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2 results

  • Chapter Two - Stress, Vulnerability, and Suicide

  • Kees van Heeringen
  • Book:
    The Neuroscience of Suicidal Behavior
    Published online:
    22 May 2019
    Print publication:
    23 August 2018, pp 23-39

  • Summary

    Although there are many pathways to suicide, studies in the domains of neuropsychology, cognitive psychology, neurobiology, and clinical psychiatry provide increasing evidence in support of a stress–diathesis model of suicidal behavior. While depression is the common final pathway to suicidal behavior, the vast majority of depressed individuals neither attempt nor complete suicide. It appears that a diathesis to suicidal behavior differentiates depressed individuals who will kill themselves from other depressed patients. The diathesis may be due to (epi-)genetic effects and childhood adversity, and is reflected by a distinct biological, psychological and clinical profile. This chapter will first review stress-diathesis models of suicidal behavior, ranging from cognitive models such as the “cry of pain” model to a neurobiological model in which deficient decision-making and its neural basis are central issues. Second, implications for treatment and prevention will be discussed. The identification of diathetic traits can be expected to facilitate early recognition of suicide risk. Vulnerability traits are open to modification early in life, and interventions during sensitive periods of development may have durable effects on vulnerability and resilience. The antisuicidal effects of drugs such as lithium and clozapine may well exert such effects via neurobiological components of the diathesis such as the serotonergic neurotransmission system.

  • Clinical models of stress

  • Mjajm Hoes
  • Journal:
    Acta Neuropsychiatrica / Volume 14 / Issue 4 / August 2002
    Published online by Cambridge University Press:
    24 June 2014, pp. 196-201
  • Background:

    Here we propose a stress model with disease-specific aspects and aspecific factors. The latter are subdivided into load (perception, psychic defence mechanisms), strain (psychophysiological responses) and stress sensu strictu (biological and behavioural compensation). Insufficiently compensated strain will result in being sick and precipitation of a specific disease according to one's predisposition. In the clinical practice, multiconditionality requires a multidimensional analysis, the the five-axial DSM-system being designed especially for this purpose. Multidisciplinary treatment is then organized accordingly, i.e. Axis I: case management, medication; Axis II, (focal) psychotherapy; Axis III, somatic specialists; Axis IV, social worker; Axis V, psychotherapy for coping deficits.

    Objective:

    To test the efficacy of this multimethodical approach.

    Method:

    In a 1-year prospective study of 257 admissions in a department of psychiatry in a general hospital, the General Health Questionnaire (30 items) was filled out at admission, discharge and first polyclinical visit post-discharge.

    Results:

    The 213 evaluable questionnaires at admission did not show differences (17–18.9) between the four groups, mood disorders (62%), alcoholism (17%), psychoses (15%) and anxiety disorders (6%). At discharge all four groups had reached the cut-off value for ‘not-sick’ (< 6), this remaining so at follow-up; the three measurements differed significantly throughout the patient groups. Hospitalization was definitely 28.2 days shorter than the Dutch mean of 42 days.

    Conclusions:

    Working to the proposed clinical model for multiconditionalty is effective on intensity and duration of disorders, sustained improvement is attained.