A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience
Issue link: http://innovationscns.epubxp.com/i/425963
Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] 184 spending three days in a coma in an intensive care unit. That attempt occurred during an episode of impulsive suicidality that occurred the day following thoughts of being "better off dead." For this reason, we believe an affirmative response to the question, "Do you think you would be better off dead?" should be taken seriously and should always be asked when assessing suicidal ideation and behavior. Result 2. Figures 2a, 2b, and 2c capture the subject's daily ratings on the thoughts "I would be better off dead," "I need to be dead," "I wish I were dead," "I wish I could go to sleep and not wake up," and "I wish I was not alive anymore" and on the subject's impulsive suicidality over the same timeframe. Discussion. The results show that the "wish to be dead" was usually inversely related to the impulsive suicidality within each 24-hour period over time. Even though the subject stated that the impulsive suicidality was alarming because she experienced it as pulling her toward suicide, she reported that her instinct was to fight against it, to feel alarmed by it, to resist it, and to wish for an opposite outcome in order to stay alive. We have found that patients who are impulsively suicidal do not always acutely wish to be dead at the same moment and often wish to get help in resisting these impulses. In our experience, this may not be generally recognized or understood by other clinicians and/or clinical investigators. Result 3. These five types of passive suicidal ideation did not move completely synchronously with each other even though they were present most days. For example, on Day 6 in Figures 2a and 3, the severity of the thought "I need to be dead" was elevated, while all other passive ideations were nonexistent. They did not all move in precise synchrony with impulsive suicidality (Figures 2a–c, 4, 5, 6, and 7). For example, on Day 22, the thought "I would be better off dead" (Figure 1), the thought "I need to be dead" (Figure 4), and the impulsive suicidality moved in the opposite direction to the thought "I wish I were dead" (Figure 5). Discussion. All the above passive ideation variants did not change to the same degree on the same day and were not synchronous with each other in this subject with daily suicidality. Consequently, in this case, they were not substitutable for each other. Result 4. Figure 5 shows an increase in the thought "I wish I were dead" following most spikes in impulsive suicidality. The subject explained that the reason for this increase in severity of the thought "I wish I were dead" is because the impulsive suicidality was so frightening that she wished she was dead in order to avoid having to experience the impulsive suicidality again. Discussion. A passive suicidal thought may be the result of another prior suicidal phenomenon, rather than its antecedent. Result 5. Figure 3 shows all five of the passive suicidal phenomena experienced over the timeframe studied. The thought "I would be better off dead" was more severe than all other passive suicidal phenomena on several days. Figure 3 illustrates two timeframes (Days 48–54 and Days 29–31) during which the thought "I would be better off dead" was rated at either a 3 or a 4, while all other passive suicidal phenomena were rated between 0 and 2. Discussion. If we were to ignore the thought "I would be better off dead" for these timeframes, this subject's passive suicidal phenomena would be collectively rated much lower than actually experienced. Result 6. Figure 8 shows the highest score of the three passive suicidal ideation phenomena captured by the S-STS and of the three passive suicidal ideation phenomena captured by the C–SSRS on the same day. The S-STS captured the following three passive suicidal ideation phenomena: 1) the thought "I would be better off dead," 2) the thought "I need to be dead," and 3) the thought "I wish I were dead," while the C–SSRS captured the following three passive suicidal ideation phenomena: 3) the thought "I wish I were dead," 4) the thought "I wish I could go to sleep and not wake up," and 5) the thought "I wish I was not alive anymore." With the exception of Day 17, Days 33 through 44, Day 65, Days 67 through 69, Day 76, Day 83, and Days 87 through 91 (24 days out of a total of 91 days), the S-STS captured the FIGURE 1. Thought "I would be better off dead."