Hayashi Naoki, Igarashi Miyabi, Imai Atsushi, Osawa Yuka, Utsumi Kaori, Ohshima Yoshio, Tokunaga Taro, Ishimoto Kayo, Maeda Naoko, Harima Hirohiko, Tatebayashi Yoshitaka, Kumagai Naoki, Nozu Makoto, Ishii Hidetoki, Okazaki Yuji
Department of Psychiatry, Tokyo Metropolitan Matsuzawa Hospital.
Seishin Shinkeigaku Zasshi. 2009;111(5):502-26.
Psychiatric patients who have shown suicidal behavior (SB) are belived to be at a particularly high risk of suicide. However, the number of studies that have sought ways to prevent suicide in this patient population is limited. The present study investigated the diagnosis and SB-related characteristics of psychiatric inpatients showing suicidal behavior prior to admission. One-hundred and fifty-seven eligible subjects were recruited from patients consecutively admitted to a large psychiatric facility during a 20-month period in 2006 and 2007, and underwent extensive research interviews. Percentages of diagnoses based on the Structured Clinical Interview for DSM-IV, Clinician Version (SCID-I, CV) in this series were: affective disorders, 62%; anxiety disorders, 55%; substance use disorders, 38%; psychotic disorders, 27%; and eating disorders, 10%. Eighty-seven percent of the subjects were diagnosed as having some type of personality disorder (PD) in the SCID-II interview. Borderline PD was diagnosed in 56% of the subjects, making it the most frequent type of PD in this series. Frequent SB in these subjects involved: self-cutting, 40%; overdosing, 32%; self-strangulation, 14%; and jumping, 11%. Step-wise logistic regression analyses were conducted to examine the association of dichotomized SB-related clinical characteristics with diagnostic categories (affective disorders, psychotic disorders, substance use disorders, anxiety disorders, and cluster A, B and C PDs). The analysis demonstrated that three diagnostic categories were dominant in the association with clinical characteristics. Cluster B PD was associated with a history of overdosing, greater aggressiveness, interpersonal and life-situational life events, and childhood maltreatment (physical abuse and neglect). Anxiety disorders were related to histories of overdosing, dissociative symptoms in SB, excessive worry concerning life problems, and childhood neglect. Affective disorders were mainly associated with the characteristics of SB or SB-related symptoms: severe depressive symptoms and hopelessness, potentially fatal SB before admission such as self-strangulation, and dissociative symptoms in SB, though they did not show a significant relationship with pre-SB characteristics such as life events or childhood maltreatment. These findings will be helpful to develop treatment guidelines, SB-prevention strategies, and future research regarding suicidal psychiatric patients.
有过自杀行为（SB）的精神科患者被认为自杀风险特别高。然而，探寻该患者群体自杀预防方法的研究数量有限。本研究调查了入院前有自杀行为的精神科住院患者的诊断情况及与自杀行为相关的特征。2006年至2007年期间，从一家大型精神科机构连续收治的患者中招募了157名符合条件的受试者，并对他们进行了广泛的研究访谈。在本系列中，基于《精神疾病诊断与统计手册》第四版临床定式访谈（SCID - I，CV）得出的诊断百分比为：情感障碍62%；焦虑障碍55%；物质使用障碍38%；精神障碍27%；进食障碍10%。在SCID - II访谈中，87%的受试者被诊断患有一种人格障碍（PD）。56%的受试者被诊断为边缘型人格障碍，这使其成为本系列中最常见的人格障碍类型。这些受试者中频繁出现的自杀行为包括：自我切割40%；过量服药32%；自我勒颈14%；跳楼11%。进行了逐步逻辑回归分析，以检验二分法的与自杀行为相关的临床特征与诊断类别（情感障碍、精神障碍、物质使用障碍、焦虑障碍以及A、B、C类人格障碍）之间的关联。分析表明，在与临床特征的关联中，有三个诊断类别占主导。B类人格障碍与过量服药史、更强的攻击性、人际和生活情境方面的生活事件以及童年虐待（身体虐待和忽视）有关。焦虑障碍与过量服药史、自杀行为中的分离症状、对生活问题的过度担忧以及童年忽视有关。情感障碍主要与自杀行为或与自杀行为相关的症状特征有关：严重的抑郁症状和绝望感、入院前潜在致命的自杀行为如自我勒颈，以及自杀行为中的分离症状，尽管它们与自杀行为前的特征如生活事件或童年虐待没有显著关系。这些发现将有助于制定治疗指南、自杀预防策略以及关于有自杀倾向的精神科患者的未来研究。
