bluuebunny/crossref_metadata_2025 huggingface dataset:
Combined coronary artery bypass grafting and aortic valve replacement
Authors: Lau Christopher , Girardi Leonard N.
Published: February 2021

Aortic valve replacement and/or coronary artery bypass grafting (CABG) have become the most common cardiac procedures as the population ages and life expectancy increases. In isolation, both CABG and aortic valve replacement are performed with excellent outcomes throughout the world with operative mortalities of 1–2%. Both procedures have seen significant advances in recent years. The combination of an aortic valve procedure and CABG adds increased complexity and risk, which must be accounted for during operative planning in order to mitigate as much of the increased risk as possible. Improvements in postoperative care, myocardial protection, and operative techniques for combined CABG and aortic valve replacement have resulted in an operative mortality of 0.8–6.4% in recent series.
Coronary artery bypass grafting with concurrent transmyocardial laser revascularization
Authors: Chan Joshua L. , Horvath Keith A.
Published: February 2021

An increasing number of patients suffer from chronic and unremitting angina pectoris that severely impacts their quality of life. The use of traditional techniques, such as coronary artery bypass graft surgery, may not provide complete revascularization in up to 25% of patients due to the severe and diffuse nature of coronary artery disease. Transmyocardial laser revascularization has emerged as a feasible surgical modality for patients with refractory angina pectoris who have exhausted standard medical and interventional options. Based on the cumulative clinical evidence, transmyocardial laser revascularization plus coronary artery bypass grafting has been shown to provide significant symptomatic relief against angina and improve overall outcomes. As a result, the use of adjunctive transmyocardial laser revascularization with coronary artery bypass grafting is warranted in select patients not amenable to complete myocardial revascularization with conventional interventions.
Guideline-directed medical therapy in coronary artery bypass grafting
Authors: Pinho-Gomes Ana-Catarina , Taggart David P.
Published: February 2021

Although mechanical revascularization revolutionized the treatment of coronary artery disease, concomitant guideline-directed medical therapy remains a cornerstone of treatment. Indeed, guideline-directed medical therapy as secondary prevention after coronary revascularization with either percutaneous coronary intervention or coronary artery bypass grafting may be a more important contributor to the risk reduction in mortality achieved by coronary revascularization than the choice between percutaneous or surgical intervention. This chapter explores the importance of GDMT following coronary artery bypass grafting and how compliance with GDMT influences surgical outcomes and the comparison with percutaneous coronary intervention, finishing with some potential strategies to improve compliance with GDMT.
Palliative Care for Children with Advanced Cancer
Authors: Koh Michelle , Craig Finella , Wolfe Joanne
Published: February 2021

This chapter on palliative care for children with advanced cancer addresses the challenges of decision making and the care of the child and family. It explores decision making with regards to ongoing treatment, advance-care planning, and the importance of establishing goals of care. The nature and management of common physical and psychological symptoms are examined, in particular pain and the use of opioids and neuropathic adjuvants. Cancer-directed therapies, specific symptom management, and steroids are discussed. The chapter also includes specific issues around the care of the child and family at the end of life, such as feeding, spiritual distress, and ongoing bereavement care. This chapter is aimed at professionals in the multidisciplinary team caring for children in this context.
Hodgkin LymphomaModern Management of Children and Young Adults
Authors: Landman-Parker Judith , Montravers Françoise
Published: February 2021

Hodgkin lymphoma (HL) is the most common cancer in adolescence and represents 15% of all cases of cancer in children and adolescents. In three decades, HL has become a highly curable lymphoid malignancy with an expected survival rate at ten years of around 90–93%. Further refinements of treatment strategy are needed in order to improve treatment results in relapsed and refractory patients and to reduce long-term morbidity of therapy, mainly secondary malignancies, cardiovascular early morbidity, and impaired fertility. Progress in imaging definition of involvement based on fluorodeoxyglucose-positron emission tomography (FDG-PET)/computed tomography (CT) and response-adapted strategy based on FDG-PET/CT intermediate evaluation has led to a reduction of radiotherapy. Procarbazine-free chemotherapy regimens with moderate anthracyclin dose will further reduce the risk of treatment’s sequelae. Recent advances in the understanding of the biology of HL have demonstrated, with promising results, the link between immune system control and Hodgkin lymphoma pathogenesis, opening the road to new treatments in relapsed and refractory patients based on targeted monoclonal antibodies.
Embryonal Tumours
Authors: Massimino Maura , Bouffet Eric , Ramaswamy Vijay
Published: February 2021

Paediatric embryonal tumours are highly heterogeneous entities which account for 15–20% of all childhood tumours of the central nervous system (CNS). Although historically considered one entity, integrated genomic analysis has unveiled this is no longer the case, and in fact CNS-PNET (primitive neuroectodermal tumour) has been removed from the World Health Organization (WHO) classification of CNS tumours. Patients are risk-stratified based on residual disease after surgery, metastatic dissemination, and, with the medulloblastoma subgroup, specific molecular features. In patients with medulloblastoma, 60–70% of patients over three years old are classified as standard-risk cases, while high-risk patients include those with disseminated and/or residual disease, large-cell and/or anaplastic histotypes, and MYC gene amplification in some protocols. Atypical teratoid rhabdoid tumours (ATRTs) are risk-stratified in a similar manner; however, recently integrated genomics has revealed the presence of three distinct molecular variants which seem to have distinct clinical features and outcomes. Clinical trials already underway or currently being planned will (1) examine the feasibility of reducing the dose of craniospinal irradiation and the volume of posterior fossa radiotherapy (RT) for patients generally considered at low biological risk (i.e. those with the WNT subgroup of medulloblastomas; (2) ascertain whether intensifying chemotherapy or RT can improve outcomes in high-risk patients; and (3) seek therapeutic targets that will enable tailored therapies, especially for relapsing patients and those at higher biological risk.
Gastrointestinal emergencies
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The gastrointestinal emergencies chapter explores a number of emergency situations that can occur with the gastrointestinal tract. These situations can occur quickly and be life-threatening. Nursing care is essential in emergency situations, for example, when there is bleeding in the upper portion of the gut, that is, haematemesis, such as from varices. Treatment can be performed via endoscopy or surgery, for example. Acute abdominal pain may be the result of a perforation or an obstruction within the bowel. A perforation of the bowel might result in peritonitis. These emergencies are explored with consideration of symptoms, causes, investigations, and treatment options. Succinct explanation of gastrointestinal emergencies within this chapter can be used within clinical practice by the nurse.
Stoma care
Authors: Burch Jennie , Collins Brigitte
Published: February 2021

The stoma care chapter explores the formation of a temporary or permanent stoma and the main types of stoma. The two main types of faecal output stoma are the colostomy and ileostomy. The urostomy or ileal conduit is a urinary output stoma. The care required for people undergoing or living with a stoma is explored and includes preoperative and postoperative care. Stoma appliances and products are described. There is information provided on dietary and discharge home from the hospital and the nursing advice needed in these situations. There are descriptions of the common complications associated with stomas and how these can be addressed as well as longer-term issues, such as living with a stoma. Reversal of a stoma is included to describe considerations related to having the stoma surgically closed. Succinct descriptions related to stomas are detailed within this chapter for use in clinical practice by the nurse.
Collective trauma
Authors: Thamotharampillai Umaharan , Somasundaram Daya
Published: February 2021

Natural and manmade disasters can severely impact on family and community structures and processes to cause collective trauma. Observations, experiences, and work in multiple migration situations around the world and literature survey have informed this study. Collective trauma can lead to migration and manifest in migrant populations as high levels of post-traumatic stress disorder, depression, depletion of social capital, dysfunctional family dynamics, loss of motivation, dependence, helplessness, hostility, distrust, suspicion, despair, alcohol and drug abuse, and a variety of social pathologies, as well as historical and transgenerational effects. Procedures, support systems, and atmospheres in host countries can mitigate and help to resolve collective trauma or exacerbate, worsen, and prolong healing. Rebuilding social capital, communality, trust, networks, feeling of collective efficacy, promoting family unity, adaptation to host culture, and learning the language can be salutary. Historical communities will have elements of resilient functioning that should be recognized, respected, and encouraged, while exclusive and maladaptive practices can be discouraged.
Out-migration and social capital
Authors: Spina Nicholas
Published: February 2021

This chapter explores how out-migration weakens social capital in sending communities. Based on game theoretical models of cooperation, it is theorized that the rate of subnational out-migration acts as a structural-level cue and informs residents about the prospect of future interactions between citizens. Heavy out-migration creates a cooperative dilemma by provoking doubt among residents about the benefits of extending trust to and engaging with strangers who may not remain in the community. This proposition is tested using subnational migration data from Bulgaria in two multivariate statistical analyses. The finding from the first set of models confirms that citizens residing in regions undergoing more out-migration report lower levels of generalized trust. A second series of tests reveal that subnational regions with more out-migration have fewer associational memberships per capita.
Refugee, migrant, and asylum seeker experiences
Authors: Lecic-Tosevski Dusica , Pejuskovic Bojana
Published: February 2021

Migration is a universal phenomenon that has occurred in all nations at all times and is being repeated throughout history. Becoming refugee/ migrant/ asylum seeker is a complex psychosocial process with significant effects and consequences on identity of individuals and new countries. That process is related to many factors and may have profound, lasting effects, causing various mental health problems. While some characteristics of migration and experiences of refugees and migrants are universal, they are also specific to each region, country and individual. What follows is the Balkan perspective in experiencing and managing the problems of migration and huge number of refugees in the last three decades. Results of the regions specific studies and the authors’ views as witnesses, organisers of programmes for mental health care of refugees and in the field of disaster and migrant psychiatry are presented. Implications for mental health and organization of mental health care both of refugees and new countries are discussed.
Immigration
Authors: Shaygani Shahram
Published: February 2021

It is important to recognize and understand the psychology of being an immigrant from a psychodynamic and existential perspective. Immigration is about attachment, separation, and re-attachment, and therefore touches some of the deepest part of human existence. During the psychiatric or psychological evaluation of patients with migrant background, the caregiver asks a series of questions about their experience and socio-demographic details that have a quantitative nature. In this chapter, the focus is on the question of the quality of being an immigrant from a phenomenological perspective and from conscious and unconscious levels during the process of migration from arrival to acculturation. Working in the field of transcultural psychiatry is not just about learning about different cultures, but also about grasping the quality of being immigrant and the process of immigration. This can contribute to empathy towards the patient, which will improve the therapeutic efficacy.
Race and racism’s impact on mental wellness
Authors: Ayonrinde Oyedeji , Miller Shadé
Published: February 2021

Race plays a considerable role in the definition and experiences of populations worldwide. Within and across borders, the phenotypic features of individuals can influence their social ranking, opportunities, and experiences of discrimination. Racism may manifest overtly or through chronic difficulties, life events, or experiences of micro-traumas and microaggressions. The cumulative effect of these can be a deterioration in mental well-being and in some occasions the precipitation and perpetuation of mental disorders. With migration, an individual may experience significant changes in racial identity and community status as they navigate a new legislative and societal infrastructure. This chapter highlights the impact of individual and institutional factors on mental well-being at the intersection of race with migration.
Acculturation and suicide-related risk among Latin American migrants
Authors: Polanco-Roman Lillian , Duarte Cristiane , Lewis-Fernández Roberto
Published: February 2021

This chapter examines suicide-related risk among Latin American migrants worldwide, exploring the finding of elevated risk among certain subgroups of Latin American and Caribbean migrants against a background of lower risk overall compared to native populations. The evidence summarized here supports the role of acculturation in rising suicide-related risk, with longer exposure to the new society represented by longer residence in the country, earlier age of migration, and later generation status. A review of sociocultural risk and protective factors relevant to the experiences of migration and acculturation that are linked to suicide-related risk is provided, as well as a summary of limitations in the existing literature. We suggest pathways that account for how acculturation impacts the onset and course of suicide-related behaviours of Latin American migrants, as well as their clinical implications and recommendations for future research and clinical work.
International medical graduates’ contributions to psychiatry— a historical review
Authors: Rao Nyapati , Ahmed Saeed , Bhugra Dinesh
Published: February 2021

In high-income countries, international medical graduates (IMGs) constitute 20–31% of medical work force, especially in disciplines like psychiatry. Variations in countries of origin, languages in which they studied medicine, their religious affiliations, gender, sexual orientation, and so on, all tend to play a role in the process of acculturation and adjustment after migration in spite of resilience. IMGs are often placed in subspecialties and geographical locations that are unpopular with local graduates, thereby increasing their isolation. There is evidence to suggest that they tend to work harder and yet are more likely to be reported to the regulators. High-income countries often for their short-term benefits tend to recruit medical workforce from countries that can ill afford to lose them. Using the history of medicine in the USA as an example, this chapter highlights some of the challenges and proposes ways forward. The isolation and difficulties in acculturation may well contribute to poor mental health.
What next?
Authors: Bhugra Dinesh
Published: February 2021

Migration occurs for a number of reasons and there are various stages and types of migration. These experiences are heterogenous and require different approaches. This chapter includes recommendations for service planning, development, and delivery for migrants’ health care. It is important that all health professionals are suitably trained in cultural competence. Explanatory models held by the patients, their carers, and families must be acknowledged and not denigrated. Researchers need to be culturally sensitive, whereas policymakers have legal and ethical obligations to provide adequate resources to deliver accessible and culturally appropriate services. The specific nature of migration and experiences carry with them specific challenges in therapeutic engagement for a number of reasons, which must be understood. Cultural values, nuances, and differences must be recognized and acknowledged. Specific recommendations are made for service planners, clinicians, policymakers, and researchers. Suggestions are made for curriculum development in cultural competence.
Heart rate
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes the normal response of the speed of the heart to exercise. The maximum heart rate (HR), or pulse rate, is related to the age of the subject. Failure to reach 80% of the predicted maximum HR is considered abnormal and is sometimes called a high heart rate reserve. Unfit subjects, and those with heart disease, have a low maximum oxygen uptake (VO2max) and rapidly reach 80% of their predicted HR. This can easily be seen if HR is plotted against VO2. If the HR is less than 80% of predicted at peak exercise, something other than the heart may have limited the subject’s exercise capacity, or their effort was sub-maximal.
Oxygen saturation
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter describes how desaturation during a cardiopulmonary exercise test (CPET) is uncommon. A fall of more than 4% from resting values is considered abnormal. Oxygen desaturation is usually caused by lung or pulmonary vascular disease, reflecting ventilation–perfusion inequality or impaired diffusion. Occasionally, a right-to-left shunt will open up in the heart during exercise. Some elite athletes show exercise-induced arterial hypoxaemia, when the ability of their muscles to utilize oxygen cannot be met by the subject’s ventilatory capacity.
Preoperative cardiopulmonary exercise testing
Authors: Kinnear William J.M. , Hull James H.
Published: February 2021

This chapter discusses how the results of a cardiopulmonary exercise test (CPET) can be used for preoperative surgical planning. A low preoperative maximum oxygen uptake (VO2max) is associated with a poor outcome. The lower the VO2max, the worse the prognosis. Use of the anaerobic threshold is less reliable. The CPET may identify clinical problems which can be optimized prior to surgery. Pre-habilitation can improve the chances of a good outcome from surgery.
Religion, more than just protective
Authors: Wasserman Camilla
Published: February 2021

Serving as an introduction to the chapters in the ‘Suicide and Religion’ section, we here look beyond the field of suicidology, where emphasis is usually placed on structural indicators and epidemiological/statistical methods. Inspired by anthropological inquiry, suicide is placed firmly among the living and considered a relational phenomenon. Anthropologists have questioned whether suicide is in fact one thing, particularly since the meaning of self and personhood remains so different across the world. Drawing on examples from the chapters ahead, we see how suicide is interpreted and rationalized in teachings of some of the world’s largest religions. We also look closer at religion as a so-called protective factor against suicide much of the research pointing to religious community. By shifting focus towards life and the living, we are presented with the opportunity to observe historical and cultural means of resisting suicide.
The Shinto religion and suicide in Japan
Authors: Kaneko Yoshihiro , Yamasaki Akiko , Arai Kiminori
Published: February 2021

The Shinto religion profoundly influences many Japanese people. It is their emotional mainstay, although it has neither common commandments nor scriptures. According to Shinto, human beings are part of nature and can live only because nature is the parent. Mankind should live in the ‘way of the gods’. The worship of ancestors is an important value in Shinto. The Shinto attitude towards suicide is somewhat ambivalent. Shinto believes that humans return to nature after death, suicide does not constitute an exception, and suicide as a sacrificial act is condoned. On the other hand, believing that life is given by nature and ancestors implies that suicide is wrong. The increasing number of suicides during recent years, mainly for socioeconomic reasons, has deeply affected the Japanese society and its attitudes towards suicide. This has resulted in many suicide prevention activities in which religion can play an important role.
Physician-assisted suicide and euthanasia in the Netherlands and Oregon
Authors: Hendin Herbert , Hendin Josephine
Published: February 2021

Physician-assisted suicide (PAS) was sanctioned in Oregon in 1977, before advances in palliative care made it possible to relieve the suffering associated with serious illnesses. Depression associated with physical illness was assumed to be an inevitable consequence of terminal illnesses. These provided the impetus for legalization in Oregon which became a model for laws, implementation, and reporting practices in the United States and other countries. Since 2002, the Netherlands have had experience with PAS, as well as euthanasia. Both environments have seen an increase in patients utilizing these practices. While there is advocacy from interest groups favouring these practices, questions are raised about the use, implementation, requirements, and reporting practices. This text explores the experience of assisted death in Oregon and the Netherlands, from medical/psychological perspectives.
Psychological theories of suicidal behaviour
Authors: Rudd M. David , Perez-Munroz Andrea
Published: February 2021

This text provides a review of prominent and influential psychological theories of suicide and suicidal behaviours. Its focus is on reviewing theories specific to suicidality, with broader theoretical approaches that do not specifically address suicide and suicidal behaviours purposefully left out. The majority of the theories presented have had direct and important implications for both the assessment and treatment of suicidality. Many of the theories have been directly tied to specific treatment paradigms, with some stemming directly from clinical practice. In line with the current front runner in therapeutic practice, most of the recent theoretical efforts have emerged from cognitive theories and approaches of suicidality.
Neurobiology and the genetics of suicide
Authors: Wasserman Danuta , Wasserman Jerzy , Rujescu Dan , Sokolowski Marcus
Published: February 2021

Besides serotonin dysfunction, many other aspects of brain neurobiology have shown to be involved in the causality of suicidal behaviour. Here we describe the range of studies performed in neurobiology of suicide, with a historical focus. The investigated involvement of genetics in each traditionally studied neurobiological systems is presented. Although, the complexities and challenges in this field may seem overwhelming, the knowledge in this area is constantly increasing, refined in its details, and small breakthroughs occur constantly. Overall, suicidal behaviour occurs on the background of a complex polygenetic and environmental diathesis, manifesting in adulthood as various disturbances in the neurotransmitters and synapses, stress hormonal responses, neuroplasticity, metabolic, and neuroinflammatory processes. While it appears that there are many possible pathways towards establishing a suicidal diathesis, our understanding of this complexity may one day reach a critical mass, enabling the development of entirely better tools for intervention, prevention, and treatment of suicidality.
Suicide in prisons and remand centres
Authors: Sarchiapone Marco , Iosue Miriam
Published: February 2021

Suicide is one of the most common causes of death in custodial settings worldwide, accounting for around 10% of prisoners’ deaths. Suicide attempts and suicidal ideation are also more common among prisoners compared to the general population. The high prevalence of suicidal behaviours among prisoners is likely the result of a complex interaction between individual vulnerability and the high level of stress and deprivation caused by the condition of confinement. Among prisoners and inmates, the prevalence of well-established suicide risk factors, such as a history of self-harm, psychopathological conditions, aggressive personality traits, and childhood trauma, is higher than in the general population. Moreover, the loss of freedom and autonomy, social isolation, lack of purposeful activity, and victimization are prison-specific stressors that showed to increase the suicide risk among inmates. Given this complexity, comprehensive multifactored prevention programmes involving the administrative, custodial, and clinical staff are the most effective in preventing suicide.
Suicide among migrants
Authors: Montgomery Adam , Bhugra Dinesh
Published: February 2021

Migration of people has occurred worldwide for thousands of years. The reasons that many people migrate are varied and due to these widely differing motivations, problems that migrants face are also diverse; they may undergo differing levels of acculturation, resulting in changes to their way of life, or physical or mental health. Worldwide, migration is on the rise, especially in Europe, where the migration and displacement of people is on a scale that has not been seen since the Second World War. Mental health problems associated with migrants are also increasing, including self-harm and suicide. This unprecedented movement of peoples provides new challenges to mental health workers and public health services on how best to offer support in suicide prevention. In this chapter, we discuss rates of self-harm and suicide in migrant populations worldwide, challenges from the recent refugee crisis, and explore primary and secondary preventative strategies against suicide.
Suicide and attempted suicide among indigenous people
Authors: Hughes Jennifer , Durkee Tony , Hadlaczky Gergö
Published: February 2021

There are hundreds of indigenous groups and peoples around the world. Examples are the Australian Aborigines, the North American Indians (Native Americans) of the United States (US) and Canada, and the Māori of New Zealand. Indigenous people often have elevated suicide rates compared with the general population in their countries, and divergent epidemiological characteristics. Social, economic, political, environmental, and historical factors influence Indigenous people’s mental health. In this chapter, the adoption of culture-specific prevention strategies as well as community-based interventions in countries where indigenous peoples live are proposed and discussed, including the importance of involving the tribal leaders in the communities, clergies, and schools, and to sustain the indigenous heritage of the region.
Suicidal behaviour and nonsuicidal self-injury among patients with eating disorders
Authors: Balazs Judit , Horvath Lili Olga
Published: February 2021

Eating disorders (EDs), especially anorexia nervosa (AN), bulimia nervosa (BN), and binge-eating disorder (BED) often co-occur with suicidal behaviour and non-suicidal self-injury (NSSI). The shared epidemiological and risk factors of EDs, suicidal behaviour, and NSSI include the self-destructive and body-focused characteristics of these behaviours; body dissatisfaction, interoceptive deficits, emotion dysregulation, impulsivity, and several environmental risk factors. Compared to the general population, lifetime rates of suicidal ideation, suicide attempts, and NSSI are increased among patients with AN, BN, or BED. Risk factors play a role in the development of suicidal behaviour in patients with EDs, including comorbid psychopathology that is associated with an increased risk of suicide itself, increased impulsive behaviours including NSSI, the duration of illness, and the number of previous treatments. Being aware of the increased risk and the ED-specific risk factors of suicidal behaviour are essential for preventing suicide and treating clinical risk factors in patients with EDs.
Suicide in men
Authors: Rutz Wolfgang , Rihmer Zoltán
Published: February 2021

Male life expectancy in Europe is between 5 and 15 years lower than women. This might be related to the fact that men, in general, approach and consume medical services only half as often as females. Between 70 and 90% of all suicides are committed in a clinical condition of major depression, paradoxically, men commit suicide 3–10 times more often than women despite being diagnosed as depressive half as often. Male depressive symptoms are different from those reported by females, mainly because of men’s alexithymic problems in recognizing and reporting their own depressive symptoms. Additionally, male depression can manifest itself more atypically as abusive, aggressive, risk-taking, or antisocial behaviour. Moreover, in the case of suicidal behaviour, males more frequently use violent or lethal methods. Training of healthcare workers to better detect male depression and increasing public awareness for male’s often atypical depression are promising tools in the prevention of suicide.
Sexual and gender minority populations and suicidal behaviours
Authors: Keeley Helen , Ó Súilleabháin Fiachra , Leane Máire
Published: February 2021

Despite the sociolegal changes that have signalled greater acceptance of sexual diversity and gender expansive identities in the twenty-first century, worldwide studies highlight the increased risk of mental health problems and suicidality for those with a sexual and/or gender minority status. This chapter discusses this increased risk of suicidality among sexual and gender minority populations across the life course. A recurring theme is that those who are less sure of their status, are most at risk. Therefore, the capacity of an individual to overcome internalized minority stress, stigma, guilt, and shame, and to reconcile, even take pride, in their sexual/gender status, is a significant issue. While sociolegal, cultural, and familial norms may seem beyond the remit of mental health professionals, affirmative and inclusive actions can be taken to support questioning youth, unsure adults, and distrustful older people, and to help improve the resilience and well-being of their LGBTQ+ service-users.
Cognitive biases in suicide risk assessment
Authors: Hadlackzy Gergö
Published: February 2021

Cognitive biases result from automatic/unconscious cognitive processes that allow us to come to quick conclusions when facing uncertain or insufficient information. Although these strategies are often useful in providing quick and efficient answers, they can also lead to systematic errors in judgement and decision-making. This text explores the potential adverse effects of cognitive biases on decisions and judgements specific to clinician’s assessment of suicidality. An in-depth description of specifically relevant heuristics and biases, such as the representativeness heuristic and confirmation bias, are described. Different strategies to minimize their negative effects on the suicide risk assessment of the patient are also discussed.
Scales for the evaluation of suicide risk
Authors: Blasco-Fontecilla Hilario , de Leon Jose
Published: February 2021

Predicting future suicidal behaviour is a well-established goal and a matter of interest for suicidologists. To date, the evaluation of suicide risk has been based on the clinician’s subjective judgement; clinicians do not routinely use psychometric scales. The C-SSRS has been proposed as a ‘gold standard’ scale for assessing suicide risk but has been criticized and prospective studies are needed. Furthermore, short scales such as the S-PLE (6 items measuring personality and life events), the UP3 (3 items measuring unbearable psychache), BDI Item 9 (‘thoughts about killing oneself’), or two specific RFL items (‘Moral Objections to Suicide’ and ‘Survival and Coping Beliefs’) are offering promising results for evaluating risk of suicidal behaviour. Although in the future after further developments, scales for evaluating suicide risk may have better potential for standard use in clinical care, combining all sources of data and incorporating new technologies may have better potential for evaluating suicide risk.
Strategies in suicide prevention
Authors: Wasserman Danuta
Published: February 2021

Strategies in suicide prevention have developed throughout the years, and progressed into conceptual models that are defined by a set of restrictive definitions. Here, classifications of two suicide preventive strategic models, namely the primary, secondary, and tertiary (PST) and universal, selective, and indicated (USI) are described, as well as a pragmatic suggestions for healthcare and public health-oriented strategies in suicide prevention. Healthcare-oriented strategies use the individual-centred approach with the focus on the treatment of patients. This chapter looks at the application and benefits of public health strategies in prevention of suicide are directed towards groups and whole populations.
Early detection of risk-taking, self-harming, and suicidal behaviour
Authors: Reichl Corinna , Kaess Michael
Published: February 2021

This text outlines the role of risk-taking and self-harming behaviours in the development and detection of suicidal behaviour and mental health problems among adolescents. Risk-taking and self-harming behaviours are observable symptoms for underlying problems of emotion regulation, impulse control or interpersonal relationships and are sensitive risk markers for early detection of developmental trajectories of suicidal behaviour and mental health problems. Due to their easy accessibility and their sensitive prediction of mental health problems, risk-taking and self-harming behaviours have been included into programmes screening for adolescents at risk of suicidal behaviour in the general population. The principles and findings of those screening programmes are discussed. Professional screenings are time consuming for participants and create costs for the healthcare system, thus, longitudinal studies are needed to test whether screening programmes are effective in reducing suicidal behaviour among adolescents.
Pharmacological and other biological treatments of suicidal individuals
Authors: Möller Hans-Jürgen
Published: February 2021

Because depressive disorders are the most frequent cause of suicidal behaviour, antidepressants are the most important drugs in the psychopharmacological prevention of suicidal behaviour. Clinical experience has shown that the reduction in suicidality achieved with antidepressants is associated with the reduction of depressive symptoms, and it is assumed that suicidal behaviour is also reduced as a consequence. However, the evidence from empirical studies is not as clear as clinicians like to believe, which might be due, at least in part, to methodological problems. Other pharmacological and biological treatment methods with lithium, neuroleptics, benzodiazepines, antiepileptics, and electroconvulsive therapy are also described.
Dialectical behaviour therapy for suicidal individuals
Authors: Brodsky Beth S. , Stanley Barbara , Gratch Ilana
Published: February 2021

Dialectical behaviour therapy (DBT) is an outpatient, cognitive behavioural treatment shown to reduce self-injury and suicidal behaviour in individuals with borderline personality disorder (BPD). In this chapter, we review the basic principles of the DBT approach to the treatment of suicidal individuals, and the status of DBT treatment and research from an international perspective. The diagnostic criteria for BPD (developed and validated in the United States) have been found to be applicable to and prevalent among various populations worldwide. The efficacy of DBT in reducing suicidal behaviour in individuals with BPD has led to its widespread adaptation in clinical settings all over the world. International clinical research teams are conducting randomized clinical trials to further test DBT’s efficacy in reducing suicidal behaviour and associated symptomatology in borderline and other clinical populations.
Cognitive and other therapies for suicidal individuals
Authors: Chesin Megan , Stanley Barbara
Published: February 2021

In this chapter, brief and longer-term cognitive therapy (CT) approaches to intervening with suicidal individuals are reviewed. Particular focus is placed on detailing conceptualization and intervention using CT, the safety planning intervention (SPI), and mindfulness-based cognitive therapy for preventing suicidal behaviour (MBCT-S). Brief summaries of a number of other evidence-based psychosocial interventions for suicidal individuals, including the collaborative assessment and management of suicidality (CAMS), psychodynamic approaches, interpersonal psychotherapy (IPT), family-focused and multisystemic treatments (FFTs), are also provided. A summary of the evidence base supporting the safety, feasibility, and effectiveness of each psychosocial intervention targeting suicidal behaviour prevention is also given.
Prevention of suicide following psychiatric hospitalization
Authors: Riblet Natalie B. , Shiner Brian
Published: February 2021

The period following a psychiatric hospitalization is a high-risk period for suicide and several factors may contribute such as problems with patient engagement. It is vital that researchers identify effective strategies to prevent suicide in the period following hospitalization. Yet, researchers face many challenges in conducting suicide research. Importantly, because the clinical outcome of greatest interest, death by suicide, is rare, researchers must rely heavily on proxy measures of suicide. Furthermore, while there have been over 30 trials of various strategies to mitigate suicide risk following hospital or emergency room discharge, there is mixed evidence regarding the efficacy of these interventions. While some studies have shown significant reduction in suicide attempts, other studies have found no difference. Few studies have demonstrated a significant effect on death by suicide. The most promising interventions include cognitive therapies for suicide prevention, the World Health Organization Brief Intervention and Contact programme.
Psychopathology and risk factors for suicide in the young
Authors: Iohan-Barak Maya , Orbach Israel
Published: February 2021

First, risk factors along the categories of pathology, emotional states, personality traits, deficits, interpersonal vulnerability factors, stressors, and facilitators and inhibitors of suicidal behaviour are classified. The second section focuses on different pathways, based on different major dynamics, showing that there is more than one cluster of suicidal behaviour in adolescents. The section also provides examples of empirical models that try to track the interactions between the various risk factors leading to suicidal behaviour. The last section consists of a presentation of several new theoretical perspectives of self-destructive behaviour among the adolescent population. Many risk factors have been implicated in suicidal behaviour. In order to gain clarity in this web of multiple risk factors, a meaningful organization of the existing data is needed. Here, we will lean on Orbach’s (1997) taxonomy of risk factors in order to facilitate the organization of data related to suicidal behaviour among adolescents.
Representations of suicide in cinema
Authors: Camy Gérard , Wasserman Camilla
Published: February 2021

Here, representations of suicide in fiction film from the United States, Europe, and South East Asia are presented. Films are helpful in addressing discourses on suicide worldwide. Typically, the sufferings of the characters considering suicide or taking their lives occupy a minor part of the plot in scenarios highlighting action, cultural, and social reflection or existential interrogations. In Hollywood dramas, redemption, punishment, lost love, and solitude are major reasons for suicides; often the consequence of genuine injustice. In the European films discussed, suicides on screen often open to comments and reflections on many tragic circumstances explaining the protagonists’ actions. Not recognizing oneself in and by society seems an important reason for suicide. Wanting to understand the motives behind the voluntary death of a peer is recurrent. Much South East Asian cinema reflects the malaise of a society, its interiorized violence, death’ fascination, and the distress of a youth lacking excitement.
The role of restricting access to potentially lethal medication in suicide prevention
Authors: Höschl Cyril , Čermáková Pavla
Published: February 2021

Overdose with medications is a common method of suicide. Reviews of suicide prevention strategies confirmed that restricting access to lethal means is effective in preventing suicides. Nevertheless, there have not been any randomized controlled trials, proving that restriction of the access to toxic medications decreases suicide rates. Existing evidence is based mainly on observational, ecological, and cohort studies. Factors such as better mental health conditions, effective treatment of depression, and improvement in socioeconomic status, may also contribute to decreasing suicide rates. Restrictive measures will have a large effect if the respective method is frequent and lethal. Although there are some concerns about substitution of suicide methods if access to a specific drug is restricted, many studies suggest a life-saving potential. Restrictive measures represent an effective and feasible public health strategy for suicide prevention, particularly in individuals that carry out briefly planned impulsive acts, and in combination with other interventions.
Prevention of suicide by jumping
Authors: Yip Paul , Guo Yingqi , Tang Lynn , Chen Ying-Yeh
Published: February 2021

Jumping from a high place is one of the notable lethal suicide methods. This method is particularly prevalent in areas where high-rise buildings are common. About 80% of the population of Hong Kong and Singapore live in high-rise buildings and jumping has accounted for more than 50% and 80% of suicides in Hong Kong and Singapore, respectively. Suicide by jumping has also accounted for 20% of suicides in Taipei City, where 35% of the buildings are six floors or higher. While ample empirical evidence supports the view that restricting access to lethal methods serve to prevent impulsive suicides, restricting means to jump down from a living environment surrounded by skyscrapers has become a real challenge. Multilayered intervention, such as fencing suicide hotspots, awareness-raising among the family and community members, safety planning and evaluation in new and existing buildings, as well as careful reporting in media should be implemented.
Restriction of alcohol consumption in suicide prevention
Authors: Hadlaczky Gergö , Wasserman Danuta
Published: February 2021

Although alcohol is lethal in high enough concentrations, it is rarely used as a primary method of suicide. The drug is nevertheless often present in the blood of suicide victims and alcohol consumption is related to suicide rates on an aggregate level. Given that a causal relationship is also supported by both natural experiments and studies on an individual level, restricting access to alcohol can arguably prevent suicides. Sensitivity of suicide rates to changes in alcohol consumption varies from one region to another, depending on cultural drinking habits. Identifying the key characteristics of cultures where changes in alcohol consumption most affect suicide rates may help in deciding where alcohol restriction policies may be effective in reducing suicide.
The World Psychiatric Association (WPA) Section of Suicidology
Authors: Carli Vladimir , Wasserman Danuta , Kahn Jean Pierre
Published: February 2021

The World Psychiatric Association (WPA) was founded with the intention of disseminating information through conferences and congresses in different regions all over the world in order to bring together the different domains of psychiatry and human sciences. The WPA has 70 Scientific Sections, but this text will specifically focus on the establishment of the Suicidology Section, as well as the activities within this Section which are being implemented. The path of suicidology is transdisciplinary, rather than having a definite location: its study was, at first, the object of philosophy, then of literature, theology, and social sciences, only in the last two centuries has it acquired a medical character, specifically in psychiatry.
The European Psychiatric Association (EPA) Section of Suicidology and Suicide Prevention
Authors: Sarchiapone Marco , Castroman Jorge Lopez , Gramaglia Carla
Published: February 2021

Suicidal behaviours still remain one of the hardest challenges for clinicians and researchers worldwide. In 2006, a Section on Suicide and Suicide Prevention was established by the European Psychiatric Association General Assembly, whose name was later changed in 2007 into the EPA Section on Suicidology and Suicide Prevention (EPA-SSSP). The original impulse for the creation of the Section was to offer a logistic frame and reference to the scientific activity of European psychiatrists. Since then, the EPA-SSSP has had an ongoing growth process. Currently, the main Section’s activities include: congress and educational activities (in the context of the annual EPA congress as well as of other congresses of national, European, and worldwide importance); Scientific activities (developing specific guidelines for the treatment of suicidal patients, sharing knowledge about suicide and suicide prevention, and fostering debate among researchers); research activities (creation of networks, aimed at sharing and implementing research and clinical projects).
The American Association of Suicidology (AAS)
Authors: Kulp Amy J. , Cerel Julie , Berman Lanny
Published: February 2021

The American Association of Suicidology (AAS) is America’s oldest and largest membership-driven non-profit association which aims to promote the understanding and prevention of suicide. After more than 50 years, the association continues to grow and provides a centralized hub in support of its mission and in service to the public and its membership. AAS brings together clinicians, crisis centres, prevention professionals, researchers, survivors of suicide loss, and suicide attempt survivors. The association programmes include an annual conference, a professional journal, training, and accreditation programmes, psychological autopsy training, and dissemination of resources and information. AAS recognizes the outstanding achievements of individuals in the field of suicidology and presents awards annually for research, service, and career milestones. In recent years, AAS has increased its partnerships and collaborations with organizations whose missions and target audience overlap with AAS.