ASCP 2016
HarmResearch gave the following presentations at the 2016 Annual Meeting of the American Society of Clinical Psychopharmacology (ASCP):
Tuesday, May 31st, 2016, 4:30 pm to 4:45 pm Oral Presentation
Wednesday, June 1st, 2016, 11:15 am to 1:00 pm Poster
Wednesday, June 1st, 2016, 4:10 pm to 4:40 pm Oral Presentation
Thursday, June 2nd, 2016, Noon to 2 pm Poster
Tuesday, May 31st, 2016 Oral Presentation
Do Suicidality Phenomena Follow a Linear or a Non-linear Progression over Time?
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3
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
Date: Tuesday, May 31st, 2016
Time: 4:30 pm to 4:45 pm
Location: Salon G, Fairmont Scottsdale Princess, Scottsdale, AZ
Abstract:
Background: It is assumed that suicidality progresses from suicidal ideations (passive suicidal ideation, then active suicidal ideation) to suicidal behaviors (suicidal preparatory behaviors, then suicide attempts). This model of progressive, linear suicidality has been the basis of much research into risk and protective factors for suicidality. Understanding the true nature of suicidality over time will help researchers build better predictive models.
Methods: Methods developed by Robert Stetson Shaw, a physicist at UCSC to analyze data from an oscillator in 2- and 3-dimensional space (2D and 3D, respectively) were used. These methods are used in non-linear dynamics theory / non-linear systems theory / turbulence theory / deterministic chaos. We adapted his methodology to an analysis conducted on 3 databases collected from the same subject over time. One is a database of over 43,000 events of suicidality captured using T-CASA. The other two databases were collected over 145 weeks, using S-STS and SPTS.
Results: The method used permitted the mathematical graphic modeling of suicidality phenomena over 3 years in the form of 2D- and 3D-attractors. The results found a non-linear dynamic relationship of suicidality phenomena over time. There was no progressive, linear relationship of suicidality phenomena over time.
Conclusions: The relationship of suicidality phenomena over time is non-linear and dynamic. To improve predictive models of suicidality, the progressive, linear models need to be abandoned in favor of non-linear, dynamic systems mathematical modeling that more accurately reflect the turbulence, the apparent unpredictability, and the dynamic nature of the complex system of suicidality.
Learning Objectives:
Following this presentation, participants will be:
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:
2. Shaw R. The dripping faucet as a model chaotic system. Ariel Press. 1984.
How to Cite:
Sheehan DV, Giddens JM. Do Suicidality Phenomena Follow a Linear or Non-linear Progression Over Time? Oral Presentation. Annual Meeting, American Society of Clinical Psychopharmacology (ASCP), Scottsdale, AZ, May, 31, 2016.
Wednesday, June 1st, 2016 Poster
A Classification of Suicidality Disorder Phenotypes
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3
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
Click here to view or download a watermarked, preview copy of this poster
Date: Wednesday, June 1st, 2016
Time: 11:15 am to 1 pm
Location: Palomino 1-7, Fairmont Scottsdale Princess, Scottsdale, AZ
Poster Number: 34
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 11 distinct suicidality disorder phenotypes. These include 1) Impulse Attack Suicidality Disorder, 2) Homicidal Suicidality Disorder 3) Psychotic Suicidality Disorder, 4) Obsessive-Compulsive Suicidality Disorder, 5) PTSD Induced Suicidality Disorder, 6) Eating Disorder / Malabsorption Suicidality Disorder, 7) Substance Induced Suicidality Disorder, 8) Medical Illness / Neurological Condition Induced Suicidality Disorder, 9) Mood Disorder Induced Suicidality Disorder, 10) Life Event Induced Suicidality Disorder, and 11) Suicidality Disorder, 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 11 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. 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.
2. Spiegelberg, H. (2015, June 11). Phenomenology. Retrieved October 24, 2015, from http://www.britannica.com/topic/phenomenology
How to Cite:
Sheehan DV, Giddens JM. A Classification of Suicidality Disorder Phenotypes (11 Phenotypes Version). Poster. Annual Meeting, American Society of Clinical Psychopharmacology (ASCP), Scottsdale, AZ, June, 1, 2016.
Wednesday, June 1st, 2016 Oral Presentation
There are Several Suicidality Disorders
in
“Is Suicidal Ideation a Symptom or a Syndrome?” Workshop
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3
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
Date: Wednesday, June 1st, 2016
Time: 4:10 pm to 4:40 pm
Location: Salon I, Fairmont Scottsdale Princess, Scottsdale, AZ
Abstract:
Suicidality is orthogonal to depression. In order to search for and investigate candidate anti-suicidality medications we need dimensional rating scales sensitive in detecting the efficacy signal and we need a classification of suicidality disorder phenotypes. Different suicidality disorder phenotypes have a different response to treatment. In those with major depressive disorder (MDD) over 65 years antidepressants are superior to placebo. In those under 25 with MDD, antidepressants worsen suicidality compared to placebo. Clozapine helps reduce suicidality in schizophrenia, while lithium helps reduce suicidality in bipolar disorder. Not all patients with suicidality respond to any of these treatments. This suggests that there may be several suicidality phenotypes and / or genotypes with different responses to treatment. If we put all patients with suicidality into one study with an anti-suicidality medication it is likely to fail, just as any SSRI or SNRI would not separate from placebo if we put all subjects with depressive symptoms into the same trail, without making distinctions between the bipolar depression and the major depressive disorder phenotypes. We cannot wait until we fully understand the pathophysiology of suicide before seeking and investigating effective pharmacological anti-suicidal treatments. One path forward in pursuit of this goal is to formulate as best we can an interim phenotypic classification of suicidality disorders and concurrently collect investigate genetic biomarkers, while we investigate the response of each to medication treatments. This presentation will offer one possible classification of suicidality disorder phenotypes as a starting point.
Learning Objectives:
Following this presentation, participants will:
1. Appreciate and to evaluate the evidence suggesting that suicidality is more a collection of different primary disorder phenotypes than a symptom complicating depression.
2. Have a working model of a classification for suicidality disorders, with related diagnostic criteria and associated structured diagnostic interview.
Literature References:
2. United Nations. Best Practice Guidelines for Developing International Statistical Classifications. UN Department of Economic and Social Affairs Statistics Division. Report from Expert Group Meeting on International Statistical Classifications. New York, NY: May 13–15, 2013.
How to Cite:
Sheehan DV, Giddens JM. There are Several Suicidality Disorders. Oral Presentation in “Is Suicidal Ideation a Symptom or a Syndrome?” Workshop. Annual Meeting, American Society of Clinical Psychopharmacology (ASCP), Scottsdale, AZ, June, 1, 2016.
Thursday, June 2nd, 2016 Poster
Case Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder (IASD)
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens 2, 3
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
Click here to view or download a watermarked, preview copy of this poster
Date: Thursday, June 2nd, 2016
Time: Noon to 2 pm
Location: Palomino 1-7, Fairmont Scottsdale Princess, Scottsdale, AZ
Poster Number: 35
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:
Sheehan DV, Giddens JM. Case Study of Magnesium in the Treatment of Impulse Attack Suicidality Disorder (IASD). Poster. Annual Meeting, American Society of Clinical Psychopharmacology (ASCP), Scottsdale, AZ, June, 2, 2016.