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Biomedical subjects

Paul S Links

Publications and source records attributed to Paul S Links.

15 recordsLinked to original sources
PubMed2006

Adolescent personality disorders in adolescent medicine.

Both BPD and ASPD are disorders whose complex presentations pose numerous clinical challenges to all health care professionals. However, early careful diagnosis and management can diminish the long-term morbidity of these illnesses and offer the hope of a better outcome. As data emerge regarding the long-term prognosis and effective treatment of PDs, clinicians are cautioned to avoid the traditional teaching that the dysfunctional patterns will necessarily continue into adulthood.

Adolescent↗
PubMed2005

Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality.

Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.

Adult↗
PubMed2005

Preventing suicidal behaviour in a general hospital psychiatric service: priorities for programming.

PURPOSE: General hospital psychiatric services are able to provide leadership and coordinate the development of suicide prevention programs for individuals serviced in general hospital settings. We completed this literature review to suggest priorities for programming. METHODS: Our procedure was to update the review by Gunnell and Frankel that guided priorities for Health of the Nation, the national suicide prevention strategy in the UK. We completed a search, using the terms suicide prevention and control, of all English-language research and clinical trials conducted between January 1, 1994, and May 1, 2004. RESULTS: We identified 82 papers. Of these, 48 were excluded and the remaining 34 were grouped by secondary care setting categories. We found no articles on screening tools for predicting risk of suicide, 16 articles on interventions for individuals with suicidal behaviour, 14 articles on the treatment of major psychiatric disorders, 1 article and 1 published abstract on discharge from hospital, and 2 articles on reducing access to means. CONCLUSIONS: Based on a review of each category, we make several program and policy recommendations, including regularly updating clinical assessment skills, using guidelines for assessment of patients following a suicide attempt, assessing the risk of suicide 24 to 48 hours before discharge from hospital, and incorporating education about reducing access to means into routine psychiatric care.

Health Planning Guidelines↗
PubMed2005

Is suicide ideation a surrogate endpoint for geriatric suicide?

The present study explored the validity of treating suicide ideation as a surrogate endpoint that can serve as a proxy for suicide in clinical intervention research with suicidal seniors. Two criteria; that suicide ideation is modulated by the proposed intervention and that modulation of suicide ideation leads to a quantitative reduction in suicide rates, were the focus of this review. A series of literature searches of the PsychINFO and Medline databases were conducted on the terms geriatric, elderly, seniors, suicide, self-destruction, clinical, randomized, trial, treatment, intervention , and ideation . Articles were analyzed if they provided sufficient information to examine whether an intervention effectively led to a reduction in suicide ideation among seniors. Two hundred and eight articles were considered for potential inclusion in this study, with 19 articles meeting final inclusion criteria. The articles reviewed were divided into three broad categories: articles supporting suicide ideation as a surrogate endpoint for geriatric suicide ( n = 6); those not supporting this hypothesis ( n = 1); and those providing insufficient information to test the hypothesis ( n = 12). The present analysis provided modest evidence for suicide ideation as a surrogate endpoint for geriatric suicide, due, in part, to a paucity of randomized controlled trials of treatment interventions for suicidal seniors, thus demonstrating a clear need for research in this area. Implications of utilizing surrogate endpoints in suicide research are discussed.

Aged↗
PubMed2005

"It's overwhelming... everything seems to be too much:" A theory of crisis for individuals with severe persistent mental illness.

Crisis in individuals with severe persistent mental illness (SPMI) is a poorly understood phenomenon for which traditional crisis models do not apply. In this study we explored the crisis experience using in-depth interviews conducted with individuals with severe persistent mental illness from two community support programs. A grounded theory of the crisis experience was developed and the results illustrate that underlying vulnerability sets the stage for crisis occurrence which involves feeling overwhelmed and lacking control and manifests as agitation/anger/aggression, being low, feeling anxious, or euphoria. Immediate responses to crises involve getting help or managing alone and numerous factors contribute to crisis resolution and prevention.

Adaptation, Psychological↗
PubMed2005

Pharmacologic management of borderline personality disorder: a case study.

General principles of the "outcome-focused" model of psychopharmacologic management of patients with BPD are illustrated using the case of Ms. A, a patient with borderline personality disorder (BPD) experiencing impulsivity such as suicidal behavior, chronic insomnia and concurrent substance abuse. The model includes (1) measurement of specific behavioral outcomes related to functioning; (2) assessment of the role of substance use/abuse in patients with BPD; (3) consideration of interventions to clarify and strengthen the boundaries of the therapeutic relationship-including short lengths of time between prescription refills, medication contracts outlining consequences if substances are obtained outside of the relationship, and urine testing to ascertain compliance; (4) an understanding of the psychodynamic meanings attributed to medication while positive and negative medication effects are monitored with treatment response or transference issues, and; (5) use of the N-of-1 approach to test the new medication vs previous medications using patient specific outcomes that are anticipated to change with the pharmacologic management.

Adult↗
PubMed2004

Social, demographic, and clinical factors related to disruptive behaviour in hospital.

OBJECTIVE: This study addresses 2 issues: first, whether the diagnosis of borderline personality disorder (BPD) or borderline traits differentiates adult patients who demonstrate disruptive behaviour during hospitalization from those patients who do not; and second, whether other clinical variables can be assessed during the emergency visit to differentiate patients who are likely to show disruptive behaviour in hospital from those who are not. METHOD: We completed a case-control, chart-based, retrospective analysis of patients consecutively admitted to an inpatient psychiatric service. We assembled 44 subjects who demonstrated evidence of disruptive behaviour during inpatient hospitalization. These subjects were matched with 61 control subjects admitted during the same time period. Potential participants were excluded if they had a diagnosis of schizophrenia, psychotic disorders, delirium, or dementia or if they had a diagnosis receiving a psychotic specifier. RESULTS: Univariate analyses revealed that patients with disruptive behaviour were significantly more likely to have been diagnosed with BPD or borderline traits than the comparison group (32.6% vs 13.4%; chi2 = 4.45, df 1; P < 0.05). According to stepwise logistic regression analysis, 4 variables significantly contributed to the final model (R2 = 0.37, P < 0.001) predicting disruptive behaviours with the following odds ratios (ORs): Axis III infectious diseases (OR 7.63; 95% CI, 1.41 to 41.67), Axis IV housing problems (OR 3.58; 95% CI, 1.21 to 10.64), history of suicidal behaviours (OR 3.46; 95% CI, 1.24 to 9.71), and problems with primary supports (OR 0.12; 95% CI, 0.03 to 0.46). This last variable was related to a reduced risk of disruptive behaviours in hospital. CONCLUSIONS: Patients at risk for disruptive behaviour during psychiatric hospitalization are characterized by a history of suicidal or impulsive-aggressive behaviour and social disadvantage.

Adult↗
PubMed2003

Assessing suicidal youth with antisocial, borderline, or narcissistic personality disorder.

OBJECTIVE: This paper has 3 objectives. First, we review the epidemiologic evidence for the association between suicidal behaviour and suicide in individuals diagnosed with antisocial, borderline, or narcissistic personality disorder. Second, we examine whether any potentially modifiable risk factors are associated with these diagnoses, based on existing empirical evidence. Last, we discuss clinical approaches to assessing youth with antisocial, borderline, or narcissistic personality disorder presenting at risk for suicide. METHOD: We reviewed the English-language literature for the last 12 years (from January 1, 1991, to December 31, 2002), using as search terms the names of the 3 disorders, as well as the key words suicide, suicidal behaviour, youth, and adolescents. RESULTS: Patients with antisocial or borderline personality disorder are likely to be at increased risk for suicidal behaviour when they demonstrate such comorbid disorders as major depressive episodes or substance abuse disorders, when they experience recent negative life events, or when they have a history of childhood sexual abuse. CONCLUSIONS: For patients with antisocial personality disorder, the risk of violence has to be judged in addition to the risk of suicide or self-harm. For patients with borderline personality disorder, interventions are determined by differentiating acute-on-chronic from chronic risk of suicidal behaviour. Finally, patients with narcissistic personality disorder can be at high risk for suicide during periods when they are not suffering from clinical depression. These episodes can seem to be unpredictable.

Adolescent↗
PubMed2002

A description of a psychosocial/psychoeducational intervention for persons with recurrent suicide attempts.

This paper gives a description of a psychosocial/psychoeducational group intervention for individuals with a history of recurrent suicide attempts. The intervention was conceived to reduce the risk of future suicidal behavior and to modify the client's psychopathology. Three features are felt to make the intervention unique from others described in the literature. First, the intervention is targeted at both men and women from an inner-city population who are often underhoused, underemployed, and undereducated. 24 of 48 clients (50%) lived alone, and 24 of those (92%) were living in subsidized housing; 33% lived in supportive housing, and one lived on the street at the time of assessment. 48% had a high-school education or less. Second, the principles of our approach stressed client validation and participation in the development and delivery of the therapy. Our frame of reference was to name ourselves as professionals with a set of skills and access to some kinds of information and clients as the experts on the experience in their lives. Third, the group content incorporated a multimodal approach to meet the varied needs of the clients. Future reports will discuss the empirical evaluation of this intervention; however, the development of specific, targeted approaches for unique individuals with recurrent suicide attempts is clearly needed.

Adult↗
PubMed2002

The role of couple therapy in the treatment of narcissistic personality disorder.

Recommendations for psychotherapeutic management of patients with narcissistic personality disorder are based on clinical experience; however, little attention has been given to the role of couple therapy with these patients. A stable intimate relationship appears to positively affect the course and outcome of narcissistic personality disorder. Based on clinical experience with narcissistic individuals in couple therapy and using a psychoanalytic framework, three characteristics that differentiate couples who will from those who will not benefit from couple therapy are described. These characteristics are the ability of the narcissistic individual to curtail acting out, the narcissistic vulnerability as evidenced by their level of defensiveness, and the couple's complementarity of narcissistic gratification. Two clinical examples are given to demonstrate the usefulness of the proposed characteristics in deciding on the appropriateness of couple therapy.

Adult↗
PubMed2002

Do hospital E-codes consistently capture suicidal behaviour?

Hospital separation data are used to study suicidal behaviour; however, there is little information about the appropriateness of these data for research and planning activities. The study purpose is to examine how consistently hospital separation E-code data reflect suicidal behaviours. Expert clinicians reviewed medical records of individuals who had a separation for self-poisoning to determine whether the self-poisoning was deliberate. Agreement among clinicians was evaluated and latent class analysis performed to derive a summary estimate of the prevalence of deliberate self-poisoning. This estimate was then compared to the prevalence of deliberate self-poisoning based on the external cause of injury (E-codes). Clinicians estimated the prevalence to be 63% higher than the E-code based prevalence. Much larger discrepancies were apparent among older age groups, those whose care was primarily medical in nature and those with a longer length of hospital stay. In acute care settings, self-poisonings among the elderly may not receive adequate attention and/or documentation. Estimating the prevalence of admissions for suicidal behaviour using hospital separation data is of questionable validity, particularly among older age groups.

Adolescent↗