APA 2017
HarmResearch gave the following presentations at the 2017 Annual Meeting of the American Psychiatric Association (APA):
Monday, May 22nd, 2017, 1 pm to 5 pm Workshop
Tuesday, May 23rd, 2017, 10 am to Noon Posters
Monday, May 22nd, 2017 Workshop
Suicidality Assessment and Documentation for Healthcare Providers
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3, 4
1 University of South Florida College of Medicine, Tampa, FL, USA
2 Harm Research Institute, Tampa, FL, USA
3 Tampa Center for Research on Suicidality, Tampa, FL, USA
4 University of South Florida College of Arts and Sciences, Tampa, FL, USA
For more information about this workshop click here
Date: Monday, May 22nd, 2017
Time: 1 pm to 5 pm
Location: Room 1A, Upper Level, San Diego Convention Center, San Diego, CA
Abstract:
Suicide is the 15th leading cause of death worldwide and a leading cause of malpractice actions in psychiatry. Clinicians become alarmed when patients discuss suicidality.
The product information on most psychiatric drugs advises clinicians to assess and monitor their patients for suicidality before starting and throughout the course of treatment. The expectations on how to properly conduct and document suicidality assessments increased significantly following the inclusion of boxed warnings on suicidality for most psychiatric medications. Healthcare providers need guidance on how to do this in a time efficient manner. Skillful assessment protects their patients, and the documentation protects the healthcare provider.
This course operationalizes how to properly assess and document suicidality:
1. Use a suicidality tracking scale to assess suicidality
2. If needed, use a suicide plan tracking scale to document suicidal planning
3. Use the structured diagnostic interview to classify patient’s suicidality symptoms into the 12 suicidality disorder phenotypes
4. Decide a course of treatment based on suicidality disorder phenotype
5. Document and summarize the findings from the above in the medical record for medico-legal protection
6. Use the suicidality tracking scales to monitor response to treatment
The faculty will involve the audience interactively at frequent intervals throughout the course through liberal use of questions and answer discussions, small group discussions, and instructional simulation games. The faculty will provide all course participants with templates and practical assessment tools that are useful in clinical practice settings.
Learning Objectives:
At the conclusion of this session the attendee will be able to:
1. Conduct and properly document a thorough suicidality assessment.
2. Identify the different suicidality disorder phenotypes and identify the treatment most likely to be helpful for each phenotype.
3. Properly monitor suicidality during the course of pharmacological and other treatments for psychiatric disorders and understand the limitations of and problems associated with suicide prediction.
Literature References:
2. Koslow, S. H., Ruiz, P., & Nemeroff, C. B. (Eds.). (2014). A Concise Guide to Understanding Suicide: Epidemiology, Pathophysiology and Prevention. Cambridge University Press.
3. Shea, S. (1999). The practical art of suicide assessment.
4. Sheehan, DV and Giddens, JM. Suicidality Disorders Criteria. In: Sheehan, DV and Giddens, JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, p. 82-126.
How to Cite:
Sheehan DV, Giddens JM. Suicidality Assessment and Documentation for Healthcare Providers. Workshop. Annual Meeting, American Psychiatric Association (APA), San Diego, CA, May, 22, 2017.
Tuesday, May 23rd, 2017 Posters
Case Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder (IASD)
Jennifer M Giddens 1, 2, 3
David V Sheehan MD, MBA, DLFAPA 2, 3, 4
1 University of South Florida College of Arts and Sciences, Tampa, FL, USA
2 Harm Research Institute, Tampa, FL, USA
3 Tampa Center for Research on Suicidality, Tampa, FL, USA
4 University of South Florida College of Medicine, Tampa, FL, USA
Click here to view or download a watermarked, preview copy of this poster
Date: Tuesday, May 23rd, 2017
Time: 10 am to Noon
Location: Exhibit Hall A, Ground Level, San Diego Convention Center, San Diego, CA
Poster Number: P7-064
Abstract:
Background: This case study reports on the effect of high magnesium oxide coupled with reduced dietary calcium intake (+Mg-Ca) in the treatment of Impulse Attack Suicidality Disorder (IASD).
Methods: Using several sensitive assessment instruments (S-STS, S-STS CMCM, T-CASA, SPTS) for suicidality phenomena and suicidality event tracking, the authors tracked the effect on suicidality of magnesium oxide in doses up to 1000 mg/day in 4 divided doses daily, coupled with a reduced dietary intake of calcium below 300 mg / day (<30% of Recommended Daily Intake). The T-CASA was rated daily, and the S-STS, the S-STS CMCM, and the SPTS rated weekly over a 166-week (3.2 year) period and covering 43,690 separate suicidality events. The subject had a 25-year history of daily suicidality that did not responded to any prior treatment including 11 antidepressants, atypical antipsychotics, anticonvulsant mood stabilizers, and lithium dose.
Results: The +Mg-Ca completely eliminated the subject’s suicidality. After 6 months free of suicidality the subject stopped the magnesium, while maintaining the low calcium intake. Within 48 hours she had a full relapse of all her prior suicidality and suicidal impulse attacks. This worsened over the ensuing week. On restarting the magnesium the suicidality decreased over the following 8 days after which she remained suicidality free for the ensuing 7 months.
Conclusion: The data from this case study suggests that high dose magnesium oxide coupled with reduced dietary calcium intake merits further investigation for the treatment of Impulse Attack Suicidality Disorder in large double blind, placebo-controlled studies.
Learning Objectives:
Following this presentation, participants will be better able to:
1. Understand how a +Mg-Ca (high magnesium oxide low calcium intake) regimen was used to treat a case of chronic Impulse Attack Suicidality Disorder (IASD).
2. Identify the symptom response profile in one subject with Impulse Attack Suicidality Disorder (IASD) in response to this +Mg-Ca (high magnesium oxide low calcium intake) regimen.
Literature References:
1. Sheehan, DV and Giddens, JM. Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder. In: Sheehan, DV and Giddens, JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, p. 249-267.
2. Sheehan, DV and Giddens, JM. Impulse Attack Suicidality Disorder. In: Sheehan, DV and Giddens, JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, p. 127-155.
How to Cite:
Giddens JM, Sheehan DV. Case Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder (IASD). Poster. Annual Meeting, American Psychiatric Association (APA), San Diego, CA, May, 23, 2017.
A Classification of Suicidality Disorder Phenotypes
(12 Phenotype Version)
Jennifer M Giddens 1, 2, 3
David V Sheehan MD, MBA, DLFAPA 2, 3, 4
1 University of South Florida College of Arts and Sciences, Tampa, FL, USA
2 Harm Research Institute, Tampa, FL, USA
3 Tampa Center for Research on Suicidality, Tampa, FL, USA
4 University of South Florida College of Medicine, Tampa, FL, USA
Click here to view or download a watermarked, preview copy of this poster
Date: Tuesday, May 23rd, 2017
Time: 10 am to Noon
Location: Exhibit Hall A, Ground Level, San Diego Convention Center, San Diego, CA
Poster Number: P7-065
Abstract:
Background: The view that suicidality is trans-nosological and that all forms of suicide are the same, is not consistent with response to pharmacological treatment evidence. For example, antidepressants make suicidality better in some patients, worse in others, and are no better than placebo for a third group. This suggests that there may be more than one type of suicidality.
Methods: We used a phenomenological approach by observing in detail and directly communicating with subjects over time about their suicidality.
Results: We developed diagnostic criteria and a related structured diagnostic interview for 12 distinct suicidality disorder phenotypes. These include 1) Impulse Attack Suicidality Disorders, 2) Homicidal Suicidality Disorders, 3) Psychotic Suicidality Disorders, 4) Obsessive Compulsive Suicidality Disorders, 5) PTSD Suicidality Disorders, 6) Eating Disorder / Malabsorption Suicidality Disorders, 7) Substance Induced Suicidality Disorders, 8) Medical Illness / Neurological Condition Induced Suicidality Disorders, 9) Anxiety Disorder Induced Suicidality Disorders, 10) Mood Disorder Induced Suicidality Disorders, 11) Life Event Induced Suicidality Disorders, and 12) Suicidality Disorders, Not Elsewhere Classified. Among these phenotypes the description of Impulse Attack Suicidality Disorder is new and has never been described from the prospective presented. This disorder is associated with unexpected, unprovoked attacks of an urgent need to kill oneself.
Conclusion: We offer 12 distinct suicidality disorder phenotypes. Because these phenotypes may have a different response to treatment, each phenotype should be investigated separately when investigating anti-suicidality treatments and when investigating the relationship between genetic and other biomarkers in suicidality.
Learning Objectives:
Following this presentation, participants will be better able to:
1. Identify the different phenotypes of suicidality disorders.
2. Appreciate that not all clinical phenotypes of suicidality disorders have the same clinical features, natural history, response to life events, prognosis, or response to treatment.
Literature References:
1. Spiegelberg, H. (2015, June 11). Phenomenology. Retrieved October 24, 2015, from http://www.britannica.com/topic/phenomenology
2. Sheehan, DV and Giddens, JM. Suicidality Disorders Criteria. In: Sheehan, DV and Giddens, JM. Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, p. 82-126.
How to Cite:
Giddens JM, Sheehan DV. A Classification of Suicidality Disorder Phenotypes (12 Phenotypes Version). Poster. Annual Meeting, American Psychiatric Association (APA), San Diego, CA, May, 23, 2017.
Suicidality: A Linear or a Non-Linear Progression Over Time?
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3, 4
1 University of South Florida College of Medicine, Tampa, FL, USA
2 Harm Research Institute, Tampa, FL, USA
3 Tampa Center for Research on Suicidality, Tampa, FL, USA
4 University of South Florida College of Arts and Sciences, Tampa, FL, USA
Click here to view or download a watermarked, preview copy of this poster
Date: Tuesday, May 23rd, 2017
Time: 10 am to Noon
Location: Exhibit Hall A, Ground Level, San Diego Convention Center, San Diego, CA
Poster Number: P7-066
Abstract:
Objective: To investigate whether the progression of suicidality phenomena over time is linear or non-linear. The model of progressive, linear suicidality is a long-standing assumption in suicidality research. Understanding the progression of suicidality over time will help researchers build better predictive models of suicidality.
Design: We adapted methods developed by Robert Stetson Shaw, a physicist at the University of California at Santa Cruz, to analyze the progression of suicidality phenomena in 2 continuous data sets from a single case over time. These methods are used in non-linear dynamics theory / non-linear systems theory / turbulence theory / deterministic chaos and permit data to be graphically displayed in 2- and 3-dimensional space over time.
Results: The method permitted the mathematical graphic modeling of suicidality phenomena over 3 years in the form of 2D and 3D attractor plots. The results showed a non-linear dynamic progression of suicidality phenomena over time. There was no linear progression in the rate of change in the relationship between suicidal ideation and behavior, over time.
Conclusion: The trajectory of suicidal phenomena over time is non-linear and dynamic. This data is displayed graphically as attractor plots that reflect the underlying structure of suicidality and its dynamic, turbulent change over time. To improve predictive models of suicidality, progressive, linear models need to be abandoned in favor of non-linear, mathematical modeling of dynamic systems that more accurately reflect the turbulence, unpredictability, and dynamic nature of the complex systems of suicidality phenomena as they move through time
Learning Objectives:
Following this presentation, participants will be better able to:
1. Understand that suicidality may not follow a linear progression, but follows a model of chaos dynamics.
2. Appreciate the need to consider non-linear dynamic systems mathematical modeling when building predictive models of suicidality.
3. Understand that most (if not all) research on risk and protective factors for suicidality are based on linear models and may not accurately model the true non-linear dynamic nature of suicidality.
Literature References:
1. Robert Shaw, The Dripping Faucet As a Model Chaotic System, Science Frontier Express Series, Aerial Press, December 1984, ISBN 0-942344-05-7.
2. Giddens JM, Sheehan DV. Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder. In: Sheehan, DV and Giddens, JM. Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, p. 249-247.
How to Cite:
Sheehan DV, Giddens JM. Suicidality: A Linear or a Non-linear Progression Over Time? Poster. Annual Meeting, American Psychiatric Association (APA), San Diego, CA, May, 23, 2017.