares knowledge with the rest of the inhabitants of the "ordinary world". In Myth, this knowledge transcends intrahistory, and becomes part of popular culture outside the tale. Objectives: The aim of this work is to adapt Hero's Journey scheme to narrative psychotherapy in psychosis. Methods: The person is invited to his own-Hero's Journey and encouraged to try identities and coping strategies through narrative approach, methaphors and hope speech that normalizes recovery. The therapist doesn't show the way but motivates the individual to undertake a journey towards well-being and develop his potential overcoming difficulties along the way. Results: The journey teaches that challenges can be embraced and profitable. Narrative processing systems steered and blocked by illness are now dynamized, promoting desirable identity narratives and integrating them in one's self. Conclusions: Recovery journey is an adaptation, growth and selfrediscovery journey whose goal is individual fulfillment and wellbeing. The "psychotic" person puts himself into a position to start high personal value trips and to become the author-narrator-hero of his life story. [ABSTRACT FROM AUTHOR]

Background: Suicide ranks as a leading cause of premature death among adolescents globally. Understanding the trends and key determinants of suicidal behavior in youth are critical for implementing educational policies and supporting preventive strategies in schools., Methods: This retrospective study examined all hospitalizations due to suicidal behavior in children and adolescents aged 11 to 18 years in Spain, using data from the Spanish National Registry of Hospital Discharges spanning 2000 to 2021., Results: Over the 22-year study period, there were 2,015,589 hospitalizations among adolescents in Spain, with 118,609 (5.9 %) cases involving mental disorders. There were 2855 admissions with suicidal behavior, constituting 2.4 % of the hospitalizations among youth with mental disorders. Girls represented 73.4 % of all hospitalizations, with a median age of 16 years. Admissions for suicidal behavior saw a four-fold increase during the last decade (p < 0.001). The in-hospital mortality rate for adolescents with suicidal behavior doubled that of those hospitalized for other mental disorders. During the first year of the COVID-19 pandemic, admissions of adolescents with suicidal behavior decreased, only to surge by 2.5-fold during 2021., Conclusion: Hospital admissions for suicidal behavior among adolescents have risen in Spain over the last two decades. Girls represented 73.4 % of these admissions, yet in-hospital mortality was more frequent in boys., Competing Interests: Declaration of competing interest None for all authors., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: In the United States, clozapine was first approved for treatment-resistant schizophrenia and then for suicidality in schizophrenia psychoses. Systematic reviews support clozapine's anti-suicidal effect, but the forensic literature stresses its lethality during overdoses., Research Design and Methods: Clozapine reports to the international pharmacovigilance database (VigiBase) were analyzed for suicidal ideation, suicide attempts, intentional overdose, and completed suicides from introduction to 1 January 2024. VigiBase uses the information component (IC) as a disproportionality analysis., Results: The clozapine ICs (range: other antipsychotics) were: 1) suicidal ideation IC = 0.570 with IC 025 = 0.454 to IC 975  = 0.680 (IC = 3.568 for aripiprazole and 1.729 for risperidone), 2) suicide attempt IC = 1.428 with IC 025 = 1.323 to IC 975  = 1.529 (IC = 4.150 for quetiapine and 2.968 for risperidone), 3) intentional overdose: IC = 0.995 with IC 025  = 0.864 to IC 975  = 1.120 (IC = 4.080 for quetiapine and 1.957 for aripiprazole), and 4) completed suicide IC = 1.133 with IC 025  = 1.026 to IC 975  = 1.235 (IC = 4.648 for quetiapine and 2.160 for risperidone). In summary, all clozapine ICs were significantly lower. We found 2391 clozapine-treated patients on the suicidality spectrum (627 cases with suicidal ideation, 752 with suicide attempt, 488 with intentional overdose, and 731 with completed suicide) but many were taking other antipsychotics. The most frequent reporting countries were the United States, the United Kingdom, and Croatia., Conclusion: This pharmacovigilance study, with all its inherent limitations, provides independent proof, not overlapping with prior literature, that clozapine may have specific strong anti-suicidal effects that do not appear to be present in other antipsychotics. Further VigiBase studies are needed to compare the lethality of an intentional overdose of clozapine (14.3%) with other antipsychotics.

Bullying is a risk factor for the physical and mental health of adolescents. The advent of new technologies has resulted in a brand-new type of bullying, cyberbullying (CB). The co-occurring effects of cyberbullying and traditional bullying(TB) forms of bullying on adolescent mental health are unclear. We performed a meta-analysis to explore the unique and combined effects of CB and TB on adverse psychological outcomes in victims by conducting a joint study of both types of bullying. By doing so, we provide the basis for a comprehensive community bullying prevention program. The database PubMed, PsyclNFO, and Web of Science were searched for studies from 2010 to 2021. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline was followed for data abstraction, and the NIH tool was used to evaluate study-level risk of bias. 42 studies with 266,888 participants were identified. Random-Effect models were used for our study. The moderator analysis was used to explore the moderator of prevalence. Studies with three groups of victims (TB only, CB only, and Both) and two groups of victims (TB and CB) were compared in subgroup analysis. The mean victimization rate was 24.32% (95% CI 20.32-28.83%) for TB and 11.10% (95% CI 9.12-13.44%) for CB. Roughly one-third of TB victims were also victimized by CB. Conversely, only about one-third of CB victims were free from TB. The estimated ORs for depression, suicidal ideation, suicide attempts, and self-harm in the three-group (TB only, CB only and Both) analysis were: depression [TB only: 3.33 (2.22-5.00); CB only: 3.38 (2.57-4.46); Both: 5.30 (2.43-11.56)]; suicidal ideations [TB only: 3.08 (2.12-4.46); CB only: 3.52 (2.38-5.20); Both: 6.64 (4.14-10.64)]; self-harm [TB only: 2.70 (1.86-3.91); CB only: 3.57 (3.20-3.98); Both: 5.57 (2.11-16.00)]; and suicide attempts: [TB only: 2.61 (1.50-4.55); CB only: 3.52 (2.50-4.98); Both: 7.82 (3.83-15.93)]. TB and CB victimization among youth are a matter of public health concern. Victimization appears to be a marker of greater psychopathological severity, particularly suicide-related issues., (© 2022. The Author(s).)

Mental disorders account for a large and increasing health burden worldwide. Characterizing the spectrum of mental disorders and trends over time in adolescents should influence education policies and support preventative strategies at schools. Retrospective study of all hospitalizations in Spain in adolescents 11-18-years old, including mental disorders as diagnosis using the Spanish National Registry of Hospital Discharges. Information was retrieved from 2000 to 2021. During the 22-year study period there were 2,015,589 hospitalizations in adolescents in Spain, of which 118,609 (5.9%) had mental disorders. The rate of psychiatric diagnoses significantly increased from 3.9% in 2000 to 9.5% in 2021. Females accounted for 55.1% of admissions. Mean age at admission declined from 17 to 15 years-old from 2000 to 2021. Mean hospital stay was 10.6 days. Mean in-hospital mortality was 0.24%. By rate order, diagnoses were: substance use disorders (SUD) (40%) > eating disorders (15%) > anxiety/posttraumatic stress disorder (PTSD) (13%) > attention deficit hyperactivity disorder (ADHD) (9%) > major depression (8%) > schizophrenia/psychosis (6%) > autism spectrum disorder (ASD) (6%) > sleep disorder (3%) > suicidal behavior (2%) > sexual disorders (1%). A significant gender dichotomy was noticed, with female predominance for internalizing disorders (i.e., anxiety, depression, suicidal behavior and eating disorders) whereas externalizing disorders (i.e., SUD, ADHD, ASD, schizophrenia and other psychoses) predominated in males. Suicidal behavior and male sex were independent predictors of in-hospital death in multivariate analysis. After the first year of the COVID-19 pandemic, hospitalizations due to mental disorders in adolescents increased by 51% in 2021. There is a growing crisis of mental health among adolescents in Spain. Although the COVID-19 pandemic has unveiled the high rate and severity of psychiatric disorders among youth, a steadily increase has occurred since the beginning of the millennium. Primary preventative strategies should be adapted to distinct and more prevalent mental disorders in adolescents., (© 2024. Springer-Verlag GmbH Germany, part of Springer Nature.)