Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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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 ] 188 ideation score on the C–SSRS and the disruption to quality of life (-0.32). As the passive ideation score on the C–SSRS worsened, the quality of life improved. There was a weak positive correlation (0.25) between the passive ideation score on the S- STS and the disruption to quality of life. In contrast, there was no significant relationship between the "better off dead" question or the total of all five of the items of passive ideation and the disruption to quality of life score (-0.03 and -0.06, respectively). On first inspection, this seems like a puzzling finding. When presented with this finding, the subject's response was as follows: "That makes sense. First, I feel that I would be better off dead. Then I experience impulsive suicidality. Immediately after the impulsive suicidality [episode], there is a reduction in symptoms. Physical exhaustion typically follows this within one day. The reduction in suicidality symptoms results in an improvement in the quality of life score, and the severe physical exhaustion results in a desire to 'go to sleep and not wake up' for a long period of time, but not necessarily the desire to die during this sleep. Since the desire to 'go to sleep and not wake up' is part of the C–SSRS passive suicidal ideation category, this results in an increase in the C–SSRS score in this category." DISCUSSION The authors consider the thought of being better off dead as one type of passive suicidal ideation. This type of passive suicidal ideation can occur alone in the absence of any of the other passive suicidal ideation. Paradoxically, in our case study, this thought was not associated with a significant change in perceived quality of life in the timeframe immediately surrounding the experience, even when it was associated with an increase in functional impairment during this time. Limitations. The limitations of this case study are that it is a case study of one subject. The subject may be outlier, and the findings may not be generalizable to other cases of suicidality. CONCLUSION The authors consider that asking the question, "Do you think that you would be better off dead?" is important and has value in all assessments of suicidality and can be an immediate antecedent to impulsive suicidality; is associated with an increase in family life/home responsibilities, social life/leisure activities, and total functional impairment; and was a consistent antecedent to 97 percent of the subject's lifetime non-halted suicide attempts. The combination of the three types of passive ideation in the S-STS appears to capture a wider diversity of possible questions probing passive suicidal ideation than the C– SSRS. REFERENCES 1. Sheehan DV, Sheehan IS, Giddens JM. Status Update on the Sheehan- Suicidality Tracking Scale (S-STS) 2014. Innov Clin Neurosci. 2014;11(9–10):93–140. 2. Lindenmayer JP, Czobor P, Alphs L, et al. InterSePT Study Group. The InterSePT scale for suicidal thinking FIGURE 8. Highest score for phenomena captured by each scale FIGURE 9. Highest score for phenomena captured by each scale and impulsive suicidality

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