Suicide among soldiers and young men in the Nordic countries 1977-1984

A comparison of suicide rates among soldiers and civilians in the Nordic countries during the 8-year period 1977-1984 revealed that suicides among soldiers were more frequent in Norway than in Sweden and Finland. An in-depth study of the suicides of Norwegian soldiers during the same time period points to selection procedures and distance from home to the soldier's duty camp as possible causal factors. The suicides were frequently precipitated by an acute crisis. Preventive measures are discussed.     

Homicide in the Nordic countries

This article reviews and assesses previous studies of homicide in the Nordic countries and compares the main findings with those from other countries. In spite of the relative sparsity of data, the nature of the available information allows a reasonably reliable comparison to be made between different Nordic countries. Although findings from separate studies vary somewhat, some general trends have been noticed and seem to apply to most of the countries in question: in particular, changes that have occurred over the last 2 decades. Thus, all the Nordic countries have experienced an increase in homicide incidence during this period, and with some notable exceptions, this increase has been quite drastic. Certain other trends have been observed, such as the prominent role of alcoholism and drug abuse in homicide offences, as well as the relative increase in nondomestic offences. Homicide followed by suicide has decreased proportionately among males, whereas this trend has not occurred to the same extent among females, who are more frequently involved in domestic homicide. Methods of homicide have also varied somewhat during the last few decades. The case of homicide in Greenland is discussed separately in view of its special circumstances. Studies dealing with the various psychiatric and mental health problems related to homicide in the Nordic countries are discussed and a hypothesis is offered about possible sociocultural factors, in particular alcohol and drug abuse, that seem to be important.     

Therapeutic results in brief-interval unilateral ECT.

The study reported comprised 104 patients with endogenous depression who were given unilateral electroconvulsive therapy (ECT). The patients were divided into two equally large groups, one receiving two and the other four treatments per week. The latter group was selected openly, while the former had been collected by a double-blind technique on a previous occasion. The severity of depression was assessed before the first treatment and on the days after the sixth and the last treatment, and at these times memory testing by WMS Forms I and II and EEG were also performed. An analysis is presented of the therapeutic effect obtained, assessed by: (1) the number of treatments applied in the two groups; (2) the reduction in the depression score; and (3) the effect achieved per treatment. In the group with frequent electrostimulation one to two addititional treatments were required, the difference being statistically significant. On the other hand, frequent stimulation tended to be more effective in terms of the reduction in the depression score. The effect per treatment was identical in the two groups. Four treatments per week did not result in a higher frequency of complications. A comparison of the five severest depressions in each of the two groups did not reveal any difference in the therapeutic effect of the two methods of treatment. It is concluded that the technique with four treatments per week instead of two offers the advantage that the duration of the treatment period is reduced by 11-12 days. As the study also revealed that the discomforts, including memory impairment, are not increased by frequent stimulation, it is recommended that unilateral ECT is administered with a frequency of four treatments per week.     

Evaluation of the combination of tryptophan and ECT in the treatment of depression. II. Biochemical analysis.

Book reviews in this article: Hirsch, H. (ed.): The family. Klawans, H. L. (ed.): Clinical neuropharmacology, Vol. 1. W. L. Linford Rees: A short textbook of psychiatry, 2nd ed. Kaplan, A. R. (ed.): Human behavior genetics.     

Electroconvulsive therapy: A review of knowledge,experience and attitudes of patients concerning the treatment

Abstract

Objectives. Despite its proven efficacy and safety, electroconvulsive therapy (ECT) has a negative image and attracts widespread public criticism. In contrast, perceptions of patients who have received ECT appear to be more favourable. This review intended to encapsulate the evidence on knowledge and views concerning ECT among its recipients. Methods. Extensive electronic and manual searches were conducted to identify all relevant studies on the subject. Results. Seventyfive reports were found suitable. The evidence from these studies suggested that patients undergoing ECT were usually poorly informed about it. This was attributable to factors such as unsatisfactory pre-treatment explanations or post-ECT memory impairment. About one-third undergoing ECT reported feeling coerced to have the treatment. Fear of ECT and distressing side effects were also present in a majority. Despite these problems, a vast majority of patients perceived ECT to be helpful and had positive views regarding the treatment. Simultaneously, a sizeable proportion was quite critical, although little was known about the extent and nature of such disapproval. Conclusions. Overall, the weight of the evidence supports the notion that patients undergoing ECT are well-disposed towards it. However, much needs to be done to improve the practice of ECT and to enhance patients’ satisfaction with the experience of treatment.     

Evaluation of the combination of tryptophan and ECT in the treatment of depression. I. Clinical analysis.

A double-blind evaluation of the antidepressant efficacy of treatment with a combination of orally administered L-tryptophan (L-TP) and electroconvulsive therapy (ECT) was made in patients suffering from endogenous depression. The patients were randomly assigned to two groups, one treated with L-TP (6 g daily) and unilateral ECT, the other with placebo and unilateral ECT. L-TP treatment was initiated at least 1 day before the first ECT and terminated 4 days after the last ECT. There was a good agreement between the two groups in several measures of antidepressant efficacy: doctors' and patients' ratings of depressive symptoms, and doctors' global rating of therapeutic effect 4 days and 1 month after the last ECT. In the L-TP group, however, there was a significantly better effect on retardation symptoms in the nurses' rating scale. This difference, which is not consistent with other measures of amelioration, contributes, at most, to a marginal therapeutic addition to the antidepressant effect of ECT. It is concluded that oral administration of L-TP, in the dose of 6 g daily, is not of practical value for potentiating the antidepressant efficacy of ECT.     

Suicide in the Nordic countries.

There are great differences in the suicide rates in the closely related Nordic countries. The suicide rates are higher in Finland, especially in males, and Denmark, especially in females, and lower in Norway and Iceland, with Sweden in a middle position. The statistics are found to be comparable. In this article the development from 1880 to the present day is described, and special emphasis is laid on the development from 1960 onwards. Denmark and Finland still keep the top position, while the rise in suicide rates, especially in the age group 15-29 years, has been most marked in Norway. Within the Nordic region Greenland has an extremely high suicide rate, especially in youngsters, while the Faroe islands have a very low rate. Tentative explanations are given for the development of suicide rates in the Nordic countries.     

Following international trends while subject to past traditions: neuropsychological test use in the Nordic countries

Abstract

Objective: Historically, the neuropsychological test traditions of the four Nordic countries have spanned from the flexible and qualitative tradition of Luria-Christensen to the quantitative large battery approach of Halstead and Kløve–Matthews. This study reports current test use and discusses whether these traditions still influence attitudes toward test use and choice of tests. Method: The study is based on survey data from 702 Nordic neuropsychologists. Results: The average participant used 9 tests in a standard assessment, and 25 tests overall in their practice. Test use was moderated by nationality, competence level, practice profile, and by attitude toward test selection. Participants who chose their tests flexibly used fewer tests than those adhering to the flexible battery approach, but had fewer tests from which to choose. Testing patients with psychiatric disorders was associated with using more tests. IQ, memory, attention, and executive function were the domains with the largest utilization rate, while tests of motor, visual/spatial, and language were used by few. There is a lack of academic achievement tests. Screening tests played a minor role in specialized assessments, and symptom validity tests were seldom applied on a standard basis. Most tests were of Anglo-American origin. Conclusions: New test methods are implemented rapidly in the Nordic countries, but test selection is also characterized by the dominating position of established and much researched tests. The Halstead–Reitan and Luria traditions are currently weak, but national differences in size of test batteries seem to be influenced by these longstanding traditions.     

Electroconvulsive seizures induce angiogenesis in adult rat hippocampus.

BACKGROUND: Electroconvulsive seizure (ECS)-treatment, a model for electroconvulsive therapy (ECT) has been shown to induce proliferation of endothelial cells in the dentate gyrus (DG) of adult rats. Here we quantified the net angiogenic response after chronic ECS-treatment in the molecular layer (ML) of the dentate gyrus. Patients undergoing ECT are routinely oxygenated to prevent hypoxia, a known inducer of angiogenesis. Therefore we also examined the effect of oxygenation on ECS-induced proliferation of endothelial cells. METHODS: Total endothelial cell numbers and vessel length were estimated utilizing design based stereological analysis methods. Endothelial cell proliferation in the DG after ECS with or without oxygenation was assessed using bromodeoxyuridine. RESULTS: The total number of endothelial cells and total vessel length was increased. Oxygenation did not abolish the ECS-induced proliferation of endothelial cells in the DG. CONCLUSIONS: ECS-treatment induces a dramatic increase in endothelial cell proliferation leading to a 30% increase in the total number of endothelial cells. The increase in cell number resulted in a 16% increase in vessel length. These findings raise the possibility that similar vascular growth is induced by clinically administered ECT.     

Electroconvulsive therapy for major depressive disorder in a patient with a permanent skull defect: A case report

Electroconvulsive therapy (ECT) is an effective and safe treatment method for a variety of psychiatric disorders, including major depressive disorder. Although there is no absolute contraindication to ECT, clinicians often hesitate to apply this method to patients with a skull defect. We report a case of ECT performed on a major depressive disorder patient with an open wound after craniectomy. We summarize successful ECT cases of patients with a permanent skull defect and discuss various factors that may influence ECT outcomes in patients with a skull defect, including electrode placement, benzodiazepines, and anticonvulsants.     

Electroconvulsive therapy and plasma prostaglandin E2 metabolite in major depressive disorder

1. 1. Animal experiments show that PGE₂ affects the release of ACTH and corticosteroids. In depressed subjects, plasma concentrations of the same hormones are increased immediately following ECT. Consequently we explored passible effects of ECT on PGE₂.

2. 2. The major plasma PGE₂ metabolite (PGEM), ACTH, and cortisol were determined by RIA.

3. 3. PGEM did not change with time alone and anesthesia without ECT also did not have a consistent effect. PGEM was significantly elevated at all post ECT sampling times. The maximum increase, about fifty percent, was attained at 15 and 30 minutes. Similar changes were observed following ECT-I and ECT-VI.

4. 4. Positive correlations between PGEM, ACTH and cortisol were obtained.

5. 5. The results demonstrate that following ECT stimulus there is a robust increase in circulating PGEM. The increased release of PGE₂ may, in part, account for the elevated plasma ACTH and cortisol.

Electroconvulsive seizures induce endothelial cell proliferation in adult rat hippocampus.

BACKGROUND: Electroconvulsive seizures, an animal model for electroconvulsive treatment, induce a strong increase in neurogenesis in the dentate gyrus of adult rats. Hippocampal neurogenesis has previously been described as occurring in an angiogenic niche. This study examines the effect of electroconvulsive seizures on proliferation of vascular cells in rat hippocampus. METHODS: Rats were injected with bromodeoxyuridine to label proliferating cells in the dentate gyrus after single/multiple electroconvulsive seizures in a dose-response study and at various time points after single electroconvulsive seizures in a time-course study. RESULTS: A dose-response effect on the number of bromodeoxyuridine-labeled endothelial cells located in the granule cell layer, hilus, and molecular layer was noted, as was the case with the number of neural precursors in the subgranular zone. The time-course study revealed that endothelial cell and neural precursor proliferation occurred in concert in response to a single electroconvulsive seizure. CONCLUSIONS: Our data suggest that in response to electroconvulsive seizures, endothelial cell and neural proliferation is coregulated. The increase in endothelial cell proliferation may act to support the increased neural proliferation and neuronal activity or vice versa, possibly leading to structural changes within the hippocampus of importance for the antidepressant effect of electroconvulsive seizures.     

Influence of tryptophan on memory functions in depressive patients treated with unilateral ECT.

With the aim of examining a possible influence on memory from L-tryptophan (L-TP), a double-blind comparison of the anterograde dysmnesic effect after a unilateral electroconvulsive therapy (ECT) series was carried out in depressive patients randomly assigned to two treatment groups, one receiving orally administered CTP (6 g daily) and ECT, the other placebo and ECT. The groups were similar in a number of background variables and in degree of depression. Scores for three operationally defined memory variables, immediate memory (IMS), delayed memory (DMS) and forgetting (FS), were obtained before the ECT series and 4 days after, the patients being on L-TP treatment or placebo on both occasions. The results were as follows: 1. Before treatment there was a higher FS in one test (30 Word-Pair Test) and after treatment a higher FS in another test (30 Face Test) in the L-TP group than in the placebo group, both findings indicating an adverse influence of L-TP. 2. There were a number of correlations between serum L-TP concentration levels and memory variables, all implying a more adverse influence on memory with higher levels of L-TP. The findings suggest that L-TP has a dysmnesic effect on memory in depressive patients treated with ECT, but they need to be confirmed before a negative influence of L-TP on memory can be considered definite.     

Electroconvulsive therapy in the medically ill.

ECT is often a necessary treatment for severe psychiatric disorders in patients with medical or neurologic comorbidity. Although the available data consist largely of cases and case series, ECT is effective in treating psychopathology despite the comorbidity. With appropriate precautions and monitoring during and after ECT, complications can be minimized.     

Electroconvulsive therapy in the treatment-resistant patient.

In medication-resistant patients with major depressive disorder, the response rate with bilateral electroconvulsive therapy (ECT) drops to 50% from the expected range of 80% to 90%. Relapse rates following ECT are high in medication-resistant depressed patients and are clustered in the first 4 months following clinical response. Medication resistance during the index episode predicts a high rate of relapse, whereas those patients who have not received an adequate medication trial prior to ECT are less likely to relapse. If a patient who fails an antidepressant trial then responds to a course of ECT, alternative pharmacologic strategies or maintenance ECT should be considered to decrease the likelihood of relapse. Patients who do not respond to a traditional course of bilateral ECT may respond subsequently to longer courses of bilateral ECT at markedly suprathreshold stimulus intensity, or may respond to a different class of antidepressant medication from that which they failed previously.     

Accessibility,standards and challenges of electroconvulsive therapy in Western industrialized countries: A German example

Abstract

Objectives. The aim of the study was to document the present situation of electroconvulsive therapy (ECT) in Germany, compare its handling with regard to other industrialized countries and with regard to a survey 12 years ago. Methods. A questionnaire on the frequency and type of administration of ECT in 2008 was sent electronically to 423 psychiatric hospitals. As needed, up to five reminders were carried out by telephone. On this occasion, the question of whether ECT is administered, could be clarified for each hospital. Results. A total of 43% (183/423) of hospitals declared to administer ECT; 63% (115/183) reported nearly 20,000 treatments. A total incidence of 30,000 treatments performed on 2800 individual patients was estimated. This means that 3.4 patients per 10⁵ inhabitants, 0.4‰ of all depressed patients, and about 1% of depressed inpatients, are treated with ECT in Germany. Conclusions. The frequency of application has increased during the last 12 years by a factor of more than 2.5 in Germany. In Western industrialized countries, numbers vary by a factor of more than 10 amongst the countries with a slow trend of equalization. The mode of implementation and the areas of conflict in which the therapy stands seem to be similar.     

Electroconvulsive therapy in the Czech Republic 1981-1989]

The authors processed statistical data on the application of electroconvulsive treatment in 1981-1989 in all in-patient psychiatric departments in the Czech Republic. During this period a slight decline of shocked subjects was recorded. Among shocked patients there is a permanent, higher relative ratio of women. Approximately every 18th discharged or deceased patient underwent electroconvulsive treatment. Psychiatric hospital departments use electroconvulsive treatment to a very different extent. Most frequently patients with the diagnosis of schizophrenic psychosis (43%), affective psychosis (36%) and other inorganic psychoses (8%) receive shock therapy.     

Electroconvulsive therapy in the medically compromised patient.

A review of the physiologic effects and potential risks--and how to reduce and manage them--of administering electroconvulsive therapy to patients with cardiovascular and cerebral disorders is presented.     

Practice of electroconvulsive therapy at the research and training hospital in Turkey

Objective  We sought to obtain an overview of electroconvulsive therapy (ECT) practice in Bakirkoy Research and Training Hospital for Psychiatric and Neurological Diseases, which is the biggest hospital for psychiatry in Turkey. Method  From 1st January 2006 to 30th June 2007, a form enquiring about evaluation of ECT was filled retrospectively. Results  The total number of patients, admitted for psychiatry during the survey period was 265,283. A total of 1,531 patients (12.4% among inpatients and 0.58% in all psychiatric admissions) received 13,618 sessions (including multiple hospitalizations) of ECT from 12,341 psychiatric inpatients during the survey period. Ninety-eight patients had multiple hospitalizations. The male-to-female ratio was 1.26–1. Patients with bipolar affective disorder, current episode manic with or without psychotic symptoms received ECT most frequently (30.3%), followed by patients with schizophrenia (29.5%), severe depressive episode with or without psychotic symptoms (include bipolar affective disorder current episode severe depression) (15.2%), other non-organic psychotic disorders (14.4%), schizoaffective disorders (6.3%), mental and behavioral disorders due to psychoactive substance abuse with psychotic disorders (3.5%) and catatonic schizophrenia (0.7%). Patients who received ECT were in age group of 25–44 years (64.7%), followed by 45–64 years (17.7%), 18–24 years (15.4%), 65 years and older (1.4%), and younger than 18 years (0.8%). All patients received modified ECT. There were no ECT-related deaths during the survey. Conclusion  The rate of ECT among all psychiatric inpatients during the survey period was 12.4%. The majority of patients who received ECT were diagnosed with bipolar affective disorder-current episode manic and schizophrenia. ECT training programs for psychiatry residents and specialists should be planned, and conducted systematically.