Suicide attempts in antisocial alcoholics

The dual diagnoses of alcoholism and antisocial personality are frequently associated with suicide attempts. A group of 94 alcoholics with antisocial personality were divided on the basis of a previous suicide attempt. A variety of symptoms, including depression, alcohol and drug abuse, conduct disorder, and violence were found more frequently in the suicide attempter group as reported on the structured interview. These emotional problems were additionally found to have an earlier onset. The results were consistent with the concept of secondary sociopathy and indicated that higher psychopathology may be associated with suicide behavior.     

The clinical implications of primary diagnostic groups among alcoholics

Interviews with patients and two resource persons were used to determine primary psychiatric diagnoses in 577 consecutive men entering an alcohol treatment program (ATP) at a veterans hospital. Twelve months later, about 95% of the sample were successfully followed up with a patient and resource person interview to establish the clinical course over the year for the four most populous diagnostic subgroups. At intake into the treatment program, the 432 group 1 primary alcoholic men were older, had a later age at onset of alcoholism, demonstrated a lower intensity of drinking, had fewer antisocial problems, and used fewer categories of drugs than the 60 men in group 2 with primary drug abuse and the 40 men in group 3 with primary antisocial personality disorder. During the follow-up, men in groups 2 and 3 had a greater likelihood of drug use, more police and social problems, and demonstrated higher (more adverse) outcomes on a clinical outcome scale. The nine group 4 men with primary affective disorder at intake demonstrated an increased risk for past suicide attempts and psychiatric care and had a higher rate of affective disorder in first-degree family members. These findings underscore the importance of distinguishing between symptoms (eg, sadness or antisocial problems) and diagnoses and the need to establish primary and secondary labels in substance abusers.     

Psychiatric disorders in relatives of probands with opiate addiction

Previous research has documented high rates of major depression and antisocial personality in opiate addicts. This study was designed to investigate the relationship of dual diagnosis in opiate-addicted probands to family history of psychiatric disorders and substance use disorders in biological relatives. Psychiatric disorders and substance use disorders were evaluated using direct interview and family history in a sample of 877 first-degree relatives of 201 opiate addicts and 360 relatives of 82 normal controls. Results indicate that (1) compared with relatives of normal subjects, opiate addicts' relatives had substantially higher rates of alcoholism, drug abuse, depression, and antisocial personality; (2) relatives of depressed opiate-addicted probands had elevated rates of major depression and anxiety disorders but not of other disorders, suggesting the validity of subtyping opiate addicts by the presence or absence of major depression; and (3) in contrast, relatives of antisocial opiate addicts had rates of disorders that were not significantly different from those of relatives of opiate addicts without antisocial personality. Implications of these findings for the classification and treatment of substance abuse are discussed.     

Psychiatric diagnoses of treatment-seeking cocaine abusers

In a sample of 298 cocaine abusers seeking inpatient (n = 149) or outpatient (n = 149) treatment, rates of psychiatric disorders were determined by means of the Schedule for Affective Disorders and Research Diagnostic Criteria. Overall, 55.7% met current and 73.5% met lifetime criteria for a psychiatric disorder other than a substance use disorder. In common with previous reports from clinical samples of cocaine abusers, these overall rates were largely accounted for by major depression, minor bipolar conditions (eg, hypomania, cyclothymic personality), anxiety disorders, antisocial personality, and history of childhood attention deficit disorder. Affective disorders and alcoholism usually followed the onset of drug abuse, while anxiety disorders, antisocial personality, and attention deficit disorder typically preceded drug abuse.     

The role of psychiatric disorders in predicting drug dependence treatment outcomes

OBJECTIVE: Previous research has demonstrated that psychiatric disorders are common among people who abuse alcohol and drugs, but few studies have examined the relationship of psychiatric disorders to drug treatment outcome. The authors conducted such an examination. METHOD: They successfully reinterviewed 401 drug-dependent subjects (94% of the baseline in-treatment sample) and determined their drug abuse status at follow-up 12 months later. RESULTS: Analyses indicated that several baseline psychiatric disorders predicted worse outcomes at follow-up. Major depression predicted using a larger number of substances and having more drug dependence diagnoses and symptoms. Alcohol dependence predicted more dependence diagnoses, antisocial personality disorder predicted using a larger number of substances, and generalized anxiety disorder predicted having more dependence diagnoses. Outcomes among men were more closely associated with psychiatric status than outcomes among women, except for phobias, which predicted a better outcome among women. CONCLUSIONS: These results are unique in their assessment of individuals dependent on illicit substances. Overall, the authors found that women with phobias had better outcomes and that men with psychiatric disorders in general, men with major depression, and men with antisocial personality disorder had worse outcomes.     

Post-traumatic stress disorder in HIV-positive incarcerated women

The primary objective of this study was to examine a sample (n = 81) of HIV-positive incarcerated women to compare those with and those without a diagnosis of lifetime post-traumatic stress disorder (PTSD) with respect to demographics and legal, psychiatric, and health utilization histories. A secondary objective was to describe the prevalence of psychiatric disorders in the sample. Eighty-one women were interviewed with the Structured Clinical Interview for DSM-IV (SCID-P), SCID II, and the Clinician Administered Post-traumatic Stress Scale for DSM-IV (CAPS). Women with lifetime PTSD (n = 60) were more likely than those without (n = 21) to be white or Hispanic and to have a history of arrests for prostitution, risky sexual behavior, and intravenous drug use. Women with lifetime PTSD were also more likely to have had outpatient psychiatric treatment, treatment with psychiatric medications, suicide attempts, lifetime cannabis abuse/dependence, lifetime major depression, and antisocial personality disorder. These results suggest that HIV-positive female inmates with lifetime PTSD are a complex population who are likely to need careful psychiatric assessment, and medical and mental health treatment.     

Psychiatric and medical diagnoses as risk factors for mortality in psychiatric patients: a case-control study

On the basis of a case-control study, the authors conclude that former psychiatric inpatients are more likely than control subjects to die of both natural and unnatural causes within 2 years of discharge. Patients who committed suicide were more likely to have had a diagnosis of affective disorder (unipolar depression) or alcoholism. Those who died of natural causes were more likely to have been admitted with medical diagnoses; no specific psychiatric diagnoses were associated with these deaths. It is doubtful that medical illnesses caused psychiatric syndromes such as depression in these inpatients. Psychiatric and medical illnesses combined may increase a patient's likelihood of seeking psychiatric help and entering the hospital.     

Solvent use as a precursor to intravenous drug abuse

Intravenous drug abuse (IVDA) is a significant public health threat, and ways of identifying individuals at high risk for IVDA are needed to plan strategies for intervention and treatment. Previous work had identified similarities in psychiatric diagnosis and patterns of drug use in IVDAs and solvent users. Using the same population, we found that 59 of 179 IVDAs (33.0%) reported a history of solvent use, which preceded the onset of IVDA in 41 of the 59. IVDAs with a history of solvent use were more likely to receive diagnoses of alcoholism and antisocial personality disorder (ASP) than IVDAs without solvent use. Even allowing for these coexisting psychiatric disorders, a reported history of solvent use increased the likelihood of also reporting IVDA by a factor of 3.2. Although the magnitude of risk is likely to differ in other populations, a history of solvent use may indicate individuals at high risk for IVDA, and youths who have used solvents should be considered at high risk for severe drug abuse, including IVDA.     

Suicide attempts and clinical risk factors in patients with bipolar and unipolar affective disorders

Background

Suicide is an important clinical problem in psychiatric patients. The highest risk of suicide attempts is noted in affective disorders.

Objective

The aim of the study was to look for suicide risk factors among sociodemographic and clinical factors, family history and stressful life events in patients with diagnosis of unipolar and bipolar affective disorder (597 patients, 563 controls).

Method

In the study, the Structured Clinical Interview for DSM-IV Axis I Disorders and the Operational Criteria Diagnostic Checklist questionnaires, a questionnaire of family history, and a questionnaire of personality disorders and life events were used.

Results

In the bipolar and unipolar affective disorders sample, we observed an association between suicidal attempts and the following: family history of psychiatric disorders, affective disorders and psychoactive substance abuse/dependence; inappropriate guilt in depression; chronic insomnia and early onset of unipolar disorder. The risk of suicide attempt differs in separate age brackets (it is greater in patients under 45 years old). No difference in family history of suicide and suicide attempts; marital status; offspring; living with family; psychotic symptoms and irritability; and coexistence of personality disorder, anxiety disorder or substance abuse/dependence with affective disorder was observed in the groups of patients with and without suicide attempt in lifetime history.     

Lifetime prevalence and age of onset of psychiatric disorders: recall 4 years later

The blind test-retest reliability of lifetime prevalence and age of onset of psychiatric diagnoses, based on the SADS-L interview and RDC over a three-to-five year period, was examined in 143 probands and their relatives. Reliability of lifetime prevalence of major depression was excellent; reliability of antisocial personality, panic disorder, drug abuse, GAD, depressive personality, and alcoholism was good; reliability of obsessive-compulsive disorder and phobia was acceptable but lower. The reliability of hyperthymia or cyclothymia was not acceptable. Reliability for major depression did not vary substantially by age or sex of the informant, but recall of major depression was significantly higher in the probands than in their relatives. The test-retest reliability for the age of onset of major depression and panic disorder was excellent, and for phobia, GAD and alcoholism, was acceptable. Both probands and relatives recalled the age of onset of their depression fairly accurately. However, there was a reduction in agreement over time. Recall after 3-4 yr was better than 5-6 yr. There was a tendency for older respondents to systematically increase the age of onset of their depression across the two interviews, although the increase was only a few years. Recall of age of onset did not differ significantly by sex of respondent or whether the respondent was a proband or relative. These findings are discussed in light of several available studies of reliability of lifetime prevalence of psychiatric diagnoses.     

Gender differences in firesetting: results from the national epidemiologic survey on alcohol and related conditions (NESARC)

This study presents gender differences in sociodemographics and in psychiatric correlates of firesetting in the United States. Data were derived from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC), a representative sample of U.S. adults. Face-to-face interviews of more than 43,000 adults were conducted in the 2001-2002 period. This study focused on the 407 subjects with a lifetime history of firesetting. The prevalence of lifetime firesetting in the U.S. was 1.7% in men and 0.4% in women. Firesetting was significantly associated with a wide range of antisocial behaviors that differed by gender. Multivariate logistic regression analyses indicated associations in both genders with psychiatric and addictive disorders. Men with a lifetime history of firesetting were significantly more likely than men without such history to have lifetime generalized anxiety disorder as well as a diagnosis of conduct disorder, antisocial personality disorder, alcohol or cannabis use disorder, and obsessive-compulsive personality disorder. Women with a lifetime history of firesetting were significantly more likely than women without such history to have lifetime alcohol or cannabis use disorder, conduct disorder, and antisocial or obsessive compulsive personality disorder, as well as psychotic disorder, bipolar disorder or schizoid personality disorder. Women with a lifetime history of firesetting were significantly more likely than men with such history to have a lifetime diagnosis of alcohol abuse and antisocial personality disorder as well as a diagnosis of schizoid personality disorder. Our findings indicate that firesetting in women could represent a behavioral manifestation of a broader spectrum than firesetting in men.     

Psychiatric disorders among individuals who drive after the recent use of alcohol and drugs

IntroductionThis cross-sectional study assessed the prevalence of psychiatric disorders among drivers, as well as the association between recent alcohol and drug use and psychiatric diagnoses using telephone interviews.MethodsDrivers (n = 1,134) included in a roadside survey from 25 Brazilian state capitals were given a breathalyzer test, and their saliva was tested for psychoactive drugs. A telephone interview was conducted to perform psychiatric disorder evaluations using the MINI. This association was analyzed with a Poisson regression model.ResultsThe prevalence of any psychiatric disorder was 40.5% among drivers with recent alcohol or drug use, compared with 12.9% among the other drivers. Alcohol/drug-positive drivers reported a higher prevalence of depression (19.4%), mania (6.5%), hypomania (5.4%), post-traumatic stress disorder (8.6%), antisocial personality (7.8%), and substance/alcohol abuse or dependence (48.1%) compared with other drivers (3.5, 2.5, 2.1, 0.5, 1.3 and 18.3% [p < 0.001], respectively). Drivers with recent alcohol or drug use were 2.5 times more likely to have a psychiatric diagnosis (CI: 1.8-3.6, p < 0.001).DiscussionThis is the first study in a low-/middle-income country to evaluate psychiatric disorders in drivers with recent alcohol or drug using telephone interviews. Psychiatric disorders were found to be associated with drug and alcohol use. This type of epidemiological information for curtailing related driving problems, as these psychiatric conditions are diagnosable.Final RemarksThe results of this study can aid in the design of interventions, treatment programs and focused psychiatric evaluations, both in Brazil and abroad.     

The association of psychiatric diagnosis with weather conditions in a large urban homeless sample

Assessment of psychiatric disorders encounters unique complexities in homeless populations. Although the use of structured diagnostic instruments has significantly improved research methodology in this area, questions remain about the validity of using cross-sectional diagnostic methods derived from studies of more general populations. In particular, the validity of structured diagnostic instruments in the assessment of schizophrenia, depression, drug use disorder, and antisocial personality disorder (ASPD) in homeless populations has been questioned. The purpose of this study was to examine the association of psychiatric diagnoses with the weather. It was hypothesized that self-report of psychiatric illness may be affected by prevailing weather conditions. Nine hundred homeless subjects randomly sampled from St. Louis shelters, day centers, and unsheltered locations were interviewed over a 1-year period. Official average daily temperature and amount of precipitation on the day of each subject's interview were compared with lifetime and current psychiatric diagnoses ascertained by the Diagnostic Interview Schedule. Similar analyses were performed in general population data from the Epidemiologic Catchment Area study. The study found that among homeless men, inclement weather on the day of interview was associated with lifetime and current diagnoses of major depression, lifetime drug use disorder, lifetime diagnosis of ASPD, and current alcohol use disorder. These findings, however, were not present in homeless women and not reflected in the general population. The results, although limited, suggest that weather may confound cross-sectional, standardized methods of psychiatric diagnosis in homeless men. Weather-related factors among homeless men are associated with ascertainment of both lifetime and current diagnosis of major depression, as well as lifetime drug use disorder and ASPD and current alcohol use disorder. Possible interpretations of these findings are discussed, with implications for intervention strategies for psychiatric disorders in the larger context of homelessness and social problems. “Rainy days and Mondays always get me down...” The Carpenters, 1971 Accepted: 30 October 1997     

Psychiatric disorders and crime: a study of pretrial psychiatric examinations.

A study of 50 consecutive individuals referred for pretrial psychiatric examination, presumably because of previous psychiatric hospitalization (82 percent), indicated that antisocial personality, alcoholism, or drug dependence was present in 80 percent. Schizophrenia or bipolar affective disorder was seen in about a third of the subjects, usually associated as well, however, with antisocial personality, alcoholism, or drug dependence. There were no significant differences in index crime between those with or without schizophenia bipolar affective disorder. It is concluded that the latter conditions occur in no more than two or three per cent of all felons.     

On mental disorder and somatic disease in suicide: A psychological autopsy study of 100 suicides in northern Sweden

Suicide is strongly correlated to mental disorders. In several studies up to more than 90% of the deceased could be given psychiatric diagnoses. The aim of this study is to account for psychiatric and somatic disorders in suicide and to discuss their relation to the suicide and the implications for preventive work. One hundred consecutive cases of suicide in Va¨sterbotten County, 25 women and 75 men, were investigated by means of telephone interviews with close relatives, police reports, psychiatric and other medical records, and data from the forensic investigation. In 96% at least one axis-I diagnosis according to DSM-III-R was found. The most common psychiatric disorders were mood disorders (63%), psychoactive substance use disorders (37%), and personality disorders (22%). Two-thirds of the subjects had one or more somatic disorder of significance for the case. In 50% of the cases two or more psychiatric diagnoses could be given. Schizophrenic subjects died on average 14 years after their first psychiatric contact, at a mean age of 36 years, whereas subjects with major depression died on average 4 years after their first contact, at 55 years. The finding that 96% of the deceased had at least one mental disorder and a high occurrence of somatic disorders is interpreted as a severe increase in the burden of the person, which restricts his/her ability to satisfy vital dependency needs. The issue of specific personality characteristics in suicide should be further investigated.     

Characteristics of alcoholics who attempt suicide

Of 298 alcoholic subjects studied by the authors, 19% (N = 57) had attempted suicide. Compared with nonattempters, suicide attempters were significantly more likely to be female, to have a lower socioeconomic status, to be younger, to have begun heavy drinking and experienced the onset of alcohol-related problems at an earlier age, to consume a greater amount of alcohol when drinking, and to have additional lifetime psychiatric diagnoses of major depression, antisocial personality disorder, substance abuse, panic disorder, phobic disorder, or generalized anxiety disorder. Also, significantly more attempters had first- or second-degree relatives who abused alcohol.     

Informant disagreement for separation anxiety disorder

OBJECTIVE: To characterize informant disagreement for separation anxiety disorder (SAD). METHOD: The sample comprised 2,779 8- to 17-year-old twins from a community-based registry. Children and their parents completed a personal interview about the child's psychiatric history. Parents completed a personal interview about their own psychiatric history and a questionnaire about their marital relationship. RESULTS: Informant agreement for SAD ranged between chance and extremely poor. Most cases of SAD were diagnosed by interview with only one informant. SAD diagnosed only by child interview was associated with an increased odds of father-rated oppositional defiant disorder, and vice versa. SAD diagnosed only by parent interview was predicted by the parental informant's history of antisocial personality disorder. SAD diagnosed only by paternal interview was also predicted by mother-rated marital conflict and dissatisfaction. CONCLUSIONS: Parents and children rarely agree about the presence of any level of child separation anxiety. A symptom "or-rule" mostly indexes diagnoses based on interview with only one informant, but the relative validity of such diagnoses remains unclear.     

Dissociative disorders and suicidality in psychiatric outpatients

Although it is common for patients with dissociative disorders to report a history of suicide attempts, there is very little data systematically comparing suicidality in patients with dissociative disorders versus patients without these disorders. The subjects in our study were 231 patients consecutively admitted to an inner-city, hospital-based outpatient psychiatric clinic. Eighty-two of these patients completed structured interviews for dissociative disorders, borderline personality disorder, and trauma history (dissociative disorders interview schedule) and for posttraumatic stress disorder and substance abuse (Structured Clinical Interview for DSM-IV). Patients receiving a dissociative disorder diagnosis were compared with nondissociative patients on measures of self-harm and suicidality. Presence of a dissociative disorder was strongly associated with all measures of self-harm and suicidality. When we focused on patients with a history of multiple suicide attempts, significant associations were found between several diagnoses (dissociative disorder; borderline personality disorder; posttraumatic stress disorder; alcohol abuse/dependence) and multiple suicide attempter status. When these diagnoses were entered in a logistic regression, a highly significant association remained for dissociative diagnosis and multiple suicide attempter status (odds ratio, 15.09; 95% confidence interval, 2.67-85.32; p = 0.002). Dissociative disorders are commonly overlooked in studies of suicidality, but in this population they were the strongest predictor of multiple suicide attempter status.     

Lifetime rhythmicity and mania as correlates of suicidal ideation and attempts in mood disorders

BACKGROUND: The aim of this study is to establish to what degree variation in lifetime experience of rhythmicity and manic-hypomanic features correlates with suicidality in individuals with mood disorders and other major psychiatric diagnoses and in a comparison group of controls. METHOD: Suicidal ideation and attempts were investigated in a clinical sample, including 77 patients with schizophrenia, 60 with borderline personality disorder, 61 with bipolar disorder, 88 with unipolar depression, and 57 with panic disorder, and in a comparison group of 102 controls. Using information derived from the diagnostic interview and a self-report assessment of mood spectrum symptoms, subjects were assigned to 3 categories according to the maximum level of suicidality achieved in the lifetime (none, ideation/plans, and suicide attempts). The association of categorical and continuous variables with suicidality levels was investigated using multinomial logistic regression models. RESULTS: Suicidal ideation and plans were more common in unipolar depression (50%) and bipolar disorder (42.4%) than in borderline personality disorder (30%), whereas the reverse was true for suicidal attempts. In each of the study groups, the number and the type of mood spectrum items endorsed, including depressive and manic-hypomanic items and rhythmicity and vegetative symptoms, were associated with increased levels of suicidality. CONCLUSIONS: Our results suggest that the assessment of lifetime rhythmicity and manic-hypomanic features may be clinically useful to identify potential suicide attempters in high-risk groups.     

Psychopathy and Axis I and Axis II psychiatric disorders in a forensic psychiatric population in Sweden

The relationship between psychopathy and mental disorders was investigated in 61 male subjects during a forensic psychiatric examination. The Psychopathy Checklist Revised (PCL-R) and the Structured Clinical Interview for DSM-III-R (SCID) were used for the assessments. Although psychotic subjects were excluded, the overall psychiatric morbidity in the study population was high. Comorbidity was common, irrespective of the degree of psychopathy. Psychopathy was strongly positively correlated with substance abuse/dependence but negatively correlated with depression. Almost all of the subjects with high PCL-R scores had DSM-III-R antisocial and/or borderline personality disorders. However, some subjects with antisocial personality disorders had medium or low PCL-R scores. When the subjects were reassessed with diagnoses of DSM-IV and ICD-10 personality disorders, the difference between psychopathy and antisocial personality disorder was reduced.