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Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)

Tracy, DK; Shergill, SS; David, AS; Fonagy, P; Zaman, R; Downer, J; Eliott, E; (2015) Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS). BJPsych Open , 1 (1) pp. 87-91. 10.1192/bjpo.bp.115.000315. Green open access

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Abstract

Globally, an estimated 5% of adults will attempt suicide at some point in their life1. Suicidal thinking and self-harm occur with many mental states and include passive neglect, putting oneself in risky situations, and many types of self-harm with varying combinations of intent and threat to life. Inevitably such a spectrum makes determining prevalence rates difficult, but typical figures estimate self-harm occurs in up to about one fifth of adolescents2 and over half of psychiatric inpatients3. A helpful way of explaining self-harming is to invoke the diathesis-stress model that proposes genetic, developmental, and temperamental factors constitute a diathesis disposition; whilst acute environmental, social, and psychological factors are situational stressors4. Gender, age, ethnicity and religion5,6, early-life7 and recent adverse events8 are associated factors in suicidal thinking and acts. Problematically most of the identified risks are common, non-specific, and of themselves reasonably weak predictors of completed suicide9-13. However self-harm itself is a strong predictor of future such behavior; it predicts adverse outcomes in adolescents14; 16% of adults repeat self-harm within a year (2% fatally so) and 7% die by suicide within nine years15. There is a need to move beyond descriptive epidemiology to understand the mechanisms behind self-harm and suicidal acts16. They are associated with high-risk decision-making, self-criticism, sensitivity to social disapproval, and an inability to use memory and reflection about alternative positive outcomes of a stressful situation. Neuropsychological work implicates deficits in impulse control and curtailment of aggression17-20, executive functioning, and emotional and affective regulation21. These mechanisms are found in many mental illnesses and are thus considered as pan-diagnostic explanations for the emergence of suicidal acts and thinking4

Type: Article
Title: Self-harm and suicidal acts: a suitable case for treatment of impulsivity-driven behaviour with repetitive transcranial magnetic stimulation (rTMS)
Open access status: An open access version is available from UCL Discovery
DOI: 10.1192/bjpo.bp.115.000315
Publisher version: http://dx.doi.org/10.1192/bjpo.bp.115.000315
Language: English
Additional information: This work is licensed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivativeWorks 3.0 license. You are free to share (copy, distribute and transmit the work), but you must attribute the author, you may not use this work for commercial purposes and you may not alter, transform, or build upon this work and distribute any derivative works you create under a similar license.
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Div of Psychology and Lang Sciences > Clinical, Edu and Hlth Psychology
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Brain Sciences > Division of Psychiatry
URI: https://discovery.ucl.ac.uk/id/eprint/1470172
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