Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) significantly impact mental health, increasing the risk of severe behaviors, including suicidality. This case report examines a 13-year-old boy with ASD and ADHD who presented to the emergency department with homicidal and suicidal ideations. Despite being prescribed risperidone and carbamazepine, his noncompliance with medication and therapy, combined with significant social stressors like physical abuse by his stepfather and his mother\'s mental health issues, exacerbated his condition. His aggressive actions toward siblings and self-harm attempts highlight the severe behavioral manifestations of these conditions. The case underscores the necessity for comprehensive and consistent intervention strategies, robust support systems, and regular follow-ups to manage ASD and ADHD effectively and mitigate the risk of severe outcomes.

UNASSIGNED: Benzodiazepines, such as flunitrazepam, may be at risk of disinhibition, leading to aggressiveness, impulsivity, self-harm, and possibly suicide attempts, whereas ramelteon may be far from disinhibition.
UNASSIGNED: In a 43-year-old female with primary insomnia, flunitrazepam alone did not induce any type of disinhibition, but the addition of ramelteon to flunitrazepam brought about disinhibition, leading to aggressiveness and finally to her suicide attempt. Her disinhibition rapidly subsided as soon as ramelteon alone was discontinued.
UNASSIGNED: These findings suggest that a suicide attempt may occur during ramelteon and flunitrazepam combination in a susceptible patient.

UNASSIGNED: An assertive case management intervention program, ACTION-J, proved effective for preventing suicide attempters from reattempting suicide within 6 months. The ACTION-J randomized trial was conducted as part of the \"National Strategic Research Projects.\" The program has been covered by the national medical payment system of Japan since 2016. The aim of the Post-ACTION-J Study (PACS) was to examine the current implementation status of assertive case management in a real-world clinical setting.
UNASSIGNED: PACS was a prospective, multicenter registry cohort study. The participants were suicide attempters admitted to the emergency departments of 10 participating medical facilities from October 2016 to September 2018. The assertive case management intervention developed by the ACTION-J Study was offered to all patients, and the primary outcome was the duration and frequency of use of the intervention at 6 months.
UNASSIGNED: A total of 1159 patients were admitted to emergency departments after a suicide attempt during the study period, 144 of whom were included in our analysis. The proportion of participants who received the intervention for 6 months was 72.2% (104/144), and 63.9% (92/144) of the patients completed ≥7 case management interviews within 6 months.
UNASSIGNED: The findings of this study indicate successful implementation of an assertive case management intervention program based on the ACTION-J Study in a real-world clinical setting, following its integration with the national medical payment scheme in Japan. The study provided the useful information that could improve the implementation of assertive case management interventions in future.

UNASSIGNED: Individuals presenting to hospital due to suicide attempt are at high risk for repeated suicidal act, yet there are meager data on the extent to which repeated suicidal acts result in death.
UNASSIGNED: This retrospective cohort study was based on a general hospital self-harm register system in a rural county in China. Identified individuals who attempted suicide were contacted and followed up for up to 8 years. Main outcomes over follow-up were: 1) suicide death, 2) nonlethal suicide attempt, and 3) suicidal acts including suicide death and nonlethal attempt. Incidence densities, correlates, and case fatality of repeated suicidal acts were estimated.
UNASSIGNED: A total of 1086 individuals (two-thirds females, mean age 40.6 years) with a suicide attempt presenting to hospital (index attempt) were identified and followed up, with most of the index attempts by pesticide ingestion (79%). Over follow-up, there were 116 suicidal acts carried out by 108 individuals (69 females, 39 males), including 34 suicide deaths (21 females, 13 males), yielding a high case-fatality of 29.3%. During follow-up, suicide death rates were also high overall and in the first year of follow-up (846.7 and 1787.2 per 100,000 person years). Over follow-up, pesticide was the most common method (47/116) of repeated suicidal act and yielded a higher case-fatality than other methods (46.8% vs 17.4%, χ2 = 11.68, P < 0.001). The incidence densities of repeated suicidal acts and nonlethal attempts were low compared to rates reported in previous literature.
UNASSIGNED: Incidence densities of repeated suicidal acts in a rural China cohort were low compared to previous studies. However, rates of suicide deaths over follow-up were high, a result driven by the high case-fatality of suicidal acts and attributable to the common use of pesticides. Reducing suicidal acts with pesticides is a key target for suicide prevention in rural China.
UNASSIGNED: Beijing Municipal High Rank Public Health Researcher Training Program, Beijing Hospitals Authority Clinical Medicine Development of Special Funding Support, and Beijing Hospitals Authority\'s Ascent Plan.

BACKGROUND: This study aimed to analyze the real-time variability of suicidal ideation intensity and the relationship between real-time and retrospective reports of suicidal ideation made on the Beck Scale for Suicidal Ideation (BSS), among young people with borderline personality disorder (BPD).
METHODS: Young people (15-25-year olds) with BPD (N = 46), recruited from two government-funded mental health services, rated the intensity of their suicidal ideation six times per day for 7 days before completing the BSS.
RESULTS: For 70% of participants, suicidal ideation changed in intensity approximately five times across the week, both within and between days. BSS ratings were most highly correlated with the highest real-time ratings of suicidal ideation. However, this was not significantly different from the relationship between the BSS and both the average and most recent ratings. Median ratings of suicidal ideation intensity were higher on the BSS compared with an equivalent question asked in real time.
CONCLUSIONS: Findings suggest that young people with BPD experience high levels of fluctuation in their intensity of suicidal ideation across a week and that retrospective reports of suicidal ideation might be more reflective of the most intense experience of suicidal ideation across the week.

Studies have highlighted the potential importance of modeling interactions for suicide attempt prediction. This case-cohort study identified risk factors for suicide attempts among persons with depression in Denmark using statistical approaches that do (random forests) or do not (least absolute shrinkage and selection operator regression [LASSO]) model interactions. Cases made a nonfatal suicide attempt (n = 6032) between 1995 and 2015. The comparison subcohort was a 5% random sample of all persons in Denmark on January 1, 1995 (n = 11 963). We used random forests and LASSO for sex-stratified prediction of suicide attempts from demographic variables, psychiatric and somatic diagnoses, and treatments. Poisonings, psychiatric disorders, and medications were important predictors for both sexes. Area under the receiver-operating characteristic curve (AUC) values were higher in LASSO models (in men, 0.85, 95% CI, 0.84-0.86; in women, 0.89, 95% C, 0.88-0.90) than random forests (in men, 0.76, 95% CI, 0.74-0.78; in women, 0.79, 95% CI = 0.78-0.81). Automatic detection of interactions via random forests did not result in better model performance than LASSO models that did not model interactions. Due to the complex nature of psychiatric comorbidity and suicide, modeling interactions may not always be the optimal statistical approach to enhancing suicide attempt prediction in high-risk samples. This article is part of a Special Collection on Mental Health.

Oculogyric crisis (OGC) is a rare type of acute dystonia characterized by spasmodic upward deviation of the eyes lasting for a few minutes to several hours. It is commonly seen with the administration of first-generation antipsychotics and rarely reported in patients taking second-generation antipsychotics. Although aripiprazole, a second-generation antipsychotic, is known for its low potential for extrapyramidal side effects (EPS), there are multiple case reports of it resulting in acute dystonia, especially OGC. In this paper, we report a case of aripiprazole-induced OGC in a 16-year-old female patient after a suicide attempt by taking 40 mg of aripiprazole and 5 g of acetaminophen. The necessary investigations were ordered, and the patient\'s dystonic symptoms resolved completely after administering parenteral diazepam and benztropine.

Suicide is an important public health issue. To examine the differences in personality characteristics between a group of adolescents with suicidal ideation (SI) and a group with a history of suicidal attempts (SA), we conducted a cross-sectional study. We enrolled 55 adolescents (51 females; 12-18 y.o.) who presented SI and/or SA. Using the Columbia Suicide Severity Rating Scale, we divided the sample into two groups: adolescents with SI and adolescents with SA. All participants filled in the Minnesota Multiphasic Personality Inventory-Adolescent (MMPI-A). Adolescents in the SA group had greater difficulties in social relations, risky behaviors, and more intense suicidal ideation compared to those in the SI group. Adolescents in the SA group scored higher in Omission, in the Lie Scale, the Conduct Problem Scale, the Less Aspirations Scale, the Repression Scale in the MMPI-A, and item 283 of the MAST compared to the other group. The results suggest that using the MMPI-A to assess certain features (e.g., tendency to lie, repression) may be helpful in identifying young people who are at high risk of suicide. However, further research is required to determine the effectiveness of using this instrument.

Obsessive-compulsive disorder (OCD) is a chronic psychiatric condition characterized by the presence of obsessions, compulsions, or both. Historically OCD was associated with good insight. However, there are more categories to the degrees of insight in OCD patients, namely good, fair, poor, absent, or delusional beliefs. It is also important to note that insight can fluctuate circumstantially. We describe a rare case of first-episode psychosis of undetermined cause presenting with suicidal ideation. After continued treatment, it was discovered to be previously undiagnosed OCD with poor insight.

Organophosphates, also known as phosphate esters, are a category of pesticide compounds that function by indirectly inhibiting the activity of an enzyme called acetylcholinesterase (AChE). AChE is responsible for breaking down acetylcholine (ACh) at the neuromuscular junction into acetic acid and choline. These compounds cause various clinical presentations upon acute toxicity, among which intermediate syndrome (IMS) exhibits an unpredictable course. This report describes the case of a farmer who ingested monocrotophos and ethanol in a suicide attempt, leading to a prolonged stay in the hospital and invasive ventilation, along with complications including ventilator-associated pneumonia. The patient received a total of 9000 mg of atropine over his 14-day hospitalization period.