AUCTORES
Globalize your Research
Review Article | DOI: https://doi.org/10.31579/2578-8868/114
1 Director of the Department of Criminal and Investigative Psychology UNIFEDER, Italy.
*Corresponding Author: Giulio Perrotta, Directorofthe Department of Criminaland Investigative Psychology UNIFEDER, Italy.
Citation: Perrotta G. (2020) Suicidal risk: definition, contexts, differential diagnosis, neural correlates and clinical strategies. J. Neuroscience and Neurological Surgery, 6(2); Doi:10.31579/2578-8868/114
Copyright: © 2020 Giulio Perrotta, This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited
Received: 27 January 2020 | Accepted: 12 February 2020 | Published: 17 February 2020
Keywords: psychology, neuroscience, depressive disorder, suicidal risk, suicide, death, psychotherapy, psychopharmacology, benzodiazipines, antidepressants, mood stabilizers, strategic approach.
Starting from the concept of suicidal risk, this work re-elaborates the main theories on the theme and related theme of mourning, proceeding with a complete examination of the possible differential diagnoses and of the neural correlates involved, up to the most suitable clinical strategies to avoid the event of death.
. Definitions, differential diagnosis and clinical contexts of the suicidal risk
2. The neural correlates in suicidal contexts
3. Clinical strategies for the management of the suicidal risk
4. Conclusions 5. References
1. Definition, differential diagnosis and clinical contexts of the suicidal risk
In common parlance, suicide (from Latin "sui caedere") is the physical act by which the person deliberately procures death; it is an extreme self-injurious gesture, which underlies the existence of a serious condition of psychological distress, be it caused by pathology or by unfortunate events of a personal nature (social, economic, work, environmental), but it can also be determined by a temporary state of psychic inability resulting from a non-psychiatric medical condition. [3] From an epidemiological point of view, the suicide rate varies according to the geographical area, the sex of the subject, the age of the subject, the previous pathological conditions and the more or less dysfunctional context of the environment that welcomes the person. With these assumptions, drawing up rankings or statistical reports, in the writer's opinion, is completely useless, because the data would change quickly and the photograph that would emerge would be only useful in that historical moment and for that geographical profile. [1] However, it is interesting to note that not all of these risk factors are of equal severity: mental disorders, for example, affect almost 50% of nefarious events, while problems in married life and emotional crises and physical problems account for 30%, as well as problems at work and financial problems, which instead affect in 15% of cases. [6] However, it is often a combination of these events that determines suicidal risk. [1]
The sociologist in Émile Durkheim, first, analyzed this phenomenon in depth, hierarchizing it and classifying it methodically, distinguishing four different types connected to equally four degrees of integration and social regulation: selfish; altruistic; fatalistic; anomic. In the first case, the subject is driven by attitudes and behaviors aimed at achieving personal interest, in the absence of a weighting of the interests of others, harmful or not to the intimate and private sphere of the surrounding environment; in the second case, the subject is driven by the belief that this decision is more or less necessary to alleviate someone else's pain or is necessary to help or save someone; in the third case, the subject while determining the final event is subject to the providential rules of fate, being the victim of adverse circumstances; in the fourth case, it is the event itself that is the standard sign of social change, meaning the author - by anomia - a state of change between normative expectations and lived reality, whether acute (usually follows a sudden change , such as the death of a relative) or chronic (usually following a sudden change, such as the death of a relative). [2] [5]
In the clinical setting, suicidal risk represents the typical variable in the presence of some well-identified psychopathologies, such as depressive disorder, bipolar disorder, personality disorders, somatic disorders, post-traumatic stress disorder, eating disorders, sleep disturbances, substance addiction, behavioral addiction (e.g. pathological gambling), burn-out syndrome and psychotic disorders (including schizophrenia). [3] of particular relevance is mourning, which can significantly affect the onset of suicidal ideas, especially if the link with the deceased was particularly close or significant. Already in DSM-IV-TR mourning had been placed among the so-called "conditions that may be the object of clinical attention", precisely to indicate how, in the normal processing process following this event, there could be difficulties such as to render the condition of the pathological survivor. However, the manual envisaged the possibility of veering towards a diagnosis of a major depressive episode if the symptoms and functional impairment persisted for more than two months, thus making the consequences of the failure to process mourning fall within a more depressive context. The DSM-5 therefore proposed the diagnosis of persistent and complicated mourning disorder to indicate precisely those conditions in which the acute manifestations of mourning, with negative experiences, of sadness, guilt, envy, anger, associated with persistent ruminations related to the causes, circumstances and consequences of the loss remain if at least twelve months have passed since the death of someone with whom the grieving individual had a close relationship, considering this period of time as discriminating between normal and pathological mourning. Furthermore, this disorder is frequently accompanied by sleep disturbances, hyperexia, asthenia and easy fatigue, as well as the intensification of dysfunctional behaviors such as the use of alcohol or drugs. The diagnostic criteria for persistent and complicated mourning disorder are:
a) the individual experienced the death of someone with whom he had a close relationship;
b) since death, at least one of the following symptoms has been present for more days than it was not present and at a clinically significant level of severity, and has persisted in adults at least twelve months and in children for at least six months after mourning:
1. a persistent desire / nostalgia for the deceased person. In young children, desire can be expressed in play and behavior also through behaviors that reflect being separated from, and also reunited with, a caregiver or another figure object of attachment;
2. sadness and intense emotional pain following death;
3. concern for the deceased;
4. concern about the circumstances of death. In children, this concern for the deceased can be expressed through the content of the game and the behavior can extend to concern for the possible death of other close people.
c) since death, at least six of the following symptoms have been present for more days than they were not present and at a clinically significant level of severity, and have persisted in adults at least twelve months and in children at least six months after mourning:
1) suffering related to death:
- marked difficulty in accepting death. In children this difficulty depends on the ability to understand the meaning and definitiveness of death.
- feeling disbelief or emotional numbness about loss.
- difficulty abandoning oneself to positive memories concerning the deceased.
- bitterness or anger in relation to loss.
- negative self-assessment in relation to the deceased or the death (e.g. sense of self-guilt).
- excessive avoidance of memories of loss (e.g. avoidance of people, places or situations associated with the deceased; in children this may include the avoidance of thoughts and feelings about the deceased.
2) social and identity disorder.
3) desire to die to be close to the deceased.
4) from the moment of death, difficulty in trusting towards the others.
5) from the moment of death, feeling of being alone or detached from others.
6) feeling that life is empty or meaningless without the deceased, or thought of not making it without the deceased.
7) confusion about one's role in life, or diminished sense of one's identity (e.g. a part of oneself has diminished together with the deceased).
8) from the moment of loss, difficulty or reluctance to pursue their interests or making plans for the future (e.g. friendships, activities).
d) the disorder causes clinically significant distress or impaired functioning in the social, occupational, or other important areas.
e) the mourning reaction is disproportionate or inconsistent with cultural or religious norms or age-appropriate.
The "suicidal risk" is nothing more than a series of circumstances capable of fueling the subject's suicidal ideation, prompting him to carry out self-injurious acts of different intensity and severity. [1] On these assumptions, the suicide has different degrees: in its chronic form it is the “actual suicide”, where the subject gets to inflict himself with a self-injurious act so serious as to reach the event of death; in its acute form is “attempt”, a non-fatal, self-inflicted, potentially harmful act intended to cause death but may or may not cause injury; in its mild form it is the "non-suicidal self-harm" act, which despite being dangerous does not cause damage aimed at the event of death. [3]
In particular, the self-injurious act performs different functions: the most accredited ones concern an emotional regulation strategy, a form of "learned" self-punishment due to a critical and invalidating life context, and again, an attempt to exit from dissociative states. In DSM-IV, self-harm is included among the symptoms of borderline personality disorder: "recurrent threats, gestures, suicidal behaviors or self-mutilating behavior". However, although some research has confirmed the existence of a strong relationship between self-harm and this personality disorder, even patients who receive other diagnoses seem to get injured in an intentional and deliberate way. In particular, subjects suffering from major depression, anxiety disorders, substance abuse, eating disorders, post-traumatic stress disorder, schizophrenia and other serious personality disorders. In addition, recent studies have investigated the existence or absence of an association between intentional self-harm and para-suicidal and suicidal gestures. It was initially hypothesized that these behaviors may be located along a continuum. However, no-suicidal self-harm gestures and para-suicidal gestures would seem to differ for some important points, including the use of different methods, physical outcomes of different severity (greater for para-suicidal and suicidal gestures) and different intentionality (no-suicidal self-harm is frequently implemented in the absence of suicidal ideation). This distinction turns out to be the starting point for the proposal made in the current diagnostic manual: no-suicidal self-harm could be conceived as a separate diagnostic category. [3]
The criteria proposed in the current diagnostic manual indeed include [3]:
a) in the last year, in five or more days, the individual has intentionally inflicted damage of some kind to the body surface capable of inducing bleeding, bruising or pain (for example, cutting, burning, stabbing, hitting himself, rubbing himself excessively), with the expectation that the injury will lead to only minor or moderate physical damage (there is no suicidal intentionality).
b) the individual is involved in self-harm activities with one or more of the following expectations:
1. get relief from a negative feeling or cognitive state;
2. solve an interpersonal difficulty.
3. induce a positive feeling.
c) self-harm is associated with at least one of the following symptoms:
1. Interpersonal difficulties or negative sensations or thoughts, such as depression, anxiety, tension, anger, generalized discomfort, self-criticism, which occur in the period immediately preceding the self-injurious gesture.
2. before making the gesture, there is a period of concern that is difficult to control regarding the gesture that the individual intends to commit.
3. self-injurious thoughts frequently present, even when the behavior is not implemented.
Suicidal risk is also connected and aggravated by some physical pathologies, such as in the case of cancer, systemic viral infections (HIV and hepatitis), chronic pain, cerebral ischemias and chronic autoimmune diseases, dementias and brain vasculopathies, as well as deficiencies chronic vitamin D and B complex, calcium or excess gold, iron, copper and zinc. [3]
2. The neural correlates in suicidal contexts
There is no known underlying pathophysiology unique to suicide or depression. [7] However, it is believed to be the result of multiple behavioral, socio-environmental and psychiatric factors. [8] Low levels of the brain neurotrophic factor (BDNF) are directly related to suicide [9] and indirectly through their role in major depression, post-traumatic stress disorder, schizophrenia and obsessive-compulsive disorder. [10] Post-mortem studies have found a reduction in BDNF levels in the hippocampus and prefrontal cortex, both in suicides with psychiatric conditions and in those without. [11] Serotonin, a brain neurotransmitter, is believed to be particularly scarce in those who die from suicide. This belief is partly based on evidence of an increase in 5-HT2A receptor levels after death. [12] Other tests include reduced levels of a degradation product of serotonin, 5-hydroxyindolacetic acid, in the cerebrospinal fluid. [13] However, direct evidence is difficult to gather. [12] Epigenetics, the study of variations in gene expression in response to environmental factors that do not alter DNA, is also believed to be useful for playing a role in suicide risk. [14]
3. Clinical strategies for the management of the suicidal risk
A healthcare professional who suspects the possibility of a patient's suicide is required to inform an authorized service to intervene, as happens if he were a family member, an acquaintance or an unknown person; the sanction provided for by most legal systems is the omission of relief, a crime punishable by imprisonment and a financial penalty. [1]
Precisely because they are fragile, these subjects should not be left alone until they are placed in a protected environment. They must be transported to a safe place (often a psychiatric facility) and by trained professionals (eg, ambulance, police). [1]
Any suicidal act, regardless of whether it is a demonstration gesture or a purposeful attempt, must be seriously considered and just as every person with a serious self-inflicted injury must be assessed and treated as a consequence of the physical injury, each person who presents signs clear clinicians of suicidal behavior must be content and protected. [1]
The initial assessment can be performed by any member of the health care professional qualified in the assessment and management of suicidal behavior. However, all patients require a psychiatric evaluation as soon as possible. A decision must be made about the patient's need for hospitalization, and whether forced hospitalization or temporary containment is necessary. Patients with psychotic disorder and those with severe depression and unresolved crisis must be hospitalized in a psychiatric unit, while patients with manifestations of potentially confounding medical disorders (e.g. delirium, seizures or fever) may need to be hospitalized in a facility medicine adapted to the appropriate precautions against suicides. Greater sensitivity is needed if the patient has a previous clinical history that could suggest suicidal behavior. The psychiatric evaluation will then identify some of the problems that contributed to the attempt and help the doctor plan appropriate treatment. It includes the following steps: establishing a relationship and listening to the patient's narrative; understand the reasons for the suicide attempt, what is the background, the events that preceded it and the circumstances in which it occurred; investigate symptoms of mental disorders that are associated with suicide; fully evaluate the patient's mental state, with particular regard to the identification of depression, anxiety, agitation, panic attacks, severe insomnia or other mental disorders, as well as alcohol or substance abuse (many of these problems require specific treatment, in addition to critical intervention); adequately understand the family and personal relationships that are often related to the suicide attempt; hold interviews with close family and friends; investigate the presence of a firearm in the house; safety planning to help patients identify suicide planning triggers and develop plans to deal with suicidal thoughts when they occur. [15] [16]
However, suicide prevention is the first active form of anticipating the problem, while requiring careful identification of people at risk. This is not always easy, as some risk signals can be silent and not clearly manifested. The most vulnerable age groups are certainly the "hinges", those that represent changes and events, such as adolescence, adulthood and old age. But still social situations such as special anniversaries, professional unemployment, economic upsets, legal problems and environmental isolation are all signs of a highly typical context for the establishment of suicidal thoughts or tendencies towards self-harm. Furthermore, previous suicide attempts, psycho-physical pathological history similar to suicide, typical clinical features such as mood deflection, depression, delusions, hallucinations, hostile or impulsive personality and chronic diseases are other typical conditions that facilitate the onset of ideation. suicidal. Finally, substance abuse, including drugs, complete the picture. [1]
With reference to the best clinical therapy, undoubtedly the combination of psychotherapy and psychopharmacology has given the best results. Identifying the morbid psychic condition is the first step to stop the spiral, possibly giving the targeted drug, with a therapy adapted to the person and frequent visits, at least in the first trimester (even three times a week, then falling to one a week in the following three months). [3]
4. Conclusions
In common parlance, suicide (from Latin "sui caedere") is the physical act by which the person deliberately procures death; it is an extreme self-injurious gesture, which underlies the existence of a serious condition of psychological distress, be it caused by pathology or by unfortunate events of a personal nature (social, economic, work, environmental), but it can also be determined by a temporary state of psychic inability resulting from a non-psychiatric medical condition. [3]
Clearly Auctoresonline and particularly Psychology and Mental Health Care Journal is dedicated to improving health care services for individuals and populations. The editorial boards' ability to efficiently recognize and share the global importance of health literacy with a variety of stakeholders. Auctoresonline publishing platform can be used to facilitate of optimal client-based services and should be added to health care professionals' repertoire of evidence-based health care resources.
Journal of Clinical Cardiology and Cardiovascular Intervention The submission and review process was adequate. However I think that the publication total value should have been enlightened in early fases. Thank you for all.
Journal of Women Health Care and Issues By the present mail, I want to say thank to you and tour colleagues for facilitating my published article. Specially thank you for the peer review process, support from the editorial office. I appreciate positively the quality of your journal.
Journal of Clinical Research and Reports I would be very delighted to submit my testimonial regarding the reviewer board and the editorial office. The reviewer board were accurate and helpful regarding any modifications for my manuscript. And the editorial office were very helpful and supportive in contacting and monitoring with any update and offering help. It was my pleasure to contribute with your promising Journal and I am looking forward for more collaboration.
We would like to thank the Journal of Thoracic Disease and Cardiothoracic Surgery because of the services they provided us for our articles. The peer-review process was done in a very excellent time manner, and the opinions of the reviewers helped us to improve our manuscript further. The editorial office had an outstanding correspondence with us and guided us in many ways. During a hard time of the pandemic that is affecting every one of us tremendously, the editorial office helped us make everything easier for publishing scientific work. Hope for a more scientific relationship with your Journal.
The peer-review process which consisted high quality queries on the paper. I did answer six reviewers’ questions and comments before the paper was accepted. The support from the editorial office is excellent.
Journal of Neuroscience and Neurological Surgery. I had the experience of publishing a research article recently. The whole process was simple from submission to publication. The reviewers made specific and valuable recommendations and corrections that improved the quality of my publication. I strongly recommend this Journal.
Dr. Katarzyna Byczkowska My testimonial covering: "The peer review process is quick and effective. The support from the editorial office is very professional and friendly. Quality of the Clinical Cardiology and Cardiovascular Interventions is scientific and publishes ground-breaking research on cardiology that is useful for other professionals in the field.
Thank you most sincerely, with regard to the support you have given in relation to the reviewing process and the processing of my article entitled "Large Cell Neuroendocrine Carcinoma of The Prostate Gland: A Review and Update" for publication in your esteemed Journal, Journal of Cancer Research and Cellular Therapeutics". The editorial team has been very supportive.
Testimony of Journal of Clinical Otorhinolaryngology: work with your Reviews has been a educational and constructive experience. The editorial office were very helpful and supportive. It was a pleasure to contribute to your Journal.
Dr. Bernard Terkimbi Utoo, I am happy to publish my scientific work in Journal of Women Health Care and Issues (JWHCI). The manuscript submission was seamless and peer review process was top notch. I was amazed that 4 reviewers worked on the manuscript which made it a highly technical, standard and excellent quality paper. I appreciate the format and consideration for the APC as well as the speed of publication. It is my pleasure to continue with this scientific relationship with the esteem JWHCI.
This is an acknowledgment for peer reviewers, editorial board of Journal of Clinical Research and Reports. They show a lot of consideration for us as publishers for our research article “Evaluation of the different factors associated with side effects of COVID-19 vaccination on medical students, Mutah university, Al-Karak, Jordan”, in a very professional and easy way. This journal is one of outstanding medical journal.
Dear Hao Jiang, to Journal of Nutrition and Food Processing We greatly appreciate the efficient, professional and rapid processing of our paper by your team. If there is anything else we should do, please do not hesitate to let us know. On behalf of my co-authors, we would like to express our great appreciation to editor and reviewers.
As an author who has recently published in the journal "Brain and Neurological Disorders". I am delighted to provide a testimonial on the peer review process, editorial office support, and the overall quality of the journal. The peer review process at Brain and Neurological Disorders is rigorous and meticulous, ensuring that only high-quality, evidence-based research is published. The reviewers are experts in their fields, and their comments and suggestions were constructive and helped improve the quality of my manuscript. The review process was timely and efficient, with clear communication from the editorial office at each stage. The support from the editorial office was exceptional throughout the entire process. The editorial staff was responsive, professional, and always willing to help. They provided valuable guidance on formatting, structure, and ethical considerations, making the submission process seamless. Moreover, they kept me informed about the status of my manuscript and provided timely updates, which made the process less stressful. The journal Brain and Neurological Disorders is of the highest quality, with a strong focus on publishing cutting-edge research in the field of neurology. The articles published in this journal are well-researched, rigorously peer-reviewed, and written by experts in the field. The journal maintains high standards, ensuring that readers are provided with the most up-to-date and reliable information on brain and neurological disorders. In conclusion, I had a wonderful experience publishing in Brain and Neurological Disorders. The peer review process was thorough, the editorial office provided exceptional support, and the journal's quality is second to none. I would highly recommend this journal to any researcher working in the field of neurology and brain disorders.
Dear Agrippa Hilda, Journal of Neuroscience and Neurological Surgery, Editorial Coordinator, I trust this message finds you well. I want to extend my appreciation for considering my article for publication in your esteemed journal. I am pleased to provide a testimonial regarding the peer review process and the support received from your editorial office. The peer review process for my paper was carried out in a highly professional and thorough manner. The feedback and comments provided by the authors were constructive and very useful in improving the quality of the manuscript. This rigorous assessment process undoubtedly contributes to the high standards maintained by your journal.
International Journal of Clinical Case Reports and Reviews. I strongly recommend to consider submitting your work to this high-quality journal. The support and availability of the Editorial staff is outstanding and the review process was both efficient and rigorous.
Thank you very much for publishing my Research Article titled “Comparing Treatment Outcome Of Allergic Rhinitis Patients After Using Fluticasone Nasal Spray And Nasal Douching" in the Journal of Clinical Otorhinolaryngology. As Medical Professionals we are immensely benefited from study of various informative Articles and Papers published in this high quality Journal. I look forward to enriching my knowledge by regular study of the Journal and contribute my future work in the field of ENT through the Journal for use by the medical fraternity. The support from the Editorial office was excellent and very prompt. I also welcome the comments received from the readers of my Research Article.
Dear Erica Kelsey, Editorial Coordinator of Cancer Research and Cellular Therapeutics Our team is very satisfied with the processing of our paper by your journal. That was fast, efficient, rigorous, but without unnecessary complications. We appreciated the very short time between the submission of the paper and its publication on line on your site.
I am very glad to say that the peer review process is very successful and fast and support from the Editorial Office. Therefore, I would like to continue our scientific relationship for a long time. And I especially thank you for your kindly attention towards my article. Have a good day!
"We recently published an article entitled “Influence of beta-Cyclodextrins upon the Degradation of Carbofuran Derivatives under Alkaline Conditions" in the Journal of “Pesticides and Biofertilizers” to show that the cyclodextrins protect the carbamates increasing their half-life time in the presence of basic conditions This will be very helpful to understand carbofuran behaviour in the analytical, agro-environmental and food areas. We greatly appreciated the interaction with the editor and the editorial team; we were particularly well accompanied during the course of the revision process, since all various steps towards publication were short and without delay".
I would like to express my gratitude towards you process of article review and submission. I found this to be very fair and expedient. Your follow up has been excellent. I have many publications in national and international journal and your process has been one of the best so far. Keep up the great work.
We are grateful for this opportunity to provide a glowing recommendation to the Journal of Psychiatry and Psychotherapy. We found that the editorial team were very supportive, helpful, kept us abreast of timelines and over all very professional in nature. The peer review process was rigorous, efficient and constructive that really enhanced our article submission. The experience with this journal remains one of our best ever and we look forward to providing future submissions in the near future.
I am very pleased to serve as EBM of the journal, I hope many years of my experience in stem cells can help the journal from one way or another. As we know, stem cells hold great potential for regenerative medicine, which are mostly used to promote the repair response of diseased, dysfunctional or injured tissue using stem cells or their derivatives. I think Stem Cell Research and Therapeutics International is a great platform to publish and share the understanding towards the biology and translational or clinical application of stem cells.
I would like to give my testimony in the support I have got by the peer review process and to support the editorial office where they were of asset to support young author like me to be encouraged to publish their work in your respected journal and globalize and share knowledge across the globe. I really give my great gratitude to your journal and the peer review including the editorial office.
I am delighted to publish our manuscript entitled "A Perspective on Cocaine Induced Stroke - Its Mechanisms and Management" in the Journal of Neuroscience and Neurological Surgery. The peer review process, support from the editorial office, and quality of the journal are excellent. The manuscripts published are of high quality and of excellent scientific value. I recommend this journal very much to colleagues.
Dr.Tania Muñoz, My experience as researcher and author of a review article in The Journal Clinical Cardiology and Interventions has been very enriching and stimulating. The editorial team is excellent, performs its work with absolute responsibility and delivery. They are proactive, dynamic and receptive to all proposals. Supporting at all times the vast universe of authors who choose them as an option for publication. The team of review specialists, members of the editorial board, are brilliant professionals, with remarkable performance in medical research and scientific methodology. Together they form a frontline team that consolidates the JCCI as a magnificent option for the publication and review of high-level medical articles and broad collective interest. I am honored to be able to share my review article and open to receive all your comments.
“The peer review process of JPMHC is quick and effective. Authors are benefited by good and professional reviewers with huge experience in the field of psychology and mental health. The support from the editorial office is very professional. People to contact to are friendly and happy to help and assist any query authors might have. Quality of the Journal is scientific and publishes ground-breaking research on mental health that is useful for other professionals in the field”.
Dear editorial department: On behalf of our team, I hereby certify the reliability and superiority of the International Journal of Clinical Case Reports and Reviews in the peer review process, editorial support, and journal quality. Firstly, the peer review process of the International Journal of Clinical Case Reports and Reviews is rigorous, fair, transparent, fast, and of high quality. The editorial department invites experts from relevant fields as anonymous reviewers to review all submitted manuscripts. These experts have rich academic backgrounds and experience, and can accurately evaluate the academic quality, originality, and suitability of manuscripts. The editorial department is committed to ensuring the rigor of the peer review process, while also making every effort to ensure a fast review cycle to meet the needs of authors and the academic community. Secondly, the editorial team of the International Journal of Clinical Case Reports and Reviews is composed of a group of senior scholars and professionals with rich experience and professional knowledge in related fields. The editorial department is committed to assisting authors in improving their manuscripts, ensuring their academic accuracy, clarity, and completeness. Editors actively collaborate with authors, providing useful suggestions and feedback to promote the improvement and development of the manuscript. We believe that the support of the editorial department is one of the key factors in ensuring the quality of the journal. Finally, the International Journal of Clinical Case Reports and Reviews is renowned for its high- quality articles and strict academic standards. The editorial department is committed to publishing innovative and academically valuable research results to promote the development and progress of related fields. The International Journal of Clinical Case Reports and Reviews is reasonably priced and ensures excellent service and quality ratio, allowing authors to obtain high-level academic publishing opportunities in an affordable manner. I hereby solemnly declare that the International Journal of Clinical Case Reports and Reviews has a high level of credibility and superiority in terms of peer review process, editorial support, reasonable fees, and journal quality. Sincerely, Rui Tao.
Clinical Cardiology and Cardiovascular Interventions I testity the covering of the peer review process, support from the editorial office, and quality of the journal.
Clinical Cardiology and Cardiovascular Interventions, we deeply appreciate the interest shown in our work and its publication. It has been a true pleasure to collaborate with you. The peer review process, as well as the support provided by the editorial office, have been exceptional, and the quality of the journal is very high, which was a determining factor in our decision to publish with you.
The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews journal clinically in the future time.
Clinical Cardiology and Cardiovascular Interventions, I would like to express my sincerest gratitude for the trust placed in our team for the publication in your journal. It has been a true pleasure to collaborate with you on this project. I am pleased to inform you that both the peer review process and the attention from the editorial coordination have been excellent. Your team has worked with dedication and professionalism to ensure that your publication meets the highest standards of quality. We are confident that this collaboration will result in mutual success, and we are eager to see the fruits of this shared effort.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, I hope this message finds you well. I want to express my utmost gratitude for your excellent work and for the dedication and speed in the publication process of my article titled "Navigating Innovation: Qualitative Insights on Using Technology for Health Education in Acute Coronary Syndrome Patients." I am very satisfied with the peer review process, the support from the editorial office, and the quality of the journal. I hope we can maintain our scientific relationship in the long term.
Dear Monica Gissare, - Editorial Coordinator of Nutrition and Food Processing. ¨My testimony with you is truly professional, with a positive response regarding the follow-up of the article and its review, you took into account my qualities and the importance of the topic¨.
Dear Dr. Jessica Magne, Editorial Coordinator 0f Clinical Cardiology and Cardiovascular Interventions, The review process for the article “The Handling of Anti-aggregants and Anticoagulants in the Oncologic Heart Patient Submitted to Surgery” was extremely rigorous and detailed. From the initial submission to the final acceptance, the editorial team at the “Journal of Clinical Cardiology and Cardiovascular Interventions” demonstrated a high level of professionalism and dedication. The reviewers provided constructive and detailed feedback, which was essential for improving the quality of our work. Communication was always clear and efficient, ensuring that all our questions were promptly addressed. The quality of the “Journal of Clinical Cardiology and Cardiovascular Interventions” is undeniable. It is a peer-reviewed, open-access publication dedicated exclusively to disseminating high-quality research in the field of clinical cardiology and cardiovascular interventions. The journal's impact factor is currently under evaluation, and it is indexed in reputable databases, which further reinforces its credibility and relevance in the scientific field. I highly recommend this journal to researchers looking for a reputable platform to publish their studies.
Dear Editorial Coordinator of the Journal of Nutrition and Food Processing! "I would like to thank the Journal of Nutrition and Food Processing for including and publishing my article. The peer review process was very quick, movement and precise. The Editorial Board has done an extremely conscientious job with much help, valuable comments and advices. I find the journal very valuable from a professional point of view, thank you very much for allowing me to be part of it and I would like to participate in the future!”
Dealing with The Journal of Neurology and Neurological Surgery was very smooth and comprehensive. The office staff took time to address my needs and the response from editors and the office was prompt and fair. I certainly hope to publish with this journal again.Their professionalism is apparent and more than satisfactory. Susan Weiner
My Testimonial Covering as fellowing: Lin-Show Chin. The peer reviewers process is quick and effective, the supports from editorial office is excellent, the quality of journal is high. I would like to collabroate with Internatioanl journal of Clinical Case Reports and Reviews.
My experience publishing in Psychology and Mental Health Care was exceptional. The peer review process was rigorous and constructive, with reviewers providing valuable insights that helped enhance the quality of our work. The editorial team was highly supportive and responsive, making the submission process smooth and efficient. The journal's commitment to high standards and academic rigor makes it a respected platform for quality research. I am grateful for the opportunity to publish in such a reputable journal.
My experience publishing in International Journal of Clinical Case Reports and Reviews was exceptional. I Come forth to Provide a Testimonial Covering the Peer Review Process and the editorial office for the Professional and Impartial Evaluation of the Manuscript.
