LETTER TO THE EDITOR

Year : 2016  |  Volume : 13  |  Issue : 3  |  Page : 149

Author reply

Avinash De Sousa
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra, India

Correspondence Address:
Avinash De Sousa
Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, Maharashtra
India

Source of Support: None, Conflict of Interest: None

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DOI: 10.4103/0973-0354.193140

• The Suicide Intent Scale - Management, Assessment and Planning (SIS-MAP) is a scale that serves as a predictor of suicide and it is a valid, sensitive, and specific tool for assessing suicide risk. In addition to the accurate prediction of level of care required, it can easily be administered by mental health clinicians and can facilitate the level of care decision through consideration of all relevant domains. It considers a wider range of risk and protective factors than previous instruments, providing clinicians with much more direction in terms of treatment and care management. ^[1]
• In an illness such as schizophrenia, suicidality may show variation with the phases and symptoms of the illness. ^[2] Suicidal thoughts are high in first-episode patients, and many nonattempters in the first episode may show high suicidality while they may not attempt suicide. In fact, it is well known that after a suicidal attempt, suicidal thoughts may reduce or at times a patient may get defensive and not reveal suicidal ideation resulting in lower scores on suicide prediction scales than nonattempters. ^[3]
• We had excluded patients with documented thyroid disease from the sample as we did not want raised thyroid-stimulating hormone (TSH) levels to confound findings. It is also a likelihood that some patients in the sample probably had undetected thyroid disease that may have caused elevated TSH levels, but we assume that it would be a small number. A positive correlation between TSH and suicidality is reported in the study, and the values of correlation should have been mentioned below [Figure 1] which was probably missed due to an oversight by the authors. The values are r = 0.2691, p = 0.0376, which is significant at p < 0.05. We thank the author of the letter for pointing out the same and also wish to state that the last paragraph of the discussion should read higher TSH rather than lower TSH.
• The reason we mention about depression is due to the fact that first-episode psychosis patients who attempt suicide may show depressive symptoms though they may not meet the diagnostic criteria for major depression, and it is very often in the depressed or low mood phases or during phases of impulsivity or in response to auditory hallucinations that a suicide attempt may occur. ^[4]

References

1.	Johnston ME, Nelson C, Shrivastava A. Dimensions of suicidality: Analyzing the domains of the SIS-MAP Suicide Risk Assessment Instrument and the development of a brief screener. Arch Suicide Res 2013;17:212-22.   [PUBMED]
2.	Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother 2010;10:1153-64.
3.	Hor K, Taylor M. Suicide and schizophrenia: A systematic review of rates and risk factors. J Psychopharmacol 2010;24 4 Suppl: 81-90.
4.	Romm KL, Rossberg JI, Berg AO, Barrett EA, Faerden A, Agartz I, et al. Depression and depressive symptoms in first episode psychosis. J Nerv Ment Dis 2010;198:67-71.   [PUBMED]