years, 58% female, 66.2% with bipolar I disorder). Depressive or manic/hypomanic onset and severity were evaluated weekly with the Longitudinal Interval Follow-up Evaluation. Suicidal behavior was defined as suicide completion or suicide attempt. Mixed states were noted in 38% of participants, primarily those with bipolar I disorder. A history of mixed states was associated with an increased risk for suicidal behavior and more time in a depressive state. A total of 71.1% of the increased risk for suicidal behavior in patients with a history of mixed state could be attributed to the depression component of the disorder. Risk for suicidal behavior increased during mania (hazard ratio [HR]: 1.96; 95% CI, 1.28-2.99; p =.0019) and depression (HR: Disruptive mood dysregulation disorder Disruptive mood dysregulation disorder (DMDD) is a childhood condition of extreme irritability, anger, and frequent, intense temper outbursts. DMDD symptoms go beyond a being a “moody” child; children with DMDD experience severe impairment that requires clinical attention. DMDD appeared for the first time in DSM-5 (APA, 2013). Symptoms of DMDD are common to disorders like bipolar disorder, oppositional defiant disorder, and conduct disorder. The disorder often co-occurs with depression, anxiety, or attention-deficit hyperactivity disorder (Sheaffer, 2018). DMDD can impair a child’s quality of life and school performance and disrupt relationships with his or her family and peers. Children with DMDD may find it hard to participate in activities or make friends. DMDD symptoms typically begin before age 10, but the diagnosis is not given to children under six or adolescents over 18. A child with DMDD experiences: Substance use disorder Suicide and mental disorders, such as depression and drug abuse, have been well-established as having a link, particularly in high-income countries (Poorolajal et al., 2016). One recent meta- analysis found that having a substance use disorder increased the odds of having suicidal ideation by 2.0- fold, the odds of a suicide attempt by 2.5-fold, and death by suicide by 1.5- fold (Poorolajal, Haghtalab, Farhadi, & Darvishi, 2016), making substance use disorders an important risk condition for suicidal behavior. Alcohol use is a significant risk factor leading to suicide and remains the leading risk factor among individuals between the ages of 14 and 49. Darvishi et al. (2015) reviewed 31 studies with 420,732 participants; they found a significant association between alcohol use disorder (AUD) and suicidal ideation, suicide attempts, and suicide. The authors concluded that there Obsessive-Compulsive and Related Disorders (OCD) The DSM-5 has removed Obsessive-Compulsive Disorder (OCD) from the chapter on anxiety and created a separate classification called Obsessive-Compulsive and Related Disorders due to the commonality of obsessive thoughts and/or repetitive behaviors (APA, 2013). OCD is a chronic, distressing disorder associated with significant functional impairment. Patients with OCD often suffer from one or more co-morbid disorders (Chaudhary, Kumar, & Mishra, 2016), major depression being the most common. Increased severity of co-morbid depressive and anxiety symptoms, increased severity of obsessions, feelings of hopelessness, and past history of suicide attempts have been associated with worsening levels of suicidality in patients with OCD. OCD has, in some studies, been identified as one of the strongest predictors of suicide among psychiatric disorders (Veisani, Mohamadian, & Delpisheh, 2017). The results of their study to assess depression and suicidality in OCD patients showed the following results: Of the study participants, 40% suffered from mild depression, whereas 16% suffered from moderate depression, and 10 and 14% had severe and very severe depression,
5.49; 95% CI, 4.01- 7.51; p <.0001) in bipolar I disorder. Risk was only increased during episodes of depression for bipolar II disorder (HR: 3.66; 95% CI, 2.51-5.35; p <.001). The effect of mixed states on suicidal behavior was less than additive for bipolar I and additive for bipolar II. According to the authors, this indicated that mixed state does not increase the risk for suicidal behavior beyond the risk associated with the depressive component. The study authors concluded that much of the suicide risk related to having a history of mixed states is not a product of the mixed state itself, but rather can be attributed to a depression- predominant course of illness. ● Severe temper outbursts (verbal or behavioral) at an average of three or more times per week that are out-of-keeping with the situation and the child’s developmental level. ● Trouble functioning due to irritability in more than one place (e.g., home, school, with peers). (NIMH, 2017) To be diagnosed with DMDD, a child must have these symptoms steadily for 12 or more months. Having DMDD as a child also increases the risk of developing ● Irritable or angry mood most of the day, nearly every day, and at least three times a week. depression or anxiety disorders in adulthood. Children diagnosed with DMDD are at increased risk of self-harm and suicidal behaviors (Sheaffer, 2018), making suicide risk assessment with DMDD diagnosed youth an important part of the treatment process (Dir et al., 2020). is sufficient evidence that AUD significantly increases the risk of suicidal ideation, suicide attempt, and completed suicide. Therefore, AUD can be considered an important predictor of suicide and a great source of premature death. Drinking alcohol excessively can negatively affect both physical and mental health, causing psychiatric disorders and increasing the risk of suicide. Countries with higher rates of alcohol use generally have higher rates of suicide. Furthermore, current evidence indicates an association between alcohol dependence and impulsive suicide attempts. In addition, there is a close link between alcohol abuse and depression, and it is often difficult to determine which of the two is the main leading condition. People with alcohol disorder should be screened for suicidality as well as other psychiatric diagnoses. respectively. Suicidal ideation was found in 52% of all patients but in 70% of female patients. A history of suicide attempt was found in 16%. It was also found that in cases of severe and very severe depression associated with OCD, all patients had suicidal ideation as compared to 35% in mild and 87.5% in moderate depressive patients. Results showed that 40% of severe depressive and 28.57% of very severe depressive patients had attempted suicide one or more times during the course of illness. Also, suicidality was found to be maximum in those with symptoms of cleanliness and contamination (57%) followed by religious obsessions (45%), sexual obsessions (33%), repeated rituals (31%) and other obsessions, like need to touch and ask (26%), respectively. (Chaudhary, Kumar, & Mishra, 2016) Based on these outcomes, researchers concluded that OCD is associated with a high risk of not only depression, but also of suicidal behavior. It is vital that OCD patients undergo detailed assessment for suicide risk and associated depression. Aggressive treatment of depression may be warranted to modify the risk of suicide. Professionals should use behavioral and cognitive techniques, along with pharmacotherapy, to target co-
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