bluuebunny/crossref_metadata_2025 huggingface dataset:
Low level of antidepressant prescription for people who later commit suicide: 15 years of experience from a population‐based drug database in Sweden
Authors: Isacsson G. , Boëthius G. , Bergman U.
Published: August 2007

The use of antidepressants has been low in Jämtland County for many years, while the suicide rate has been among the highest in Sweden. A continuous outpatient prescription recording system has been in operation in Jämtland since 1970. Through this system we traced the prescription pattern of 80 individuals who committed suicide from 1970 to 1984. Suicide patients obtained 1.5 times more prescription drugs than 80 matched controls, mainly psychotropics and vitamins. During the 3 months prior to the suicide, half of the patients had received medical attention and 73% of the women and 40% of the men had obtained prescription drugs, in one‐third from the psychiatric department. While 53% and 29%, respectively, obtained psychotropic drugs, only 13% and 9% respectively were prescribed antidepressants, often in low doses. People who will commit suicide often seek medical help. The low rate of antidepressant prescription in patients committing suicide probably reflects insufficient diagnosis and treatment of depressive disorders. It is urgent – for the individual as well as for society – that diagnostic and pharmacotherapeutic routines be improved.
Discriminant validity of a reduced set of Mini‐Mental State Examination items for dementia and Alzheimer's disease
Authors: Wells J. C. , Keyl P. M. , Chase G. A. , Aboraya A. , Folstein M. F. , Anthony J. C.
Published: August 2007

Linear discriminant analysis was used to construct a series of discriminant functions including subsets of demographic variables and Mini‐Mental State Examination item responses for a case series and a population sample. A 9‐item discriminant function including the variables for time orientation, recall, calculation, copying a figure, age, writing, 3‐step command, naming, and race distinguished demented subjects from community controls with 91% sensitivity and 88% specificity. The same discriminant function classified Alzheimer's disease patients and controls with 96% sensitivity and 98% specificity. This discriminant function has been cross‐validated as a potential screening instrument for Alzheimer's disease in a community‐based sample.
Cases of buprenorphine abuse in India
Authors: Singh R. A. , Mattoo S. K. , Malhotra A. , Varma V. K.
Published: August 2007

Buprenorphine was introduced as a potent analgesic with low abuse potential. Reports of buprenorphine abuse by opiate abusers have accumulated over the years, highlighting its use as a cheap alternative to heroin. The lower potency compared with heroin is being compensated by using a cocktail of buprenorphine with benzodiazepines or cyclizine. This study of 18 cases seen over 3 years broadly confirms these findings. Four cases reported haematemesis during acute withdrawal, a symptom not reported in earlier studies.
Suicides in the former Soviet republics
Authors: Värnik A. , Wasserman D.
Published: August 2007

The suicide rate in the former Soviet Union rose from 17.1 per 100,000 inhabitants in 1965 to 29.6 in 1984. In regions of long‐standing traditional lifestyles, strong religious faith and multi‐generation families (the Caucasus and central Asia), the suicide rate was low, whereas in regions with sociopolitical antagonisms (Baltic States) and forced social changes (Russia), it was high. A significant decline in the suicide rate (34.5%), from 29.6 to 19.4 per 100,000 inhabitants, occurred in 1984–1988 throughout the Soviet Union, in the hopeful period of social democratization and stiff restrictions on the sale of alcohol. Rates varied widely between different republics ‐ from 1.8 in Armenia to 26.3 in Lithuania and 24.3 in the Russian Soviet Federated Socialist Republic (RSFSR) in 1988. In contrast to the pattern in several countries in western Europe, the suicide rates in the Russian SFSR were much higher in the rural regions than in the urban ones.
Platelet 3H‐imipramine binding during recovery from depression
Authors: Ellis P. M. , Beeston R. , McIntosh C. J. , Salmond C. E. , Cooke R. R.
Published: August 2007

Decreased binding of tritiated imipramine to platelets has been considered to be a potential biological marker of depression. However, it has been unclear how binding values alter during treatment and recovery. This study investigated imipramine binding parameters and depressive symptoms in 25 patients suffering from major depression at entry to the study and 1, 3 and 6 months later. Although the initial Bmax values were significantly lower in the depressed patients than in healthy subjects, it was not possible to establish a clear relationship between recovery from depression and Bmax. The power of this study to detect an effect of at least 10% of the variance in Bmax due to factors related to recovery from depression was 0.78.
The social network of people who attempt suicide
Authors: Magne‐Ingvar U. , Öjehagen A. , Träskman‐Bendz L.
Published: August 2007

Social characteristics and self‐rating of social support by means of the Interview Schedule for Social Interaction were investigated in 75 inpatients after a suicide attempt. We found that very few suicide attempters (13%) had a well functioning relationship, and two‐thirds had problems in their occupational situation. Divorced patients had unsatisfactory social interaction compared with those who were married or cohabiting and with those who were single or widowed. Employees and students more often had deep emotional relations than those who were unemployed or in vocational rehabilitation. The latter were also less satisfied with their social interaction than those who were retired or had a disability pension. Poor social interaction was more commonly reported by patients with dysthymia than by those in other diagnostic subgroups. We conclude that an evaluation of the social network should be an integral part of the clinical handling of suicide attempters, since it forms a basis for planning psychiatric treatment.
The assessment of insight in clinical psychiatry: a new scale
Authors: Marková I. S. , Berrios G. E.
Published: August 2007

Difficulties surrounding the meaning of insight in psychiatry have led to neglect of its assessment in clinical practice. A study is described in which an insight scale was constructed and tested in a sample of 43 patients suffering from schizophrenia or depression. The results showed that the insight instrument was able to provide a qualitative and quantitative assessment of insight. Qualitative features brought out by the scale included patients’ perception of changes within themselves and within their environment, their recognition of being ill and their acknowledgment of needing help. Quantitative measurements showed that there was a significant improvement in the level of insight over the period of hospital admission. In addition, scores obtained on the insight scale were inversely correlated with the severity of the patients’ disorder, though these correlations occurred at different times in relation to the different disorders. We thus postulate that other factors (such as intellect, past experience, personality etc.) must be involved in modulating the expression of insight. Although the insight instrument needs refining, we suggest that it may be a useful tool in the further exploration of insight in clinical practice.
A population‐based survey of the characteristics of high school students with and without a history of suicidal behavior
Authors: Garnefski N. , Diekstra R. F. W. , Heus P. de
Published: August 2007

In a sample of 570 15‐ and 16‐year‐old normal high school students, the characteristics of those with and without a history of suicidal behavior were compared. In a written inquiry, information was obtained on family background, emotional and behavioral problems, sexual and physical abuse and suicidal thoughts and behavior. Differences between the students with and without a history of suicidal behavior were statistically analyzed for boys and girls separately by a matched control design. The results for both boys and girls indicated that the experience of sexual abuse, feelings of loneliness, depressed mood, low self‐esteem and the use of drugs were particularly strongly related to suicidal thoughts and behavior; for girls, physical abuse and for boys, low self‐reported academic achievement appeared to be clearly related aspects. Furthermore, the strong interrelations between all of these variables is underlined, suggesting a multi‐problem background of youngsters with a history of suicidal behavior.
The Parental Bonding Instrument in adolescent patients with anorexia nervosa
Authors: Russell J. D. , Kopec‐Schrader E. , Rey J. M. , Beumont P. J. V.
Published: August 2007

The Parental Bonding Instrument (PBI) was administered to 54 adolescent patients with anorexia nervosa. Scores were compared with those of matched groups of normal and of nonanorectic adolescents referred for assessment to an adolescent psychiatric unit. Significant differences between the 3 groups were demonstrated with respect to care and protection dimensions. Overall scores of subjects in the anorectic group resembled those of normals rather than those of referred patients. Anorexia nervosa patients described their fathers and mothers as being more caring and their mothers as being less overprotective than did psychiatrically referred peers. The study raised questions concerning the use of the PBI in adolescents, in particular those with anorexia nervosa, and the role of the family in the aetiogenesis of this condition.
Clusters in a cohort of untreated schizophrenia: prognostic importance, atypical cases and the familial versus sporadic distinction
Authors: Jönsson S. A. T. , Jonsson H.
Published: August 2007

In search of features of prognostic importance, a cohort of patients admitted to a mental hospital in 1925 was investigated by means of multivariate clustering techniques. Using K‐means cluster analysis or Q‐factor analysis, a group containing cases with unfavourable prognosis was isolated. Other groups derived were prognostically heterogeneous. One group of patients, in early phases similar to good prognosis schizoaffective psychoses, could be distinguished and characterized by non‐symptom items. There was initial periodicity and onset was acute. They were, on average, younger than the other subjects and there was no personality deviation or emotional disturbance before onset of disease. A family history of mental illness was rare. Two of the factors were positively and negatively characterized by items covering familial history of mental illness, thus seemingly confirming the familial vs sporadic distinction in the subclassification of schizophrenia. Though the clinical pictures were distinctively different at the time when the ratings underlying the analysis were made, approximately the same proportion of cases in the two groups had independently been diagnosed as paranoid schizophrenia ‐ also taking the course of illness into account. It could furthermore be shown that the population at risk ‐ siblings and children of subjects ‐ as well as the observed number of years at risk in these groups were significantly smaller in the sporadic group than in the familial group. This was a combined effect of a lower fertility in subjects and parents in the sporadic group and a higher rate of drop out due to mortality and other reasons among siblings of these subjects. The same tendency was indicated when subjects with and without family history irrespective of factor belongingness were compared. It cannot be concluded that the familial vs sporadic distinction is without relevance in the research on schizophrenia, but its essence may easily be obscured, if the population at risk is not taken into account.
Similarities in diagnostic comorbidity between suicide among young people in Sweden and the United States
Authors: Rich C. L. , Runeson B. S.
Published: August 2007

A significant difference in the prevalence of personality disorders was reported between similar studies of suicide among young people (under age 30) performed in San Diego, California (10% of 133 cases), and Göteborg, Sweden (34% of 58 cases). The difference was due entirely to the absence of borderline personality disorder (BPD) reported in the San Diego sample. In this study, we used preselected variables to reassess the suicides from the San Diego study for criteria consistent with BPD. We found that 41% met the criteria, which was now not significantly different from the Göteborg sample. Comparisons among a number of other demographic, social, and diagnostic variables revealed many similarities in the two samples, particularly Axis I comorbidity with depression and/or substance abuse and Axis II comorbidity with antisocial personality disorder. We conclude that the characteristics associated with BPD identify similar young persons who committed suicide in Sweden and the United States. Questions remain as to whether or not Axis I and II disorders are independent in relation to suicide. The comorbidity pattern described here must be considered seriously in the clinical setting for its fatal implications.
Does case management reduce the rehospitalization rate?
Authors: Rössler W. , Löffler W. , Fätkenheuer B. , Riecher‐Rössler A.
Published: August 2007

It was expected from deinstitutionalization that outpatient care could replace hospital care. But many empirical studies proved that the number of admissions to psychiatric hospitals rose when community‐based care developed. This might be due to the lack of coordination and cooperation of extramural services. The concept of case management therefore originated in the last few years. In this study the effect of case management on the rehospitalization rate is examined by analyzing the data of 4 social‐psychiatric services responsible for defined catchment areas. During the evaluation period of 2.5 years, 162 patients dismissed from psychiatric hospitals were referred to those services. For each of these index patients a matched control patient was identified, each identical in diagnosis, sex, age, living conditions and number of previous inpatient episodes. The results of a survival analysis show that there are no significant effects of case management on the rate of rehospitalization nor on the length of time in hospital in case of a rehospitalization.
Persistent auditory hallucinations correlate with the size of the third ventricle in schizophrenic patients
Authors: Cullberg J. , Nybäck H.
Published: August 2007

In a study of psychotherapy in schizophrenic patients, the existence of certain clinical and anamnestic variables, such as persistent auditory hallucinations, was found to correlate with a negative outcome. To test whether these clinical variables could be a sign of organic brain abnormality, the records of 33 schizophrenic patients who had been examined by computerized tomography (CT) were investigated regarding the occurrence of these symptoms. A significant correlation was found between width of the third ventricle and the occurrence of such auditory hallucinations, which also persisted between acute phases. No correlation was found between the CT measures and other clinical characteristics, including hallucinations rated at admission by the Comprehensive Psychopathological Rating Scale (CPRS). The results are interpreted to suggest a disturbance of diencephalic brain regions in a subgroup of schizophrenic patients that are further characterized by persistent auditory hallucinations and a lack of response to psychodynamic psychotherapy.
Antabuse treatment for excessive users of alcohol
Authors: Hardt F.
Published: August 2007

Antabuse treatment has mostly been applied to alcohol dependent patients although the heavy users of alcohol are responsible for the major parts of alcohol related problems in our societies.

The heavy users of alcohol should be identified both by the general practitioners and the hospital doctors in any field and the first intervention should be a health interview connected with a biological monitoring of alcohol damages and thereby many patients would be motivated for moderate drinking. If this is not the case, heavy users should be encouraged to a 6 or better a 12 months supervised treatment with Antabuse. This treatment has especially been effective in employees with work‐related alcohol problems.
Evaluation of community psychiatry: a cross‐sectional study
Authors: Valbak K. , Sørensen L. V. , Lindhardt A.
Published: August 2007

This study demonstrates a simple epidemiological method to evaluate the changes in service pattern for a defined catchment area after the establishment of a hospital‐based community psychiatry service in Denmark. It measures the number of patients in contact with the service on 2 census days, before the new service was introduced and 3 years later, and deals with quantitative measures of sex, age, diagnosis and type of service contact. The services for 2 other areas are used as controls. A new community psychiatry service with an office situated outside the hospital is described and is shown to be superior to both the psychiatry service from the hospital and the rest of the hospital service: the number of inpatients and day patients were reduced by 42%vs 12% and 16% respectively. The number of outpatients increased by 104% in the new service compared with 23% for the service located at the hospital. The increase in outpatient care for the service outside the hospital was mainly caused by contact with middle‐aged women with personality disorders.
AIDS and multiple sclerosis: neural and mental features
Authors: Morriss R. , Schaerf F. , Brandt J. , McArthur J. , Folstein M.
Published: August 2007

The presence of mental disorder and cognitive functioning were examined in groups of 20 multiple sclerosis (MS) and homosexual acquired immunodeficiency syndrome (AIDS) ambulatory male outpatients matched for disability and demographic features. Patients who were somatically ill, had past central nervous system infection or tumours or abused intravenous drugs or alcohol were excluded. The groups significantly differed in mental symptoms and mental disorders (DSM‐III classification) seen currently and after the diagnosis of MS or human immunodeficiency virus‐I infection. AIDS patients had pre‐existing anxiety disorders that affected their current mental symptoms. MS patients showed more evidence of cognitive impairment than equally disabled AIDS patients. The differing neural and mental features are discussed in relation to the current concepts of subcortical and cortical disorders.
Biological correlates of the Newcastle Scale in depressive illness: a multivariate approach
Authors: Staner L. , Maes M. , Bouillon E. , Linkowski P.
Published: August 2007

Rapid eye movement latency (RL), delta max thyroid‐stimulating hormone (dmTSH) and 1600 (DST16) and 2300 (DST23) post‐dexamethasone cortisol values were determined in a group of 93 depressed patients who were assessed with the Newcastle Endogenous Depression Diagnostic Index (NEDDI). After the effects of age, gender and severity of illness were controlled for, stepwise multiple regression showed that depressive psychomotor activity and weight loss were the 2 NEDDI items most contributing to explain DST23 variance, as was depressive psychomotor activity for dmTSH variance. When the depressive sample was dichotomized according to the presence of these 2 items, the 2 groups had significantly different DST16, DST23, dmTSH and RL values. This suggests that weight loss, agitation and retardation could represent a core feature of a biologically mediated depressive subtype.
Neuroleptic medication and reduced risk of prostate cancer in schizophrenic patients
Authors: Mortensen P. B.
Published: August 2007

A decreased incidence of cancer of the prostate has been demonstrated in a cohort of 6168 chronic schizophrenic patients followed up from 1957 to 1984. A case‐control study was performed based on this cohort to determine the possible influence of neuroleptic treatment and other factors on the risk of developing prostate cancer. Thirty‐eight male schizophrenic patients who had developed prostate cancer during the observation period were compared with 76 age‐ and sex‐matched controls from the same cohort. The only significant association was that of a reduced risk of prostate cancer among those who had been treated with a cumulative dose of high‐dose phenothiazines (primarily chlorpromazine) of 15 g or more. These patients had been treated with an average daily dose of 145 mg chlorpromazine for an average of 12.5 years. No other significant risk factors were identified.
Anxiety, impulsivity and depressed mood in relation to suicidal and violent behavior
Authors: Apter A. , Plutchik R. , van Praag H. M.
Published: August 2007

Many different variables have been associated with suicidal behavior as well as with violent behavior. This study was designed to test a model that attempts to relate such variables to violence and suicide risk. Sixty psychiatric patients were evaluated and divided into suicidal and nonsuicidal groups and then into violent and nonviolent groups. Scores on suicide risk, violence risk, anxiety, anger, impulsivity and mood were then compared between these groups. In a second analysis, scores on suicide risk and violence risk were correlated with all the other variables. Anxiety and impulsivity were found to strongly correlate with suicide risk. Angry and resentful mood correlated with violence risk; trait anxiety correlated negatively with violence risk. The results contribute further insight into the authors' two‐stage model of countervailing forces.
Two subtypes of adolescent suicide attempters
Authors: Kienhorst C. W. M. , de Wilde E. J. , van den Bout J. , van der Burg E. , Diekstra R. F. W. , Wolters W. H. G.
Published: August 2007

An empirical classification of 203 adolescent suicide attempters (mean age 17.3) was achieved using multiple correspondence analysis. The characteristics upon which the classification is based concern sociodemographic as well as psychological variables. Two groups are identified: the first is predominantly characterized by recent problematic behaviors, whereas the second group is primarily characterized by problematic circumstances. Analyzing related variables, the first group seems to have special clinical and preventive interest, because of its high risk for recidivism. The second group seems to have a satisfactory level of functioning.
Autoimmunity in depression: increased antiphospholipid autoantibodies
Authors: Maes M. , Meltzer H. , Jacobs J. , Suy E. , Calabrese J. , Minner B. , Raus J.
Published: August 2007

Some groups have recently reported higher titers of autoantibodies in depressed subjects than in normal controls. The present study investigates whether depressed patients exhibit increased antiphospholipid antibody titers compared with normal controls. The authors measured the binding index (BI) of antiphosphatidylserine (APSA), antipartial thromboplastin (APTA) and anticardiolipin (ACA) in 22 minor, 23 simple major and 20 melancholic depressives, 10 healthy controls and 104 normal controls with negative autoantibody sera. Depressed subjects exhibited significantly higher APSA and APTA antibody titers compared with normal controls. A large number of depressed subjects (± 54%) showed APTA and APSA positivity, defined as BI≥2 standard deviations above the mean BI of normal controls. There was a significant discrimination (≥2.8 standard deviations) between melancholic subjects and healthy controls with respect to BI of ACA, APSA and APTA. However, by using a more conservative value for phospholipid positivity (i.e., BI≥5 standard deviations above the mean BI of a reference sample of normal sera), the subject's autoantibody titers were, on the whole, within the normal range. Our results point towards a higher expression of antiphospholipid antibodies during depression but a much lower incidence of positive patients than in classical autoimmune disorders, such as systemic lupus erythematosus.
Treatment of obsessive‐compulsive disorder by psychosurgery
Authors: Hay P. , Sachdev P. , Cumming S. , Smith J. S. , Lee T. , Kitchener P. , Matheson J.
Published: August 2007

We report a longitudinal study of 26 patients with medically intractable obsessive‐compulsive disorder (OCD) who were treated with psychosurgery and had a comprehensive follow‐up for a mean 10 years. Seventeen patients had combined orbitomedial and cingulate lesions, 6 cingulate lesions only and 3 orbitomedial lesions only. Eighteen patients were interviewed personally and lesions verified on magnetic resonance imaging scans in fourteen. On a 6‐point global rating scale, 10 (38%) patients had obvious improvement, another 6 (23%) showed mild improvement of doubtful clinical value, and the remaining 10 showed either no change (n= 6; 23%) or were judged to be worse (n= 4; 15%). Both obsessive and compulsive symptoms improved, and this change was independent of the changes in anxiety and depression scores. No significant predictors of improvement were identified. Patients with cingulate lesions only fared worse. Eight patients who had a second operation did not show much improvement. A comparison of a subgroup of patients with 10 matched nonsurgical OCD controls supported the contention that the improvement in OCD was attributable to the psychosurgery. Important adverse effects in the stereotactic surgery group (n= 20) were epilepsy (1 patient) and personality change (2 patients). The psychosurgery group performed relatively poorly on the Wisconsin Card Sort Test but did not show any deterioration in Wechsler Intelligence and Memory scores.
Clinical, endocrine and neurochemical effects of moclobemide in depressed patients
Authors: Alevizos B. , Hatzimanolis J. , Markianos M. , Stefanis C. N.
Published: August 2007

The clinical efficacy of the monoamine oxidase A inhibitor moclobemide and its effect on the dexamethasone suppression test (DST) and plasma and urine methoxyhydroxyphenylglycol (MHPG) were investigated in 26 depressed patients during a 4‐week clinical trial. Fourteen patients (54%) responded favourably to the treatment (50% or more reduction of the Hamilton Rating Scale for Depression score). All (8) patients with an abnormal DST responded to treatment; 11 of 16 patients with a normal DST did not respond. Patients with low pretreatment MHPG excretion, according to the median value, were more frequently treatment responders. Plasma and urine MHPG were significantly decreased by treatment. The results indicate that low excretion of MHPG and cortisol nonsuppression may be considered as predictors of favourable clinical response to moclobemide treatment.
Two‐year stability of self‐reported problems in an epidemiological sample of adolescents
Authors: Verhulst F. C. , van Wattum P. J.
Published: August 2007

This study investigated the stability and change of problems reported by adolescents during a 2‐year period. An epidemiological sample of 580 adolescents aged 11–16 at the initial assessment completed the Youth Self‐Report on two occasions. We found high stability in the level of Youth Self‐Report total problem scores. The highest stability was found for aggressive behavior. Problem scores tended to increase across time. This increase was greater for girls than for boys, especially for the somatic complaints syndrome. Of the adolescents who could be regarded as deviant at the initial assessment, 42% could still be regarded as deviant 2 years later.
The anterior pituitary responds normally to protirelin in obsessive‐compulsive disorder: evidence to support a neuroendocrine serotonergic deficit
Authors: Lucey J. V. , Butcher G. , Clare A. W. , Dinan T. G.
Published: August 2007

The prolactin and thyroid‐stimulating hormone (TSH) responses to protirelin and the prolactin and cortisol responses to d‐fenfluramine were measured in 8 outpatients with DSM‐III‐R obsessive‐compulsive disorder (OCD). The results were compared to those in 8 age‐ and sex‐matched healthy controls. The responses to d‐fenfluramine were significantly attenuated in the OCD patients, but there was no significant difference between the responses to protirelin in OCD patients and healthy controls. The data suggest that, in OCD, blunting of prolactin responses to the serotonin‐releasing agent d‐fenfluramine is due to a central abnormality and not due to a pituitary deficit.
Psychotic features and the course of Alzheimer's disease: relationship to cognitive, electroencephalographic and computerized tomography findings
Authors: Förstl H. , Besthorn C. , Geiger‐Kabisch C. , Sattel H. , Schreiter‐Gasser U.
Published: August 2007

Thirty‐one of 50 patients satisfying the NINCDS‐ADRDA criteria of probable or possible Alzheimer's disease showed psychotic features during a 2‐year observation period. Paranoid delusions were reported in 23 patients, delusional misidentification in 17, visual hallucinations in 16 and auditory hallucinations in 8. All of the 7 patients who died within the observation period had suffered from psychotic features even before the preterminal phase of illness. A faster progression of illness towards more severe stages of dementia was associated with paranoid delusions and hallucinations but not with delusional misidentification. We could not prove a significant influence of age, age of onset, cognitive performance, ventricular enlargement or the severity of quantitative electroencephalographic changes at initial examination on the course of illness. This may indicate that specific psychotic features and their potential organic substrate exert an effect on the progression of illness and on survival in Alzheimer's disease, which is not related to gross brain atrophy and generalized neurophysiological changes.
Suicide and attempted suicide reported by general practitioners in Belgium, 1990–1991
Authors: Van Casteren V. , Van der Veken J. , Tafforeau J. , Van Oyen H.
Published: August 2007

In 1990–1991 the Belgian sentinel network of general practitioners recorded suicide and suicide attempts within their practices. The annual attempted suicide rate is estimated at 13.0 cases per 10,000 inhabitants. The highest incidence rates are found among women and young people. The annual suicide rate is estimated at 2.3 cases per 10,000 inhabitants, with the highest rates in men and in elderly people. The highest incidence rates of suicide attempts as well as of suicide are found among divorced people. About 30% of the attempters and committers made at least one earlier attempt. Drug overdose and hanging are the most frequently used methods, respectively when attempting and committing suicide. About 60% of both committers and attempters contacted their general practitioner within a period of 1 month preceding the attempt. Nearly half of the attempters and of the committers were treated for a mental disorder in the year preceding the attempt.
Development of personality disorders in children and adolescents with obsessive‐compulsive disorder A 6‐ to 22‐year follow‐up study
Authors: Thomsen P. H. , Mikkelsen H. U.
Published: August 2007

Forty‐seven people with admissions in childhood for obsessive‐compulsive disorder (OCD) and 49 child psychiatric controls were followed up in young adulthood and assessed for DSM‐III‐R personality disorders with the Structured Clinical Interview for DSM‐III‐R Personality Disorders. The number of personality disorders in OCD patients did not differ significantly from the number in controls. The most common personality disorder was avoidant personality disorder (significantly more frequent than in controls), whereas obsessive‐compulsive personality disorder (OCPD) was not found more often in the OCD group. Subjects with OCD in adulthood seemed to have OCPD more often than childhood OCD patients with no OCD at follow‐up. In the whole group, histrionic personality disorders were more common in women than in men and OCPD more common in men than in women, whereas borderline personality disorder was most common among women in the OCD group. The presence of a personality disorder in adulthood could not be correlated with such childhood factors as social background, symptoms or age of onset of OCD.
Increased soluble interleukin‐2 receptor concentrations in suicide attempters
Authors: Nässberger L. , Träskman‐Bendz L.
Published: August 2007

Several biochemical parameters such as monoamines and corticosteroids are considered to play a role in the underlying pathogenetic mechanisms in mood disorders. It has also been proposed that disturbances of the immune system may be responsible for mental disorders. Increased concentrations of plasma soluble interleukin‐2 receptor (S‐IL‐2R) reflect an activation of T‐lymphocytes. In plasma samples from medication‐free suicide attempters with various psychiatric diagnoses (mainly mood disorders), we found a median S‐IL‐2R concentration far above the range of healthy controls. No sex differences and no differences between diagnostic and suicidal subgroups were noted. In follow‐up samples, the S‐IL‐2R remained at high levels. In cerebrospinal fluid samples from patients, S‐IL‐2R levels were all below 200 U/ml. No samples from controls were available. We were unable to find pronounced associations between plasma S‐IL‐2R and various monoaminergic measures in plasma, 24‐h urine and cerebrospinal fluid. There was, however, a tendency of an association between S‐IL‐2R and the ratio of norepinephrine‐epinephrine in 24‐h urine, as well as plasma and cerebrospinal fluid 4‐hydroxy‐3‐methoxymethylglycol. There was no significant association between post‐dexamethasone plasma cortisol, 24‐h urinary cortisol and plasma S‐IL‐2R. Both when studied as medication‐free inpatients and during follow‐up as outpatients, there were no apparent associations between ratings of psychopathology and plasma S‐IL‐2R. This study clearly shows that an imbalance of the immune system was present in psychiatric patients studied after a suicide attempt. Furthermore, the immune dysfunction, shown as high S‐IL‐2R, seems to be independent of drug therapy.
Dim light melatonin onset and circadian temperature during a constant routine in hypersomnic winter depression
Authors: Dahl K. , Avery D. H. , Lewy A. J. , Savage M. V. , Brengelmann G. L. , Larsen L. H. , Vitiello M. V. , Prinz P. N.
Published: August 2007

The onset of melatonin secretion under dim light conditions (DLMO) and the circadian temperature rhythm during a constant routine were assessed in 6 female controls and 6 female patients with winter depression (seasonal affective disorder, SAD) before and after bright light treatment. After sleep was standardized for 6 days, the subjects were sleep‐deprived and at bedrest for 27 h while core temperature and evening melatonin levels were determined. The DLMO of the SAD patients was phase‐delayed compared with controls (2310 vs 2138); with bright light treatment, the DLMO advanced (2310 to 2135). The minimum of the fitted rectal temperature rhythm was phase‐delayed in the SAD group compared with the controls (0542 vs 0316); with bright light treatment, the minimum advanced (0542 vs 0336).
A second labour market?
Authors: Eikelmann B. , Reker T.
Published: August 2007

In Germany, the vocational rehabilitation of chronically mentally ill people is concentrated on the sheltered labour market, supplemented by special programmes for the care and reintegration of mentally ill people on the open labour market. Our investigation covered 502 representatively selected patients in sheltered employment (outpatient work therapy, firms for mentally ill people, workshops for the disabled). The sociodemographic, anamnestic and psychopathological data reveal that these are chronically mentally ill people with significant disabilities, making comprehensive social care and psychiatric treatment essential. Most of the subjects intend to remain in sheltered employment; only 20% hope to change to the open labour market. The level of subjective job satisfaction is surprisingly high despite generally inadequate pay, though it has to be pointed out that many long‐term patients are presumably resigned to their circumstances. In conclusion, the relationship of the open labour market to sheltered employment is the subject of critical discussion.
Predicting the long‐term outcome of affective disorders
Authors: Deister A. , Marneros A.
Published: August 2007

Factors influencing the long‐term outcome of affective disorders were investigated in 106 patients with an average length of course of 28 years. Univariate statistical analyses, stepwise multiple discriminance analyses and path analysis were applied. A direct unfavourable influence on the frequency of persisting alteration (evaluated according to the Global Assessment Scale) was found to have the low self‐confident premorbid personality and a higher number of episodes during course, whereas only the variable “male” had such an influence on the social consequences of the illness. The variable “manic episode” (bipolarity) and “age at onset” had only an indirect influence, in that bipolar patients had more episodes, and younger patients more frequently had a bipolar course and therefore had more episodes. The unfavourable long‐term outcome was due in those cases to the higher number of episodes.
Pathways to psychiatric care in Cantabria
Authors: Vázquez‐Barquero J. L. , Castanedo S. Herrera , Artal J. A. , Nuñez J. Cuesta , Gaite L. , Goldberg D. , Sartorius N.
Published: August 2007

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service‐related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establishe first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.
Cooperatives as a social enterprise in Italy: a place for social integration and rehabilitation
Authors: Savio M. , Righetti A.
Published: August 2007

This article analyses the history and development of an integrated cooperative established in 1981 in northern Italy. Integrated cooperatives, otherwise known as social enterprises, are among the most interesting activities developed in the area of social assistance and rehabiliation in recent years in Italy. In particular, they acquired relevance in the care of mentally disordered people by providing them with job opportunities, which is an important rehabilitative and integrative factor. The aim of social enterprises is two‐fold. They have the economic goal of offering remunerative work just as any other commercial enterprise, as well as the social mandate of promoting the physical, social, and mental health of their members. A positive coexistence between market competition and rehabilitation is therefore constantly pursued. This research aimed at analysing the working and social experience of people employed by the cooperative during its 10‐year life. The study was limited to those who had a social or health problem when entering the cooperative. The investigation was promoted by cooperative members, who felt the need to document their experience and to undertake initiatives towards evaluating the rehabilitative value of the social enterprise. The results show that cooperative members come from different marginalized areas of social and health distress, of which the two largest are social service users and psychiatric service users. There is a noticeable turn‐over rate, which underlines one function of the cooperative as being a transitional working context from which users can gain access to other more rewarding job opportunities in the labour market.
Daytime consumption of triazolam
Authors: Martínez‐Cano H. , Vela‐Bueno A.
Published: August 2007

Six cases of daytime use of triazolam are reported. In all cases, daytime anxiety following the night‐time use of this short‐acting, high‐potency hypnotic benzodiazepine led to the use of the drug during the day. Tolerance to the hypnotic and anxiolytic effects of the drug developed, as shown by a significant escalation of both the bedtime and daytime doses.
Lithium augmentation in sertraline‐resistant depression: a preliminary dose‐response study
Authors: Dinan T. G.
Published: August 2007

Eleven patients with DSM‐III‐R major depression who were treatment‐resistant to sertraline were allocated for lithium augmentation therapy. In conjunction with their sertraline, 6 received lithium carbonate 400 mg at night and 5 received 800 mg at night. A total of 7 patients responded within 1 week. The degree of response was not related to the serum lithium level. Patients with lithium levels as low as 0.3 mEq/l responded. No significant side effects were reported.
The impact of availability, attraction and lethality of suicide methods on suicide rates in Germany
Authors: Wiedenmann A. , Weyerer S.
Published: August 2007

Substantial fluctuations have prevailed in both the rate and particular methods of suicide in the Federal Republic of Germany during the past 40 years. The current study examines the extent to which the availability, attraction and lethality of particular methods of suicide affect suicide rates. A close relationship existed in the period from 1949 and 1989 between the peaks of the suicide rate and the percentage of low threshold suicide methods according to De Catanzaro, whereby suicide in this context is understood to mean suicide by shooting or intake of solid, liquid or gaseous poisons. Our hypothetically expected lesser compensation between high and low threshold methods for women was confirmed. Between 1963 and 1976 the rate of suicide committed using domestic gas receded dramatically. Within the same period, however, the rate of suicide committed using other poisons rose accordingly.
Suicide rate, prevalence of diagnosed depression and prevalence of working physicians in Hungary
Authors: Rihmer Z. , Rutz W. , Barsi J.
Published: August 2007

Based on the well‐known relationship between depression and suicide, we investigated the regional distribution of the suicide rate, rate of diagnosed depression and prevalence of working physicians in Hungary. A strong significant positive correlation was found between the rate of working physicians and rate of diagnosed depression, and both parameters showed a strong significant negative correlation with the suicide rate. The more physicians per 100,000 inhabitants, the better is the recognition of depression and the lower is the suicide rate in the given region. The rate of working doctors was significantly higher in the counties located in western Hungary, which may have a role in the lower suicide mortality in this area of the country.
The schizophrenia high‐risk project in Copenhagen: three decades of progress
Authors: Cannon T. D. , Mednick S. A.
Published: August 2007

We describe the design, theoretical approach and major recent findings of a prospective longitudinal study of the offspring of schizophrenic mothers and controls, initiated in 1962 by Sarnoff Mednick and Fini Schulsinger in Copenhagen, Denmark. Over 90% of the original 207 high‐risk and 104 low‐risk subjects have been successfully followed up since the initial assessment. At the time of the most recent assessment (1989), the subjects averaged 42 years of age and were nearly completely through the risk period for developing schizophrenia. By relating the lifetime psychiatric diagnoses of the subjects back to information on their premorbid experiences and functioning, we have identified several precursors of schizophrenia. This paper reviews our recent findings concerning whether outcomes of schizophrenia that differ in the relative prominence of negative versus positive symptoms represent discrete longitudinal syndromes. Predominantly negative and predominantly positive symptom schizophrenia were found to follow different patterns of symptom development from adolescence through the adult course of illness and were predicted by different combinations of genetic and environmental influences. Taken together, the findings suggest that the pathological processes underlying these two forms of schizophrenia are 1) partly independent of each other, 2) at least partly active during the premorbid state and 3) to some degree stable in the adult course of illness.
Death due to overdose of antidepressants: experiences from Norway
Authors: Retterstøl N.
Published: August 2007

During the last 20 years the suicide rate in Norway has doubled. This also applies to suicide by intoxication. Antidepressants comprise a constantly increasing part of the intoxication means used in suicides, as demonstrated in this article. The tricyclic antidepressants amitriptyline and doxepin, the most commonly used antidepressants in Norway, are also the two leading antidepressants causing death by intoxication. Less toxic antidepressants should be prescribed whenever possible.
Regional cerebral blood flow in affective disorder
Authors: Bolwig T. G.
Published: August 2007

The results of two‐dimensional cerebral blood flow (CBF) studies in depression and the results of measurements of regional CBF (rCBF) using single photon emission computerized tomography (SPECT) are briefly reviewed. A technical outline of both types of method is described. The majority of SPECT studies point to a decreased CBF in untreated patients with a tendency towards normalization, but other studies suggest that, following treatment, there is an increase above normal either from a decreased or an abnormally high initial level. One study has pointed to unipolar patients having lower flow in the right temporal and parietal lobes relative to normals, whereas non‐endogenous patients did not differ significantly from normal controls. Bipolar depressives have been found to have higher flow values than normals in the parietal and temporal lobes in the left hemispheres. This relevant aspect or a possible relationship between type of depression and hemispheric asymmetry needs further study for full classification. Thus, most investigations designed to determine which brain structures might be involved in regulating affect have not been very successful, which may be a consequence of the biological heterogeneity of these disorders or of the limited spatial resolution of the techniques used for investigation. Even if some of these technical difficulties can be overcome with measurements of receptor kinetics supplemented, other biological variables that have proved valuable in psychiatry (such as rapid eye movement latency and biogenic amines) should be studied to find more precise biological markers for depressive illness.
Organic Mental Disorders as Hypothetical Pathogenetic Processes
Authors: Lindqvist G. , Malmgren H.
Published: August 2007

A new diagnostic system for organic psychiatry is presented. We first define “organic psychiatry”, and then give the theoretical basis for conceiving organic‐psychiatric disorders in terms of hypothetical psychopathogenetic processes, HPP:s. Such hypothetical disorders are not strictly identical to the clusters of symptoms in which they typically manifest themselves, since the symptoms may be concealed or modified by intervening factors in non‐typical circumstances and/or in the simultaneous presence of several disorders. The six basic disorders in our system are Astheno‐Emotional Disorder (AED), Somnolence‐Sopor‐Coma Disorder (SSCD), Hallucination‐Coenestopathy‐Dcpersonalisation Disorder (HCDD), Confusional Disorder (CD), Emotional‐Motivational Blunting Disorder (EMD) and Korsakoff's Amnestic Disorder (KAD). We describe their usual etiologies, their typical symptoms and course, and some forms of interaction between tliem.