APA 2019
HarmResearch gave the following presentations at the 2019 Annual Meeting of the American Psychiatric Association (APA):
Tuesday, May 21st, 2019, 10 to 11:30 am Session
Tuesday, May 21st, 2019, 2 to 4 pm Posters
Tuesday, May 21st, 2019 Session
Novel Approaches to Understanding, Identifying, and Treating Suicidal Impulsivity
Date: Tuesday, May 21st, 2019
Time: 10 to 11:30 am
Location: Room 153, Upper Mezzanine, Moscone South, Moscone Center, San Francisco, CA
Session Number: 1289
Abstract:
1. Impulsive Suicidality: A Brief Review of Literature
Dr. David V. Sheehan, MD, MBA, DLFAPA, Distinguished University Health Professor Emeritus at the University of South Florida College of Medicine, Tampa, Florida, USA
Dr. Sheehan will share a brief review of the literature on the relationship between impulsivity and suicidality. 62% of suicide attempts are impulsive rather than planned. Yet there has been more focus on assessing future suicide plans and intent while giving less attention to understanding the nature of impulsive suicidality.
2. Unexpected Suicidal Impulse Attacks and Impulse Attack Suicidality Disorder
Jennifer M. Giddens, BA, Harm Research Institute, Tampa, Florida, USA.
Jennifer Giddens will share a description of a unique phenotype of suicidality where patients experience an unexpected, unprovoked sudden urge to make a suicide attempt. This presentation will describe the phenomena associated with these Unexpected Suicidal Impulse Attacks and with Impulse Attack Suicidality Disorder including associated functional impairment and specific questions which can be used to assess this unique suicidal phenomenon.
3. Case Studies of Magnesium in the Treatment of Impulse Attack Suicidality Disorder
Dr. Danilo Quiroz, Director Académico Fundación Neuropsiquiátrica de Santiago – NEPSIS & Profesor Adjunto Universidad Diego Portales, Santiago, Chile and Dr. David V. Sheehan, MD, MBA, DLFAPA, Distinguished University Health Professor Emeritus at University of South Florida College of Medicine
Dr. Quiroz and Dr. Sheehan will present studies on the use of magnesium oxide in the treatment of Impulse Attack Suicidality Disorder, including patient videos.
4. Panel Discussion: Questions and Answers
Session Schedule:
90 minute Session
5 minutes introduction
20 minutes for each presentation
25 minutes for panel discussion
Learning Objectives:
1. Understand the general trait impulsivity and specific suicidal state impulsivity.
2. Understand the phenomena and functional impairment associated with suicidal impulsivity.
3. Understand how to question patients about suicidal impulsivity and monitor this over time.
4. Understand how to identify impulsive suicidality.
5. Understand the importance of identifying patients with impulsive suicidality prior to prescribing pharmacological treatments for suicidality.
How to Cite:
Sheehan DV, Giddens JM, Quiroz, D. Novel Approaches to Understanding, Identifying, and Treating Suicidal Impulsivity. Session. Annual Meeting, American Psychiatric Association (APA), San Francisco, CA, May, 21, 2019.
Tuesday, May 21st, 2019 Posters
Do the Impact of ‘Risk Factors’ or ‘Protective Factors’ for Suicidality
Change in Response to Effective Treatment? A Case Study
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens BA 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: Tuesday, May 21st, 2019
Time: 2 to 4 pm
Location: Rooms 3/4, Exhibition Level, Moscone South, Moscone Center, San Francisco, CA
Poster Number: P8-97
Abstract:
Background: This case study reports the treatment effect on the impact of known ‘risk and protective factors’ on an individual’s suicidality. Such factors are usually deemed immutable and not considered sensitive to change in direct response to effective treatment for suicidality, in the way that suicidality thoughts and behaviors are. Assessment of risk and protective factors is usually considered a necessary component of any thorough assessment of suicidality.
Methods: A 31-year-old female subject who experienced suicidality almost daily for over 20 years prospectively collected a self-report data series over 80 weeks using the Sheehan – Suicidality Tracking Scale Clinically Meaningful Change Measure version (S-STS CMCM), covering a timeframe before, during and after effective treatment for suicidality. This extended version of the scale contains a section on the dimensional assessment of a wide range of both ‘risk’ and ‘protective’ factors for suicidality. These can be assessed over time within each individual.
Results: The data show a change in the subject’s perception of the impact the ‘risk’ and ‘protective’ factors had on her following effective treatment, in a way that differed from the impact these factors had on her while she was chronically suicidal before effective treatment.
Conclusion: Effective treatment for suicidality can impact the ‘risk factors’ and ‘protective factors’ within a single individual, although there was no evidence of objective change in these external risk factors themselves. Both ‘risk’ and protective factors for suicidality may not be as immutable within each individual as previously thought and may be sensitive to treatment effects.
Learning Objectives:
Following this presentation, participants will be better able to:
1. Appreciate that both ‘risk’ and ‘protective’ factors for suicidality may not be as immutable within each individual as previously thought.
2. Appreciate that both ‘risk’ and ‘protective’ factors for suicidality may be sensitive to treatment effects.
Literature References:
1. Sheehan, D. V., Giddens, J. M., & Sheehan, I. S. (2014). Status Update on the Sheehan-Suicidality Tracking Scale (S-STS) 2014. Innovations in Clinical Neuroscience, 11(9-10), 93. PDF: http://innovationscns.epubxp.com/i/425963/92
2. Sheehan DV, Giddens, JM. Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015.
How to Cite:
Sheehan DV, Giddens JM. Do the Impact of ‘Risk Factors’ or ‘Protective Factors’ for Suicidality Change in Response to Effective Treatment? A Case Study. Poster. Annual Meeting, American Psychiatric Association (APA), San Francisco, CA, May, 21, 2019.
Does Citalopram Increase the Frequency of Up-Switches of Impulsive Suicidality
in a Subject With Impulse Attack Suicidality Disorder? A Case Study
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens BA 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: Tuesday, May 21st, 2019
Time: 2 to 4 pm
Location: Rooms 3/4, Exhibition Level, Moscone South, Moscone Center, San Francisco, CA
Poster Number: P8-98
Abstract:
Background: This case study reports the effect of the SSRI citalopram in causing up-switches of impulsive suicidality.
Methods: A 29-year-old female subject who experienced suicidality almost daily for over 20 years prospectively collected a self-report data series over 248 days using the computerized versions of the Suicidality Modifiers Scale (SMS) and the Sheehan – Suicidality Tracking Scale (S-STS), covering a timeframe before, during and after a 116-day trial of citalopram. The S-STS data was mapped into the C-CASA 2010 and FDA-CASA 2012 categories and compared to the scores for the severity of impulsive suicidality from the SMS.
Results: The SMS data show a 39% increase in up-switches in suicidal impulsivity while the subject was taking the citalopram. The data show the C-CASA 2010 and FDA-CASA 2012 categories were unable to detect this signal of increased up-switches in suicidal impulsivity. The data in some of these C-CASA 2010 and FDA-CASA 2012 categories suggest that the subject’s suicidality was improving while these danger signals were worsening.
Conclusion: The SSRI citalopram is associated with an increase in up-switches in suicidal impulsivity in a non-Bipolar Disorder subject. That the existing safety detecting classification algorithms used by the US Food and Drug Administration (2010 and 2012) can fail to detect a serious suicidal adverse event such as the one described above is a cause for serious concern and needs to be corrected. Any rating instrument or classification “algorithm” used to detect safety signals of suicidality needs to include an item on impulsive suicidality.
Learning Objectives:
Following this presentation, participants will be better able to:
1. Appreciate that some phenotypes of suicidality disorders can be worsened by an SSRI.
2. Appreciate that some classification systems and some classification assessment instruments will detect this treatment emergent suicidality while others will fail to do so or will show improvement in suicidality at exactly the same time.
Literature References:
1. Sheehan DV, Giddens JM. Does citalopram increase the frequency of up-switches of impulsive suicidality in a subject with Impulse Attack Suicidality Disorder? – A case study. In: Sheehan, DV and Giddens, JM. (2015). Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015, 226-248.
2. United States Food and Drug Administration, United States Department of Health and Human Services. Guidance for Industry: Suicidality: Prospective Assessment of Occurrence in Clinical Trials, Draft Guidance. [October 1, 2014]. http://www.fda.gov/downloads/Drugs/Guidances/UCM225130.pdf August 2012. Revision 1.
How to Cite:
Sheehan DV, Giddens JM. Does citalopram increase the frequency of up-switches of impulsive suicidality in a subject with Impulse Attack Suicidality Disorder? – A case study. Poster. Annual Meeting, American Psychiatric Association (APA), San Francisco, CA, May, 21, 2019.
Is the Count of Suicidal Events an Acceptable Substitute for the Seriousness of Suicidal Events
in Rating Each Suicidal Phenomenon? A Case Study
David V Sheehan MD, MBA, DLFAPA 1, 2, 3
Jennifer M Giddens BA 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: Tuesday, May 21st, 2019
Time: 2 to 4 pm
Location: Rooms 3/4, Exhibition Level, Moscone South, Moscone Center, San Francisco, CA
Poster Number: P8-99
Abstract:
Background: This case study investigates which of the following is a more sensitive measure of the gravity of suicidality: 1) the count of suicidality events of each suicidality phenomenon, or 2) the dimensional measurement of the seriousness of each suicidality phenomenon.
Methods: A 30-year-old female subject who experienced suicidality almost daily for over 20 years prospectively collected a self-report data series over 552 days using the computerized versions of the Sheehan – Suicidality Tracking Scale (S-STS). The seriousness of each suicidality phenomenon was captured using the S-STS. The count of suicidality events was captured using the Tampa – Classification Algorithm for Suicidality Assessment (T-CASA).
Results: Most of the time the seriousness of the suicidality event was more sensitive in detecting the gravity of the suicidality, than the count of the suicidality events, for each suicidal phenomenon, within a timeframe. This was particularly true for impulsive suicidality.
Conclusion: The count of suicidal events is not an acceptable substitute for the dimensional assessment of the seriousness of each suicidal phenomenon. Any rating instrument used to detect safety signals of suicidality, should include a dimensional assessment of seriousness of each suicidal phenomenon, rather than relying on the count of suicidality events.
Learning Objectives:
Following this presentation, participants will be better able to:
1. Appreciate that measuring the seriousness of suicidality events is a more sensitive measure than the count of suicidality events within a timeframe.
2. Appreciate the limitations in the sensitivity of counts of suicidality in assessing suicidality.
Literature References:
1. Sheehan, D. V., Giddens, J. M., & Sheehan, I. S. (2014). Status Update on the Sheehan-Suicidality Tracking Scale (S-STS) 2014. Innovations in Clinical Neuroscience, 11(9-10), 93. PDF: http://innovationscns.epubxp.com/i/425963/92
2. Sheehan DV, Giddens, JM. Suicidality: A Roadmap for Assessment and Treatment. (1st ed.). Tampa, FL: Harm Research Press. November 2015.
How to Cite:
Sheehan DV, Giddens JM. Is the Count of Suicidal Events an Acceptable Substitute for the Seriousness of Suicidal Events in Rating Each Suicidal Phenomenon? A Case Study. Poster. Annual Meeting, American Psychiatric Association (APA), San Francisco, CA, May, 21, 2019.