Psychiatric Disorders - Science topic

What are some strategies for improving adherence to clozapine therapy in patients with psychiatric disorders?

At the beginning of May 2023, the World Health Organisation lifted the state of global epidemiological emergency associated with Covid-19. In Poland, the state of heightened epidemiological emergency associated with Covid-19 is not due to be lifted until the end of June 2023. This is likely to increase the scale of ongoing research into the various secondary effects of the Covid-19 pandemic, both the post-pandemic, post-vaccine health effects, then also the social and economic effects, including, for example, on the issue of rising inflation from 2021 generated by the introduction of a large amount of additional money into the economy during the Covid-19 pandemic, which was mainly intended to limit the scale of the increase in unemployment caused by the introduced lockdowns. In Poland, the PIS government is mainly responsible for the deterioration of children's mental state, which unreflectively and without applied research and public consultation introduced large-scale lockdowns imposed on selected sectors of the economy, national quarantines, universal e-learning, social distancing in public places, etc. ... and even a ban on entering forests during part of the period of wave 1 of the pandemic.

From mid-2022 onwards, more and more comparative studies began to appear, which compared internationally the question of the correlation between the rate of development of the pandemic, the number of deaths categorised as caused by the severe Covid-19 disease state and the occurrence of co-morbidities, usually in more than 90 per cent of cases, and the so-called 'anti-pandemic safety instruments' introduced to varying degrees in individual countries. The results of the study did not confirm the findings of the study, which was based on the results of the research carried out by the European Centre for Disease Prevention and Control (ECDC). The results of the research carried out did not support the thesis regarding the validity of the

of the lockdowns introduced during the coronavirus (Covid-19) pandemic as an instrument to significantly reduce the level of mortality caused solely by the severe Covid-19 condition, exclusively, i.e. by subtracting the factor of co-morbidities. In some countries, the generating factors of specific comorbidities were key influential determinants shaping mortality levels. For example, in Poland, where, due to the government's neglect and deliberate slowing down and blocking of the development of renewable energy sources in recent years, more than three quarters of energy is still produced by the technologically backward dirty power industry based on burning hard coal and lignite, which generates the worst air quality in cities during heating periods compared to Europe and the world. This poor air quality, determined by high levels of particulate matter (PM 2.5, PM 10, etc.), is the source of premature deaths, estimated at around 50 000 people, i.e. deaths caused by respiratory and other diseases resulting from high levels of air pollution. Such diseases are examples of diseases coexisting with Covid-19, which were compounding factors in the level of mortality qualified as caused by these diseases in combination with Covid-19 during the pandemic. In the government-led pandemic risk management process, different structures were adopted to prioritise safety on the one hand for health and on the other hand also for socio-economic safety. Different solutions were adopted in the countries in terms of the applied anti-pandemic safety and anti-crisis instruments with regard to the economy. Consequently, the effects of these measures were also not the same. The economic impact of the coronavirus pandemic (Covid-19) and the applied anti-pandemic instruments also varied significantly between the various different industries and sectors of the economy.

These systemic anti-pandemic measures mainly benefited the technology sectors, companies operating on the Internet, businesses developing e-commerce, courier companies, state-owned companies receiving additional government contracts for the production of anti-pandemic assortments, e.g. hand disinfectant fluids, production of protective masks, etc. On the other hand, there were many more companies and enterprises, mainly operating in the service sectors, which were subject to lockdowns and suffered severe financial losses, some going out of business because of them, which in macroeconomic terms generated a deep recession of the economy during the 1st wave of the pandemic. However, as it later turned out, there were many more problems caused by such anti-pandemic socio-economic policies. Among these various secondary effects of the negative and particularly socially significant problems generated by the misguided antipandemic socio-economic policy, one stands out the increasing scale of psychological problems in children, which have significantly worsened since March 2020, i.e. since the lockdowns introduced during the coronavirus (Covid-19) pandemic, national quarantines, universal e-learning, social distancing in public places, etc., and have been exacerbated by the controversial pseudo-reforms applied to the education system over the past few years. In Poland, this problem is very serious. This is confirmed, inter alia, by the data on the growing scale of child suicides in the period from 2020 to 2022. Lockdowns, national quarantines, universal e-learning, social distancing in public places, etc., introduced and applied on a large scale during the coronavirus (Covid-19) pandemic in Poland, have caused disorders in the social development of children and adolescents. In view of this, it is essential to create and develop programmes to support the social development of children, programmes of psychological assistance for children, which should prevent the growing scale of psychological problems in children.

In view of the above, I address the following question to the Honourable Community of scientists and researchers:

And what is your opinion on this topic?

What is your opinion on this subject?

Please respond,

I invite you all to discuss,

Thank you very much,

Best wishes,

Dariusz Prokopowicz

The GHQ (generalized health questionnaire) 12, which is scored from 0-36 to determine the psychiatric disorder. There are few similar questions and the respondent may not be interested to give enough time for interview, keeping this limitations in mind if the questionnaire is modified then how should I validate it? Thanks in advance.

It is well known that mammals like horses and dogs develop psychiatry conditions such as depression. What are the other mental health conditions do the animals develop?

Most of the cohorts related to psychiatric disorders (Childhood and Adolescence Psychopathology) are present in Western countries (mainly UK, Sweden, Netherlands, Norway, and Finland). Why there are no well-known cohorts associated with Romanic or Slavic ethnicity? Are there any future efforts OR any limitations?

Thank you in advance.

Hi everyone, I am looking for ways to quantify psychiatric comorbidity / comorbidity severity in our sample** (primary diagnosis of interest: major depression) more elaborately, rather than simply reporting the average number of present comorbid psychiatric conditions. Are you familiar with indices/scores I could calculate for each patient, that, for example, allow weighing different conditions differently (I would perhaps naively assume that personality disorders would receive a greater weight with respect to comorbidity severity than, let's say, a specific phobia). Data collection has already been completed, so unfortunately I'm unable to apply additional questionnaires/assessments. (Comorbid) Diagnoses have been established by SKID-interviews and I am hoping to find a way to build on those.

Any ideas are greatly appreciated, thanks so much in advance!

I am writing a chapter on medico legal aspects of Epilepsy for a reference book.

I wish to collect your opinions and reasoning behind it to make a gentle reference while elaborating my point.

I am intending to elaborate my views on how epilepsy is a psychiatric disorder. Your opinions if befitting could be referred with due acknowledgement.

Please reinforce your opinions with sound reasoning or mentioning validating source of information.

Plenty of more or less useful EEG databases are available online. However, it is hard to find EEG data at baseline before intervention of any kind in psychiatric disorders. There are several studies in this topic in e.g. major depression (e.g. iSPOT or EMBARC), but there is nearly nothing on this topic available for free usage online. Can you help and provide databases or personal data on this topic. Not restricted to major depression but on any kind of psychiatric disorders?

Quetiapine has pharmacological properties that cover almost the entire spectrum of currently known anti-psychotic, anti-depressive medications, among others. The dose of Quetiapine can be used to alter the pharmacological effect it has on the patient. Does this open possibilities for reaching a clinical diagnosis by the use of Quetiapine and its' response on the patient?

The focus of my interest is on the risk factors.

I know that CBT, for example, is an evidence-based treatment for MDD. What about supportive psychotherapy?

We are inexperienced researchers and need help. We are interested in the phenomenology of pseudo hallucinations. We believe that clinicians can differentiate the experience of auditory hallucinations and pseudo hallucinations, possibly through features of dissociation. It is just hard to operationalise. Any advise would be great

Hi, I’m carrying out my master thesis on people who were sentenced to serve time in prison and who, during incarceration, present psychiatric decompensation. I’m interested in the official procedure that applies to this type of person. To do this, it seems important to compare different procedures based on national legislation. For example, here is a brief presentation of the procedure in Belgium:

In Belgium, a prisoner who, during their detention, is in a state of “dementia, mental disorder or mental retardation, making them incapable of controlling their actions” is placed in a “secured” psychiatric section to access therapeutic care under a law called the “Loi de Defense Sociale”.  In our country, the prisoner is first placed on the psychiatric wing of the prison and they are subject to an observation by a psychiatrist. If during the evaluation, the psychiatrist notices the presence of one of the aforementioned states, a request is made to the Minister of Justice to transfer them to an appropriate social protection establishment. Once this request has been accepted, the prisoner resides in one of the social protection establishments where they will again be evaluated and transferred to the service that best matches their needs. Then, the duration of the stay depends on the mental development of the prisoner and the possibility of their social rehabilitation. Once the prisoner's mental state has improved, the psychiatric hold is then lifted and they can continue to serve their sentence in prison. The time left to serve is decided by the “commission de Défense Sociale” who makes decisions relative to parole and release dates. The “commission de Défense Sociale” is composed of a magistrate, a lawyer and psychiatrist.

I would like to know the procedure for people who present psychiatric decompensation during a prison sentence in your country. I would very much appreciate if you could explain your country’s procedure in a few lines so that I can compare different judicial systems in my thesis.

Thank you in advance.

Needs to be fairly short and accessible. Preferably relating to MH in children but that's not essential.

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In  inpatient treatment of psychiatric disorders multiple variables account to the effect of treatment. The patient time spent receiving milieu therapy is one big and complex variable. The ward staffs skills are a part of this and we assume that increased level of milieu therapy skills among staff members would increase treatment effects. Unfortunately few studies target this topic.  I hope others have experiences regarding this topic?

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Lets take the hypotension or hypertension in the same anxiety disorder in different patients. The disease its the same for the both patients psychiatrically, but the cardiovascular is different. Is there an endocrinal explanation, or is it more like the signaling of the spectrum of apparatus joined with the somatical design of the act ?

Hi,

I'm interested in studies from the last 5-6 years which describe stages of accepting mental illness. Clear stages of coping from after the diagnosis or the emerge of symptoms, until the person accept the illness and live with it.

Thanks,

Michal.

Which are the advantages of psychoanalytical nosography of clinical structures (neuroses, psychoses, perversions) over international classifications of mental disorders (DSM; IDC)?

For an explanation of RDoC, click here https://www.nimh.nih.gov/research-priorities/rdoc/index.shtml

Most of the psychiatry textbooks don't have detailed material on Isight

The basis for specifically distorted schematic faces might be subtle parieto-occipital dysfunction, apparently regressing early in dementia and HIV infection.

Dear Prof. Brand

Is it possible me and Mrs Keshavarsi participate in sleep in child psychiatric disorders project?

when Lorazepam is contraindicated or Lorazepam is in effective in organic catatonic state...does a dose of Tofisopam show some hope?

Hi,

I'm interested in narrative studies from the last 5-6 years which have specifically researched the subjective experience of being in psychiatric hospitalization, or the experiences regarding the treatment and settings of psychiatric hospitals.

Thanks,

Michal.

Abnormal brain oscillations have been related to some of the underlying mechanisms of psychiatric disorders including unipolar depression and bipolar disorder.  Adverse life events are well-known factors that can trigger or worsen the symptoms of depression. Are adverse life events related to abnormal brain oscillations? If yes, how?

What are these tests?

Psychiatric illnesses like depression, schizophrenia, obsessive compulsive, mania and many other labels are life long illnesses. We used to attribute it to genetic factors and neurotransmitters imbalance and start treatment which mostly is lifelong. How and what are your trials to uncover an underlying primary cause?

While suicides and suicide attempts (i.e., deliberate acts with intent to die) are fairly prevalent among heroin users the literature and experience indicated that comparatively few, if any, used their drug of choice as a lethal means. Many "chronically suicidal" heroin users often threaten to take their lives by a heroin O/D but while these folks have high risk they seem to be low on intent. Means such as prescription drugs, firearms, etc. were more frequently used by those who became acutely suicidal.. In the past 6 months I've encountered several cases where the heroin user acted in a manner indicating an actual suicide attempt not an O/D. Some left notes or texts, some took steps suggesting they wanted to avoid rescue, all took IV bolus doses. From what I can determine all were active users who had not lost tolerance because of jail or hospitalization and used heroin from a customary source and not laced with fentanyl. All were men in 20s or 30s with histories of drug use dating to their teens but only graduating to heroin within a few years. 

Do you have any reference about the "syndrom of munchausen by procuration" in case of young mothers and her baby ?

Thanks,

O. Moyano

In literature most of the researchs about treatment response using DSM-IV or DSM5 criterias, CGI-I, PTSD-I scores but none of seperate treatment response negative or positive as binary. 

In depression trials, researchers use Beck Depression Inventory or HAM-D score %50 reduction for negative or positive treatment response. Is it ok to use PTSD-I score %50 reduction for treatment response?

Thank you for your answers. 

How culture shapes the development of abnormal personality functioning?

ANK3 gene was found to be changed in some psychological disorders such as bipolar disorders, depression and schizophrenia. I need any article that confirms this fact.  

PTSD (post traumatic stress disorder) is a psychological disorder after a person is exposed to trauma (directly or indirectly). It is characterized by intrusive thoughts, flashbacks of the event, night mares, sleep disturbances, avoidance, negative emotions and beliefs, lasting for one month.

There is evidence of rich input and output connectivity between claustrum and cerebral cortex. Cerebral cortex is responsible for a wide range of higher functions including information processing.

social or physical environment that can be modified to manage auditory hallucinations. 

In patients with schizophrenia, after several times of relapse, the patients' response to previous antipsychotic medication seems to become poor or take longer time to achieve response. Is there any hypothesis to explain this phenomenon ? 

In 2006 the UN adopted the Convention on the Rights of Persons with Disabilities (CDPcD); This suggests a profound change of look-interventionist welfare, one integrator preventive model. Of the most relevant and has caused more debate articles is the 12th referring to the legal capacity of persons with disabilities; This is particularly relevant in relation to involuntary placement of persons with severe psychiatric disorders. This presents a review of the relationship between psychiatric disorders and psychosocial disabilities, some reforms have been conducted in various countries with regard to their models of mental health disorders that are considered most disabling globally and some strategies for weigh the level of disability that may occur; as well as the situation in Mexico of these and the existing debate between some rights and involuntary detention of these patients.

Expressed emotionality has been defined in respect of family members with psychiatric disorders. However, people who face different behavioral and psychosocial problems may also have family members with high expressed emotionality. Are there any studies regarding that? And what about EE on a continuum of any illness like schizophrenia or bipolar ?

Are there any scales (studies) to assess Expressed Emotionality (EE) in healthy individuals, who may be at risk of developing a psychiatric disorder ?

.What are the educational programs can be used with the problem of fear of school?

Many old and new treatments for psychiatric disorders involve vestibular stimulation. These include swings and roundabouts; emetics and anti-emetics (eg chlorpromazine); ECT, which I think works by resetting the vestibular system; immersion of head in cold water (equivalent to bilateral cold caloric test). So would someone like to take some psychotics to an amusement park and see if they are helped by a roller coaster ride?

In this study I have always been perceived that AIP was the main findings, however when looking at the results again I am not sure if there is an error in the findings or I have been blinded (most likely the latter) to think that AIP has been the main finding of this study but in actual fact PCTis,  where his main finding as far as the results of the urine tests. In his results he states that 4 were positive PBG and 270 positive porphyrins, his final conclusion was that his study found 7 with AIP and 4 with PCT. I hope this makes sense. I am using this study in my thesis.  I have enclosed a copy of the article. Thanks Karen

i am looking for a good dissociation questionnaire, other than the DES. i would like something that had been validated and has been cited often.

I have thought of 8 session Relapse Prevention module and Motivational Interviewing module already.

Homocysteine and severity of psychiatric disorders.

I need to know more about this distinction and the discussion going on about these two 'types' of psychopathology.

I also need to know more about the person who first made this distinction in psychopathology.

Thank you!

I am interested in:

I have found the patient acceptability for the model to be very high, but I foresee problems in being able to demonstrate patient outcomes - other than knowledge acquisition.

Thanks in advance,

Richard.

In the studies that concern associations between DUP and various outcome categories, the participants are always treated, they just differ in the duration of illness before receiving the first treatment. From a purely scientific point of view, it seems to me that treatment is an intervening variable that cannot be controlled and therefore the measured results are distorted. Do you know any study where a treated and a truly untreated samples are compared?

I'm looking for some articles on the level of insight individuals with personality disorders have.

This refers to The Adolescent Depression knowledge Questionnaire with authors Hart, S.R, et.al

How may I receive permission to use the scale?

There seems to be quite a bit of short-term research, but I wonder if anyone out there is doing long-term research – 20-year or 10-year incidence of serious psychiatric disorders.

I included psychiatric ADRs following surgery on the web site www.april.org.uk and was astonished at the amount of feed back from the public.

 

Suicides including that of James the son of Clare Milford-Haven just around 10 days after his surgery. My daughter's sudden onset of psychosis 7 days after her wisdom teeth were removed were not the only stories of post operative psychiatric disturbance recorded. 

 

A lady doctor contacted me as her son also became paranoid just 7 days after surgery. A man who had surgery and was given co-amoxiclav became paranoid and under section was given anti-psychotics he felt he did not need as he was recovering. He feels the anti-psychotic medication damaged his brain and recovery is slow...None of these people had a previous history of psychiatric illness. a case of co-amoxiclav induced psychosis was reported in a letter and spoken of at our conference by anaesthetist Dr Anita Holdcroft in 2008.

 

My daughter had previously suffered a sudden onset of psychosis following taking sulphasalazine...when I asked her anaesthetist if there are guidelines given to anaesthetists, about which drugs or anaesthetic agents to avoid for patients known to be vulnerable to psychiatric ADRs - I was told this was not covered in the medical education he received.

I have followed up with the Royal College of Anaesthetists and find there is poor communication in the gathering of ADR information following surgery and linked to anaesthetics...The MHRA have refused to reinstate the Yellow Card reporting forms specifically for anaesthetists. The system for reporting and collating information does not seem to have improved since guidelines following the D of H Inquiry into Dental Anaesthesia in 2000 (A Conscious Decision).

 

The Report published July 2000  recommended the RCA should collect ADR information. A Professor at the Royal College of Anaesthetists, I knew personally, stated he could not inform the membership as he "Did not have the resources". I asked him to try and he stated " Well it is only a recommendation”.

The Report  by the Chief Medical Officer and Chief Dental Officer recommended' the following:

 

It is recommended that the extent of morbidity associated with general anaesthesia and conscious sedation is recorded and analysed by the Royal College of Anaesthetists and the Society for the Advancement of Anaesthesia in Dentistry respectively. In addition it is recommended that the General Dental Council’s guidance more specifically addresses the need for dentists to comply with the need to report to the appropriate bodies adverse events and reactions, as a matter of good professional practice.

Surely this 'good professional practice' applies to the need to report and collate ADR information on drugs prescribed or used during, before or following surgery? 

 

Full report is archived here: 

 

My concern is there is little attention paid to this directive and my research recently finds it is not clear how anaesthetists or GPs record ADRs following surgery or if there is any effort to rectify this lack of data collection. Furthermore medical education should include the understanding of drugs that affect mental capacity and trigger psychiatric disturbance and the need to understand pharmacogenetics and how some people are vulnerable to psychiatric ADRs.

Coroners do not have to record on death certificates if a person recently had surgery.

Dear public,

I have the Manifestations, Causes, and Treatment of Schizophrenia Questionnaire test. But all of the questions are shortened, and it doesn't come with scoring instructions. I have permission to use the test through psychINFO but at this point it is unusable since I don't have enough information. I have contacted Furnham but I have not gotten a reply. Does anyone know where I can find the scoring instructions?

Thank you,

Erinn Szarek

Beck depression inventory

There is environmental factors that influence children with ADHD?

We are currently reviewing research findings about meta-cognitive beliefs (beliefs about cognitive processes that measured by Meta-cognitive Questionnaire and its variations). If you could share with us any unpublished data of meta-cognitive beliefs involving patients diagnosed with psychiatric disorders, we would appreciate a lot!

Thank you very much!

Best Wishes,

Kira Sun

Support groups may be led by professionals or leaderless.  Groups may be divided by eating disorders or everyone together.  Support groups may be coed. Any information would be helpful.

our institution does not conduct/record psychiatric ratings scales during routine clinical work. If I was to get 2 psychiatrists to read a chart independently, and try to assign CGI-S (severity) and CGI-I (improvement) scores as well as functioning scores like GAF/CGAS based on history notes at admission and discharge - would these be valid outcome measures for research purposes?

Greeting!

Could you please suggest any additional expected predictor of suicide among hospitalized psychiatric patients to be investigated for a future research?

This is the initial list:

1- being young,

2- male gender.

3- high level of education.

4- history of prior suicide attempts.

5- presence of depressive symptoms.

6- presence of active psychotic symptoms.

7- good insight to illness

Kind regards,,,

Ahmad.

Causation determinations

I am looking for US graduate programs and I beginning my search by finding potential research mentors. My research interests specifically encompass identity and interpersonal problems associated with borderline personality disorder.  

Is there any evidence or personal clinical experience regarding the efficacy of antidepressants for depressive disorder and anxiety disorder in patients with carbon monoxide intoxication?

When a patient has previous history of depressive disorder and generalized anxiety disorder and later attempted suicide with subsequent carbon monoxide intoxication, is there any literature discussing the efficacy of antidepressants before or after the intoxication? Would the original antidepressant before the intoxication still be the best choice?

Would CO intoxication-induded Parkinsonism of the patient influence the choice of antidepressant?

I am looking at what the impact would be on timeliness and quality of discharge if nurses were able to make discharge decisions in the absence of a Consultant Psychiatrist. Any expereinces of thoughts on the subject would be appreciated.

We are launching now in Cambridge MA with sites planned in Montreal and London in 2014. --Devin Hosea -- devin@alumni.princeton.edu -- for more detailed info than web synopsis below. Would very much appreciate comments from the ADDICTION MEDICINE and MEDICAL TECHNOLOGY communities. Thanks!

If anyone has any papers or knowledge regarding any novel interventions that have suggested it is a preventative rather than remedial measure for combat stress or memories of traumatic events, I would be very grateful :)

Thanks

Holly

I am interested to find out if anyone is using this online tool that was developed here in WA. If so, what do you like about it and if this is new to you would you be willing to use it?

Can anyone recommend literature on hepatits C and depression/psychiatric disorders as hcv-induced comorbidity?

regards!

chaim

We are currently reviewing research findings regarding 'jumping to conclusions' bias (a data-gathering bias typically measured by the beads task and its variants). If you could share with us any unpublished data of the JTC bias involving patients with psychosis or other psychiatric disorders, we'd love to hear from you!

Thank you very much!

Regards,

Suzanne So

I am interested to conduct a baseline survey (and aimed to extend it), however to accomplish this task I haven't acquired any purposeful literature. If anyone ll provide me literature of self-regulation in relation with health regulation, that would be more appreciable.

By acute services I am referring to home treatment, crisis, respite and acute inpatients services.

By co-production, I am referring to services that have been co-designed and/or delivered with service users and/or people who have a lived experience of using this type of service.

Examples of co-production in mental health services tend to focus on primary and secondary care, so we have examples of Therapeutic Communities or third sector services that use the co-production model.

I am interested in any case studies, examples of services (I am based in the UK but am open to whatever is going on elsewhere), evaluations, research or other papers on this subject.

I am also interested in any work that has been done on improving the experience of service users who experience psychological distress and are admitted to acute services. In particular, presenting with self-harm, suicidal ideation, considered of danger to themselves or others - the types of presentations that are associated with personality disorders.  These types of presentations are often viewed as problematic in acute services as they are not purely biological and cannot be solely treated with medication.  Any work that has been done around improving services, treatment, staff confidence, reduction of stigma in this area would be very helpful.

As you can see, I'm quite open regarding ideas/papers that may inform this, as I am aware that work regarding co-production and improving the experience of service users who experience psychological distress in Acute services is not abundantly available at the moment!

Parents of children with ASD are frequently asking me about oxygen therapy for their children. I need some evidences about the topic. Do you agree using Hyperbaric Oxygen Therapy for autism? is there any evidence about it?

Suicidology is a comparatively new field of inquiry but it appears to have acquired, as Kuhn (The Structure of Scientific Revolutions, 1962) would say, a paradigm. This concept proposes that in any field there is a set of widely shared assumptions. The paradigm defines the field and shapes the rules of the game. The paradigm determines what gets studied, the methods, and how the findings are interpreted. It defines the needs addressed. A paradigm supplies "all the answers" to researchers' and practitioners' questions. A paradigm is self-sustaining. Its tenets are defended and change is resisted. What I call the "mental illness model" seems, to some degree, to serve this purpose in suicidology. Mental illness is the prevailing risk factor for suicide. The psychological autopsy, which has been called "the gold standard," consistently finds clear signs of mental illness in 90% of suicide victims. It is argued that the other 10% also had mental illness but either the signs or the research were not strong enough to reveal the presence of a disorder. Suicide is, ipso facto, associated with mental illness because anyone felt to be suicidal by providers, police, or ER physicians has a high probability of having their risk assessed by a psychiatrist and a very good chance of at least a short stay in an inpatient psychiatric setting. Inevitably those determined to be suicidal to any degree acquire a psychiatric diagnosis. Better and/or more accessible mental health treatment is regularly touted as best way to prevent suicide at every age. However, perhaps a "paradigm shift" is gaining momentum as the theoretical models of Joiner and O'Connor, which do not assign priority to mental illness, take hold. What do you think?