BACKGROUND & AIMS: OBJECTIVE AND METHOD:The article reviews the literature on the psychodynamics of suicide, focusing on factors that will help in evaluating and treating the young suicidal patient. Articles published in refereed journals and books and book chapters based on such articles are the source of most of the material. Articles that first brought a new finding to notice are given preference. Methodological limitations and contradictions with the data of other studies are pointed out. FINDINGS:The psychodynamic meaning of suicide for a patient derives from both affective and cognitive components. Rage, hopelessness, despair, and guilt are important affective states in which young patients commit suicide. The meanings of suicide can be usefully organized around the conscious (cognitive) and unconscious meanings given to death by the suicidal patient: death as reunion, death as rebirth, death as retaliatory abandonment, death as revenge, and death as self-punishment or atonement. CONCLUSIONS:Knowledge of the psychodynamics helps to distinguish which patients with any given diagnosis are at risk for suicide. Such knowledge is essential to the psychotherapeutic treatment of the young suicidal patient. Topics for future research include the role of anxiety in suicide; the capacity to bear hopelessness, rage, and other unpleasant affects without regression; the use of particular defense mechanisms in distinguishing the risk of either suicidal or violent behavior; and the relation of specific psychodynamic conflicts seen in suicidal patients to particular psychiatric diagnoses.

背景与目标：

BACKGROUND & AIMS: :National suicide rates differ to a high extent. Tentative explanations for this finding reach from macro-social to population-genetic models. Still unexplored is the influence of cultural values, i.e. the association between the acceptance of suicide motives in a population and the national suicide rates. The goal of this study was the development and evaluation of a questionnaire on the acceptance of suicide motives (ASM), an instrument which will be used for transcultural psychiatric research in a multi-centre study. Additionally the first results of a trial with 153 healthy Austrians are presented. Test-Retest reliability of the five scales ranged from r=0.74 after to r=0.89 for 3 months interval. The internal consistency of scales was very good (Cronbachs Alpha 0.71 after to 0.88). The Austrians especially accept motives associated with physical frailty or guilt feelings and less those associated with shame. The acceptance of suicide motives relatively stable in terms of age and gender. Thus, the ASM seems to be suited as an instrument for cultural comparative studies on the detection of reasons of national suicide rates.

背景与目标： : 全国自杀率差异很大。对这一发现的初步解释从宏观社会模型到人口遗传模型。尚未探索的是文化价值观的影响，即人口中自杀动机的接受与全国自杀率之间的关联。这项研究的目的是开发和评估有关接受自杀动机 (ASM) 的问卷，该问卷将在多中心研究中用于跨文化精神病学研究。此外，还介绍了153名健康奥地利人的试验的初步结果。五个量表的重测信度范围从r = 0.74到r = 0.89，间隔3个月。量表的内部一致性非常好 (Cronbachs α 在0.88后0.71)。奥地利人特别接受与身体虚弱或内感有关的动机，而较少接受与羞耻有关的动机。在年龄和性别方面，对自杀动机的接受相对稳定。因此，ASM似乎适合作为检测国家自杀率原因的文化比较研究的工具。

BACKGROUND & AIMS: BACKGROUND:Brief Contact Interventions (BCIs) after a suicide attempt (SA) are an important element of prevention against SA and suicide. They are easier to generalize to an entire population than other forms of intervention. VigilanS generalizes to a whole French region a BCI combining resource cards, telephone calls and mailings, according to a predefined algorithm. It was implemented gradually in the Nord-Pas-de-Calais (NPC), France, between 2015 and 2018. Here, we evaluate the effectiveness of VigilanS, in terms of SA reduction, using annual data collected by participating centers. Hypothesis tested: the higher the VigilanS implementation in a center (measured by penetrance), the greater the decrease in the number of SA observed in this center. METHODS:The study period was from 2014 to 2018, across all of NPC centers. We performed a series of linear regressions, each center representing a statistical unit. The outcome was the change in the number of SA, relative to the initial number, and the predictive variable was VigilanS' penetrance: number of patients included in VigilanS over the total number of SA. Search for influential points (points beyond threshold values of 3 influence criteria) and weighted least squares estimations were performed. RESULTS:Twenty-one centers were running VigilanS in 2018, with an average penetrance of 32%. A significant relationship was identified, showing a sharp decrease in SA as a function of penetrance (slope = - 1.13; p = 3*10- 5). The model suggested that a 25% of penetrance would yield a SA decrease of 41%. CONCLUSION:VigilanS has the potential to reduce SA. Subgroup analyzes are needed to further evaluate its effectiveness. Subgroup analyses remain to be done, in order to evaluate the specific variations of SA by group.

背景与目标：

BACKGROUND & AIMS: :The goal of the study was to determine social and diagnostic characteristics of persons who end their lives by jumping from heights and to compare the characteristics of those who jump from bridges with those jumping from other sites. Data on suicide in Switzerland between 1990 and 2003 were collected from the Swiss Federal Statistical Office and from local authorities. Persons who jumped from heights in general were more likely to suffer from schizophrenia than those who used other methods. Persons who jumped from bridges were younger than those committing suicide by other methods. Compared with those who jumped from other sites, subjects were on average 14.3 years younger and more often male. Individuals who jumped from bridges close to psychiatric hospitals were more likely to suffer from psychiatric illness. Individuals who jump from bridges differ in certain characteristics from those who jump from other sites. For future classification it may be helpful to distinguish suicides from bridges from suicides from other heights. For prevention of suicide from bridges, attention should be paid to characteristics of young persons at risk.

背景与目标： : 该研究的目的是确定通过从高处跳下而结束生命的人的社会和诊断特征，并比较从桥梁跳下者与从其他地点跳下者的特征。瑞士1990年和2003自杀的数据是从瑞士联邦统计局和地方当局收集的。从高处跳下的人比使用其他方法的人更容易患精神分裂症。从桥上跳下的人比通过其他方法自杀的人年轻。与那些从其他地方跳下来的人相比，受试者平均年轻14.3岁，男性更常见。从精神病医院附近的桥梁跳下的人更有可能患有精神病。从桥上跳下来的人与从其他地点跳下来的人在某些特征上有所不同。对于将来的分类，将自杀与桥梁与自杀与其他高度区分可能会有所帮助。为了防止桥梁自杀，应注意处于危险中的年轻人的特征。

BACKGROUND & AIMS: :Homicide-followed-by-suicide (referred to as "homicide-suicide") incidents are rare events but can have a profound impact on families and communities. A better understanding of perpetrator characteristics and how they compare with those of other homicide suspects and suicide decedents might provide insight into the nature of these violent acts. This report is based on 2003-2005 data from 17 US states participating in the National Violent Death Reporting System, a unique, incident-based, active surveillance system that integrates data on violent deaths from multiple sources. Of the 408 homicide-suicide incidents identified, most incidents were committed with a firearm (88.2%) and perpetrated by males (91.4%), those over 19 years of age (97.6%), and those of white race (77.0%); however, just over half of filicide (killing of children)-suicides (51.5%) were perpetrated by females. Over 55% of male homicide-suicide perpetrators versus 26.4% of other male suicide decedents had prior intimate partner conflicts (P < 0.001). In fact, having a history of intimate partner conflicts was even common among homicide-suicide perpetrators who did not victimize their intimate partners. Recognition of the link between intimate partner conflicts and homicide-suicide incidents and strategies involving collaboration among the court/legal and mental health systems might prevent these incidents.

背景与目标： : 杀人后自杀 (简称 “杀人自杀”) 事件是罕见的事件，但可能对家庭和社区产生深远影响。更好地了解犯罪者的特征以及它们如何与其他凶杀案嫌疑人和自杀死者的特征进行比较，可能会深入了解这些暴力行为的性质。本报告基于美国17个州的2003 2005数据，参与了国家暴力死亡报告系统，这是一个独特的，基于事件的主动监视系统，集成了来自多个来源的暴力死亡数据。在确定的408起杀人自杀事件中，大多数是用枪支 (88.2%) 犯下的，由男性 (91.4%) 、19岁以上 (97.6%) 和白人 (77.0%) 犯下; 然而，一半以上的杀人 (杀害儿童) 自杀 (51.5%) 是由女性实施的。超过55% 的男性凶杀自杀肇事者与其他26.4% 的男性自杀死者先前有亲密伴侣冲突 (P <0.001)。事实上，有亲密伴侣冲突的历史甚至在杀人自杀的肇事者中很常见，他们没有伤害他们的亲密伴侣。认识到亲密伴侣冲突与杀人自杀事件之间的联系以及涉及法院/法律和精神卫生系统之间合作的战略可能会预防这些事件。

BACKGROUND & AIMS: :The purpose of this study was to collect descriptive information on a large number of children, adolescents and young adults who had committed suicide. The medical examiner's records for deaths of persons 25 and under from non-natural causes were reviewed; 656 youth suicides were identified. Children, adolescents and young adults who committed suicide were most likely to be older males with a current psychiatric disorder, usually an affective disorder or alcohol or drug abuse. Suicides appeared to be impulsive and triggered by age-normative precipitants. Sex, age and cohort differences are presented. Results are evaluated in light of previous research.

背景与目标： : 这项研究的目的是收集有关自杀的大量儿童，青少年和年轻人的描述性信息。审查了体检医师关于25岁及以下非自然原因死亡的记录; 确定了656名青年自杀事件。自杀的儿童，青少年和年轻人最有可能是患有当前精神疾病的老年男性，通常是情感障碍，酒精或药物滥用。自杀似乎是冲动的，并由年龄规范的沉淀物引发。给出了性别、年龄和队列差异。结果根据以前的研究进行评估。

BACKGROUND & AIMS: :Genital self-mutilation is mostly seen among psychotic, affective and gender identity disorder(s). We present here a rare case report of such genital self-mutilation in a person with a hypochondriacal delusion of infection with HIV precipitated by erroneous and anxiety-provoking miscommunication during HIV testing. Such cases remind us of the need for systematic and appropriate pre-test and post-test HIV counseling, to help prevent such outcomes.

背景与目标： : 生殖器自残主要见于精神病，情感和性别认同障碍。我们在这里提供了一种罕见的病例报告，该病例报告是在艾滋病毒检测过程中由于错误和引起焦虑的误解而导致的艾滋病毒感染的软骨病妄想。这种情况提醒我们，需要系统和适当的测试前和测试后的艾滋病毒咨询，以帮助预防这种结果。

BACKGROUND & AIMS: :Escherichia coli B nitroreductase (NR) has been expressed stably in MDA-MB-361 human breast adenocarcinoma cells either as the wild-type protein (wtNR), which is distributed evenly between the cytoplasmic and nuclear compartments, or targeted to the mitochondrion (mtNR). Whereas bacterial NR is active as a dimer, a proportion of wtNR is monomeric. In contrast, mtNR is mostly dimeric, suggesting that it adopts a more stable, native conformation. Despite this, when tested in gene-directed enzyme prodrug therapy cell cytotoxicity studies, cells expressing wtNR or mtNR had similar sensitivity to the prodrug CB1954 and mounted similar bystander killing effects. Furthermore, when short prodrug exposures were given, wtNR was more efficient at killing cells than mtNR. These data demonstrate that the site of enzyme expression and prodrug activation is an important variable that requires consideration in suicide gene therapy approaches.

背景与目标： : 大肠杆菌B硝基还原酶 (NR) 已在MDA-MB-361人乳腺腺癌细胞中稳定表达为野生型蛋白 (wtNR)，该蛋白均匀分布在细胞质和核区室之间，或靶向线粒体 (mtNR)。细菌NR作为二聚体具有活性，而wtNR的一部分是单体的。相反，mtNR主要是二聚体，表明它采用了更稳定的天然构象。尽管如此，当在基因导向酶前药疗法细胞细胞毒性研究中进行测试时，表达wtNR或mtNR的细胞具有与前药CB1954相似的敏感性，并具有相似的旁观者杀伤作用。此外，当给予短时间的前药暴露时，wtNR在杀死细胞方面比mtNR更有效。这些数据表明，酶表达和前药激活的位点是自杀基因治疗方法中需要考虑的重要变量。

BACKGROUND & AIMS: :The relationship between suicide and dementia has not systematically been investigated, although the prevalence of both, dementia and suicide, increases with age. In contrast to patients with other psychiatric disorders, patients with dementia were not found to die from suicide more often than expected (SMR, 0). Thus the diagnosis of dementia does not contribute to the elevated suicide risk in old age. In studies using the psychological autopsy method, dementia was rarely diagnosed in suicide victims. Suicide attempts were observed in less than 1% of all patients with dementia. Depression as an important common risk factor of suicide and dementia is often found in patients with Alzheimer's disease (0% to 86%) as well as in patients with multi-infarct dementia (20% to 45%). However major depression was found significantly more often in vascular dementia than in dementia of Alzheimer type. Suicidal thoughts and intents, wishes to die and feelings that life is not worth living were reported in 1% to 42% of all patients with dementia, especially if these patients also suffered from depression. This review comprehensively presents the association between cognitive deficits, insight in early stages of dementia and suicidality and possible confounders which have not systematically been investigated up to now.

背景与目标： : 自杀和痴呆之间的关系尚未得到系统的调查，尽管痴呆和自杀的患病率随着年龄的增长而增加。与患有其他精神疾病的患者相比，未发现痴呆症患者死于自杀的频率高于预期 (SMR，0)。因此，痴呆症的诊断不会导致老年自杀风险升高。在使用心理尸检方法的研究中，很少在自杀受害者中诊断出痴呆症。在所有痴呆症患者中，只有不到1% 的人观察到自杀未遂。抑郁症是自杀和痴呆的重要常见危险因素，通常在阿尔茨海默氏病患者 (0% 至86%) 以及多梗塞性痴呆患者 (20% 至45%) 中发现。然而，在血管性痴呆中发现的重度抑郁症比在阿尔茨海默型痴呆中发现的更多。1% 所有痴呆症患者的42%，自杀的想法和意图，希望死亡和生活不值得生活的感觉，特别是如果这些患者也患有抑郁症。这篇综述全面介绍了认知缺陷，痴呆症早期阶段的洞察力和自杀倾向与可能的混杂因素之间的关联，到目前为止尚未系统地进行研究。

BACKGROUND & AIMS: :Three hundred and twenty-eight patients aged 45 years and over with major depression, dysthymic disorder or adjustment disorder with depressed mood (according to DSM-III) were asked about childhood loss experiences (death of one or both parents or at least 1 year's separation) and their current state of health. No statistically significant relationships were found between experiences of loss in childhood and type of depression, sex and age at first episode. However, there was an increased incidence of suicide attempts in patients with experiences of loss in childhood, both by separation and by death of parents. The increased suicidal tendency could mainly be attributed to loss of the father.

背景与目标： : 向三百二十八名年龄在45岁及以上的患有严重抑郁症，心境恶劣障碍或情绪低落的适应障碍 (根据dsm-iii) 的患者询问了童年的失落经历 (父母一方或双方的死亡或至少一年的死亡) 分离) 和他们目前的健康状况。儿童期的失落经历与抑郁症的类型，初次发作时的性别和年龄之间没有统计学上的显着关系。然而，由于父母的分居和死亡，童年时期经历过丧失的患者自杀未遂的发生率增加。自杀倾向的增加主要归因于父亲的丧失。

BACKGROUND & AIMS: OBJECTIVE:To examine the hypothesis that lifetime suicide attempts in a sample of depressed individuals is greater among those who remember their parents as rejecting or neglecting in childhood. METHOD:Database analyses of patients referred to a public hospital Mood Disorders Unit in Sydney, over a consecutive 10-year period. Patients met DSM-IV criteria for depression, had completed a self-report questionnaire regarding perception of parental rearing, and had responded to a probe question assessing lifetime suicide attempts (n = 343). RESULTS:Female patients who perceived themselves as rejected/neglected by either parent in childhood had a greater chance of making at least one lifetime suicide attempt. No such associations were found for males. CONCLUSION:Perception of rejecting/neglectful parents was associated with lifetime suicide attempts in females only, inviting research explicating any such gender specificity.

背景与目标：

BACKGROUND & AIMS: OBJECTIVE:Suicide rates among Indigenous peoples in Canada are at least twice that of their non-Indigenous counterparts. Although contemporary stressors contribute to this increased risk, historical experiences such as the Indian Residential School (IRS) system may also have continuing links with the risk for suicidal thoughts and behaviors. The current investigation examined the intergenerational and cumulative links between familial IRS attendance in relation to lifetime suicide ideation and attempts among First Nations adults living on-reserve. METHOD:Data from the 2008-2010 First Nations Regional Health Survey were analyzed, and participants comprised a representative sample of First Nations adults older than 18 years (weighted N = 127,338; IRS attendees were excluded). Of those who knew their familial IRS history, 38.0% had no history of attendance, 19.3% had a grandparent who attended, 16.2% had a parent who attended, and 26.5% had a parent and grandparent who attended. RESULTS:Exposure of one previous familial generation to the IRS experience was associated with increased risk for lifetime suicide ideation (odds ratio [OR], 1.46; 95% confidence interval [CI], 1.16 to 1.84; P = 0.001) and attempts (OR, 1.44; 95% CI, 1.07 to 1.94; P < 0.016) compared with those with no IRS history. Having 2 generations of IRS familial history was associated with greater odds of reporting a suicide attempt compared with having one generation (OR, 1.35; 95% CI, 1.05 to 1.75; P = 0.022), which was reduced when current levels of distress and ideation were accounted for. CONCLUSION:Findings support the existence of linkages between intergenerational exposure to IRS and risk for suicidal ideation and attempts and for a potential cumulative risk in relation to suicide attempts across generations.

背景与目标：

BACKGROUND & AIMS: BACKGROUND:Suicide rates have been climbing in the U.S., particularly in Rocky Mountain states such as Colorado. Benzodiazepines have been linked with suicidal ideation, but there have been few population level assessments of this link. We conducted a public health assessment to determine the epidemiology and prevalence of recent benzodiazepine exposure, among suicide deaths in Colorado from 2015 to 17. METHODS:This epidemiologic assessment linked Colorado's Prescription Drug Monitoring Program, death certificate data, and Violent Death Reporting System to determine patterns of benzodiazepine exposure among suicide deaths in Colorado between 2015 and 2017. Recent benzodiazepine exposure was defined as receiving a prescription within 30 days of death or having a positive toxicology screen post-mortem. RESULTS:Among the 3465 suicide deaths in Colorado between 2015 and 2017, 20% had recent benzodiazepine exposure, and nearly 50% of those also had recent opioid exposure. Recent benzodiazepine exposure was more common among females than males (34% versus 16%). Among suicide deaths, those who died via drug overdose were more likely to have had recent benzodiazepine exposure (48%), compared to suicides by firearm (17%), hanging/asphyxiation (13%) and all other methods (approximately 20%). CONCLUSIONS:Benzodiazepines have been linked to suicidal ideation, but population level assessments of benzodiazepine exposure among suicide deaths are rare. Our epidemiologic assessment indicates a relatively high prevalence of recent benzodiazepine exposure that warrants further investigation from both clinical and public health perspectives.

背景与目标：

BACKGROUND & AIMS: :Recently, we reported about exosomes possessing messenger RNA (mRNA) of suicide gene secreted from mesenchymal stem/stromal cells (MSCs) engineered to express the suicide gene-fused yeast cytosine deaminase::uracil phosphoribosyltransferase (yCD::UPRT). The yCD::UPRT-MSC exosomes are internalized by tumor cells and intracellularly convert prodrug 5-fluorocytosine (5-FC) to cytotoxic drug 5-fluorouracil (5-FU). Human tumor cells with the potential to metastasize release exosomes involved in the creation of a premetastatic niche at the predicted organs. We found that cancer cells stably transduced with yCD::UPRT gene by retrovirus infection released exosomes acting similarly like yCD::UPRT-MSC exosomes. Different types of tumor cells were transduced with the yCD::UPRT gene. The homogenous cell population of yCD::UPRT-transduced tumor cells expressed the yCD::UPRT suicide gene and secreted continuously exosomes with suicide gene mRNA in their cargo. All tumor cell suicide gene exosomes upon internalization into the recipient tumor cells induced the cell death by intracellular conversion of 5-FC to 5-FU and to 5-FUMP in a dose-dependent manner. Most of tumor cell-derived suicide gene exosomes were tumor tropic, in 5-FC presence they killed tumor cells but did not inhibit the growth of human skin fibroblast as well as DP-MSCs. Tumor cell-derived suicide gene exosomes home to their cells of origin and hold an exciting potential to become innovative specific therapy for tumors and potentially for metastases.

背景与目标： : 最近，我们报道了具有从间充质干细胞/基质细胞 (MSCs) 分泌的自杀基因信使RNA (mRNA) 的外来体，该基因经工程改造以表达自杀基因融合的酵母胞嘧啶脱氨酶:: 尿嘧啶磷酸核糖基转移酶 (yCD::UPRT)。yCD::UPRT-MSC外泌体被肿瘤细胞内化，并在细胞内将前药5-氟胞嘧啶 (5-FC) 转化为细胞毒性药物5-氟尿嘧啶 (5-FU)。具有转移释放外来体潜力的人类肿瘤细胞，参与在预测器官中形成转移前生态位。我们发现癌细胞通过逆转录病毒感染稳定地转导了yCD::UPRT基因，释放出的外泌体类似于yCD::UPRT-MSC外泌体。用yCD::UPRT基因转导不同类型的肿瘤细胞。yCD::UPRT转导的肿瘤细胞的同质细胞群表达yCD::UPRT自杀基因，并在其货物中连续分泌带有自杀基因mRNA的外泌体。所有肿瘤细胞自杀基因外泌体内化到受体肿瘤细胞后，均通过以剂量依赖性方式将5-FC细胞内转化为5-FU和5-FUMP诱导细胞死亡。大多数肿瘤细胞衍生的自杀基因外泌体是嗜瘤的，在5-FC的存在下，它们杀死了肿瘤细胞，但不抑制人皮肤成纤维细胞和dp-mscs的生长。肿瘤细胞衍生的自杀基因外泌体位于其起源细胞的家中，并具有令人兴奋的潜力，可以成为针对肿瘤和潜在转移的创新特异性疗法。

BACKGROUND & AIMS: BACKGROUND:Patients with psychiatric disorders have a high rate of suicide. The present study investigated factors influencing hospital stays for Japanese patients with psychiatric disorders attempting suicide by jumping. METHODS:We diagnosed all suicide attempts (n = 113) by jumping based on the International Classification of Diseases 10th Revision (ICD-10) and investigated the mean hospital stays of patients with each diagnosis based on the ICD-10 code. We then analyzed differences in the demographic and clinical characteristics between the diagnostic groups to identify factors influencing the duration of hospital stay. RESULTS:Patients diagnosed with schizophrenia (F2 code) were the most frequent (32.7%) of all diagnoses; therefore, we divided the diagnostic groups into schizophrenia group (n = 37) and other psychiatric diagnoses group (n = 76). The patients with schizophrenia showed a significantly longer hospital stay (125.7 ± 63.9 days) compared with the patients with other psychiatric diagnoses (83.6 ± 63.2) (β ± SE = 42.1 ± 12.7, p = 0.0013), whereas there was no difference in the jump height between the two groups (the average was the 3rd to 4th floor; p > 0.05). The number of injured parts, particularly lower-limb fractures, was significantly higher (p = 0.017) in patients with schizophrenia than in patients with other psychiatric diagnoses. The duration of psychiatric treatment in patients with schizophrenia were significantly longer (z = 3.4, p = 0.001) than in patients with other psychiatric diagnoses. CONCLUSION:Our findings indicate that the number of injuries and the body parts injured in patients with schizophrenia are associated with a longer duration of hospital stay following a suicide attempt by jumping. The current use of antipsychotics and a longer duration of taking antipsychotics might contribute to the risk of bone fracture via hyperprolactinemia. Further cognitive impairment in patients with schizophrenia might prevent rehabilitation for the management of lower-limb fractures. From these results, we suggest that clinicians should monitor the level of prolactin and cognitive function in patients with schizophrenia in future studies on managing of lower-limb fractures.

背景与目标：