On the development of depressive states from a psychodynamic viewpoint

The author analyzes the temporal dimension of depression by making reference to one of the clinical cases he treated and re-examining a clinical case analyzed by Edith Jacobson. According to the result of his observations, the developmental psychodynamics of a depressive state normally appears to take place in two distinct phases: a first narcissistic loss, which gives rise to an integrative conflict and to the formation of a certain identificatory structure, is later followed by a second narcissistic loss, which leads to the real depressive state. The two phases present a specific, intrinsic connection constituted by the implication of the same identificatory element of the self, recognition of which can favour a clinical work that more closely adheres to the deep dynamics of depression.     

Expansion of Genetic Services Utilizing a General Genetic Counseling Clinic

We established a general genetic counseling clinic (GCC) to help reduce long wait times for new patient appointments and to enhance services for a subset of patients. Genetic counselors, who are licensed in Tennessee, were the primary providers and MD geneticists served as medical advisors. This article describes the clinic referral sources, reasons for referral and patient dispositions following their GCC visit(s). We obtained patients by triaging referrals made to our medical genetics division. Over 24 months, our GCC provided timely visits for 321 patients, allowing the MD geneticists to focus on patients needing a clinical exam and/or complex medical management. Following their GCC visit(s), over 80 % of patients did not need additional appointments with an MD geneticist. The GCC allowed the genetic counselor to spend more time with patients than is possible in our traditional medical genetics clinic. Patient satisfaction surveys (n?=?30) were very positive overall concerning the care provided. Added benefits for the genetic counselors were increased professional responsibility, autonomy and visibility as health care providers. We conclude that genetic counselors are accepted as health care providers by patients and referring providers for a subset of clinical genetics cases. A GCC can expand genetic services, complement more traditional genetic clinic models and utilize the strengths of the genetic counselor health care provider.     

Hitting the Bull’s Eye in Personality Disorders Psychotherapy

Psychotherapy of personality disorders (PD) is gaining momentum, though the progress has been mostly concerned borderline PD, with the other disorders largely neglected. In parallel, many empirically tested approaches focus on a limited understanding of psychopathology, for example poor mentalization or affect dysregulation, while PD are complex entities; they require clinicians paying attention to multiple therapy targets in order to be treated effectively and for a hope of actual recovery. I contend here that a more comprehensive account of psychopathology is needed; therefore the papers in this special issue focus on some of these aspects, such as difficulties in mental state understanding, dysfunctional representations of self with others, poor affect regulation and lack of access to adaptive and healthy self-aspects. The papers included in this special issue try and provide the readers with an intensive qualitative account of how therapists can act and yield improvements in these domains, with the hope of improving clinicians’ abilities to treat PD no matter what their preferred orientation is.     

Clarifying the Role of Psychological Pain in the Risks of Suicidal Ideation and Suicidal Acts among Patients with Major Depressive Episodes

The role of psychological pain in the risk of suicide was explored using a three‐dimensional psychological pain model (pain arousal, painful feelings, pain avoidance). The sample consisted of 111 outpatients with major depressive episodes, including 28 individuals with suicidal histories. They completed the Chinese version of the Beck Scale for Suicide Ideation (BSI), the Beck Depression Inventory (BDI), the Psychache Scale, and the three‐dimensional Psychological Pain Scale (TDPPS). A structured clinical interview was conducted to assess the history of suicidal acts. Significant correlations were found among BDI, BSI, and TDPPS scores (p < .01). Stepwise regression analyses showed that only pain avoidance scores significantly predicted suicide ideation at one's worst point (β = .79, p < .001) and suicidal acts (β = .46, p < .001). Pain avoidance was also a better predictor of current suicidal ideation (β = .37, p = .001) than were BDI scores (β = .31, p < .01). Increased levels of pain avoidance during a major depressive episode may be a dominant component of the motivation for suicide. Future clinical assessments for populations at high risk of suicide should include measures of psychological pain to reduce the incidence of suicide.     

The Temporal Association Between Self‐Injurious Thoughts and Psychotic Symptoms: A Mobile Phone Assessment Study

The relationship between psychotic symptoms and self‐injurious thoughts (SITs) remains unclear. The short‐term temporal associations between psychotic symptoms and SITs were explored. A sample of 36 people with a diagnosis of a psychotic disorder or at‐risk mental state completed mobile phone‐based measures at multiple times each day for 1 week. Clustered regression with time‐lagged variables supported a relationship between paranoia and subsequent SITs. Hallucinations did not predict these thoughts when controlling for paranoia. The role of specific psychotic symptoms in triggering SITs is highlighted and the importance of considering these factors in risk management is discussed.     

To What Extent Does the Reporting Behavior of the Media Regarding a Celebrity Suicide Influence Subsequent Suicides in South Korea?

This study investigated the nature of media coverage of a national entertainer's suicide and its impact on subsequent suicides. After the celebrity suicide, the number of suicide‐related articles reported surged around 80 times in the week after the suicide compared with the week prior. Many articles (37.1%) violated several critical items on the World Health Organization suicide reporting guidelines, like containing a detailed suicide method. Most gender and age subgroups were at significantly higher risk of suicide during the 4 weeks after the celebrity suicide. Results imply that massive and noncompliant media coverage of a celebrity suicide can cause a large‐scale copycat effect.     

Interaction of Combat Exposure and Unit Cohesion in Predicting Suicide‐Related Ideation Among Post‐Deployment Soldiers

Suicide is one of the leading causes of death among U.S. Army soldiers. Suicide‐related ideation, which is associated with suicide attempts and suicide, can cause considerable distress. In a sample of 1,663 recently redeployed soldiers, we used factor analysis and structural equation modeling to test the associations between combat exposure, unit cohesion, and their interaction in predicting suicide‐related ideation. We found that combat exposure was a significant risk factor for suicide‐related ideation, while unit cohesion was a significant protective factor. The significant interaction between the two factors indicated that soldiers who experienced greater combat exposure but also had higher levels of unit cohesion had relatively lower levels of suicide‐related ideation. In addition, those who had higher levels of combat exposure and lower unit cohesion were most at risk for suicide‐related ideation. Our findings indicate the importance of unit cohesion in protecting soldiers from suicide‐related ideation and suggest a higher risk group of soldiers who should be targeted for interventions.     

A psychoanalytic interpretation of bipolar disorder

Abstract

The author proposes viewing mania as a form of defense against the state of depression resulting from “narcissistic overidentification with the depressive object” (i.e., the object in relation to which the depressive state developed), rather than as a periodic rebellion against such an internalized object. An account of the analytic psychotherapy of a clinical case of bipolar depression serves to illustrate this point of view, linked to the author’s specific conception of the dynamics of depression.     

Mental Disorders,Comorbidity, and Pre‐enlistment Suicidal Behavior Among New Soldiers in the U.S. Army: Results from the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS)

We examined the associations between mental disorders and suicidal behavior (ideation, plans, and attempts) among new soldiers using data from the New Soldier Study (NSS) component of the Army Study to Assess Risk and Resilience in Servicemembers (Army STARRS; N = 38,507). Most new soldiers with a pre‐enlistment history of suicide attempt reported a prior mental disorder (59.0%). Each disorder examined was associated with increased odds of suicidal behavior (ORs = 2.6–8.6). Only PTSD and disorders characterized by irritability and impulsive/aggressive behavior (i.e., bipolar disorder, conduct disorder, oppositional defiant disorder, and attention‐deficit/hyperactivity disorder) predicted unplanned attempts among ideators. Mental disorders are important predictors of pre‐enlistment suicidal behavior among new soldiers and should figure prominently in suicide screening and prevention efforts.