Attempted-suicide trends in Stockholm County, Sweden, 1975-1985

A total of 22,961 admissions, representing 19,127 individuals, diagnosed as certain or undetermined attempted suicide were registered in the computer medical information system in Stockholm County for the study period 1975-1985. Two different statistical regression models were used to describe the trends of attempted suicide and undetermined attempted suicide. A simple linear ordinary least squares model generally performed better at describing the observed rates in sex- and age-specific rates of attempted suicide when the diagnosis of attempted suicide was certain. Significantly increasing attempted-suicide trends for men over 35 and women over 45 as well as for all ages pooled for both men and women were found. Undetermined attempted suicides were described better by a quadratic model than by the linear model. Women 35-44 and 65-85 years old and men 25-54 years old were found to have an increasing initial phase followed by a leveling out in the rates around 1980-1982, with weak evidence that the rate might even be slowly decreasing. Comparing earlier findings of decreasing rates in completed suicides for all ages, and findings in this study of increasing attempted-suicide trends during the same period, we believe that improved somatic and psychiatric treatment of attempted-suicide patients may partly account for the decreased rates of completed suicides.     

Cannabis psychosis and paranoid schizophrenia.

The initial clinical symptoms of 25 consecutive cases of cannabis psychosis of the paranoid type and 25 consecutive cases of paranoid schizophrenia were studied and compared, in order to delineate features that would enable a differentiation of the two conditions. It was observed that the patients with cannabis psychosis substantially differed in terms of behavioral manifestations. Most of these patients were violent and panicky and demonstrated bizzare behavior, but they possessed some insight into the nature of their illness. Schizophrenic patients manifested these disturbances and characteristics less frequently. Subjects with cannabis psychosis showed rapid ideation and flight of ideas, whereas the characteristic schizophrenic thought-disorder was found mostly in schizophrenic patients.     

Changing trends in first admissions and readmissions for mania and schizophrenia in New Zealand, 1974 to 1984

From 1974 to 1984 in New Zealand there was a significant decline in first psychiatric admissions for the functional psychoses. This decline is due to decreasing first admission rates for schizophrenia and depressive psychoses, despite an increasing first admission rate for mania. Although a small part of the declining first admission rate for schizophrenia may be due to the increasing diagnosis of mania, this is insufficient to explain all the decline and suggests an actual decline in the incidence of schizophrenia. Over this same period readmissions for functional psychoses increased, with the most marked increase being in manic readmissions. Although a variety of factors influence readmission rates, the marked rise in manic readmissions suggests broadening diagnostic criteria for mania.     

Mortality and causes of death in schizophrenia in Stockholm county, Sweden

A study of mortality for all patients with a first hospital diagnosis of schizophrenia in Stockholm County, Sweden, during 1973 to 1995 was performed, by linking the in-patient register with the national cause-of-death register. Overall and cause-specific standardized mortality ratios (SMR) were calculated by 5-year age classes and 5-year calendar time periods. The number of excess deaths was calculated by reducing the observed number of deaths by those expected. Our results confirmed a marked increase in mortality in schizophrenia both in males and females. Natural (somatic) causes of death was the main cause of excess deaths, with more than half of the excess deaths in females, and almost half of the excess deaths in males. Suicide was the specific cause of the largest number of excess deaths in males, while in females it was cardiovascular disease. SMRs were increased in both natural and unnatural causes of death, with 2.8 for males and 2.4 for females for all deaths, but were highest in suicide with 15.7 for males and 19.7 for females, and in unspecified violence with 11.7 for males and 9.9 for females. SMRs in suicide were especially high in young patients in the first year after the first diagnosis.     

Different rates of first admissions for psychosis in migrant groups in Paris

Purpose

The association between migration and psychosis has been reported in the past decades in many European countries. Despite large-scale migration into France, epidemiological data on the incidence of psychosis in this population are lacking. In this study, we compare the incidence rates of first admission for psychosis among natives and first generation migrants.

Methods

Two-hundred and fifty-eight patients aged 15+ with first admission for psychosis were identified in the catchment area of the 20th district of Paris between 2005 and 2009. Standardised incidence rates and incidence rate ratios were calculated for migrant and native groups.

Results

We found higher rates of admissions for psychosis in the migrant group (IRR 2.9, 95 % CI 0.9–9.8) compared to individuals born in France. Among migrants, incidence was higher in individuals from Sub-Saharan Africa compared to natives (IRR 7.1, CI 95 % 2.3–21.8), whereas the incidence was similar for those from Europe (IRR 1.2, CI 95 % 0.3–5.1) and from North Africa (IRR 1.4, CI 95 % 0.4–5.6).

Conclusions

Our findings suggest that Sub-Saharan migrants were identified as the most vulnerable migrant group for developing psychosis in France, but additional work is warranted to confirm these trends.     

Seasonality of first admissions for schizophrenia in the Southern Hemisphere

Northern Hemisphere studies of first admissions for schizophrenia have shown an excess of summer admissions (June, July and August) compared to other times of the year. The within-year fluctuations in first admissions could be related to meteorological factors that fluctuate between seasons (e.g. temperature, photoperiod) and/or social factors (e.g. holidays, religious events). If meteorological factors were primarily responsible for the fluctuation, then Southern Hemisphere studies should find excess first admissions in December, January and February. This paper presents the first season of first admission study of schizophrenia in the Southern Hemisphere. The month and year of first admission for schizophrenia (ICD 8/9) for 4487 male and 3252 female, Australian-born individuals were extracted from a Queensland mental health register. Spectral analysis showed a strong annual periodicity of first admissions for males with the peak in August (Southern Hemisphere winter) and a trough in the summer months (December to February). The pattern for females also displayed annual periodicity. These results correspond to the Northern Hemisphere reports of excess of schizophrenia first admissions in terms of the month of the year but not the season of excess. Further work is needed in order to clarify the impact of latitude and meteorological factors on the month of first admission for schizophrenia.     

Narcolepsy, paranoid psychosis, and analeptic abuse

Analeptic-induced paranoid psychosis occasionally occurs in the treatment of narcolepsy. Two cases illustrate how analeptic abuse can contribute to the development of paranoid psychosis in narcolepsy and greatly complicate treatment.     

Increase in first admissions for schizophrenia and other major psychoses in Italy

Despite reports of falling first-admission rates for schizophrenia in some Western countries, methodological problems and bias preclude a definite conclusion about a genuine fall in the incidence of schizophrenia. This study set out to test the hypothesis that first admissions for schizophrenia in Italy have fallen in recent years. All admissions rated as 'first contact' in Italy from 1984 to 1994 for severe mental illnesses to general hospital psychiatric services, as reported in the Italian National Institute for Statistics Health-Care Yearbooks, were considered. Data were analyzed as rates per 100000 in the general population, and changes over time in incidence of schizophrenia, paranoia, affective psychoses and drug-induced psychoses (diagnosed according to ICD 9) were recorded. Changes in rates over time, with rates as the dependent variable and years as the independent variable, were the main outcome measure. First-admission rates for schizophrenia and paranoia increased progressively from 1984 to 1994, as did those for affective psychoses, mania and, to a lesser extent, major depression. In the same period, all admissions (both total and rated as 'first-contact') for mental disorders increased. Although linear regression tests for admission rates in most, but not all, cases indicate a significant ascending linear trend, quadratic model results show a significantly better fit than does the simple linear regression model for the majority of data. The change described by the quadratic model suggests an increase in admission rates more marked in the second half than in the first half of the period of the study. First-admission rates for schizophrenia and, to a lesser extent, paranoia seemed to increase concurrent to a decrease in first-admission rates for 'other' non-organic psychoses. Contrary to reports from other Western countries, hospital incidence in Italy for schizophrenia is on the increase, as is that for other severe psychoses. This increase is likely to be a reflection of changes in mental health-care organisation, in treatment and diagnostic patterns, and in cultural attitudes towards mental illness. Radical changes in the true incidence of psychoses, in particular of mood disorders, as described elsewhere, cannot be ruled out as contributing factors. Data bias and limitations preclude a generalisation of results, however.     

Epidemiology of long-term functional psychosis in three different areas in Stockholm County

This study is the first in a series investigating different aspects of living conditions and care utilization in a total population with long-term functional psychoses (LFP). The study cohort (n = 302) was defined as people that: were aged 18-64 years, were affected by a nonorganic psychosis continuously during at least 6 months, showed psychotic features or residual symptoms during 1984, and had their home address in the study area during 1984. The study area consists of one rural and one suburban municipality, and one urban parish (57,035 inhabitants aged 18-64 years). The LFP concept used shows a high interrater reliability (kappa = 0.93). The one-year prevalence in the rural, suburban and urban areas was 3.4, 5.6 and 6.6 per 1000 respectively, thus producing a gradient from the rural to the urban areas. The prevalence of schizophrenia (DSM-III) was 2.6, 3.8 and 5.0 per 1000 respectively. The other diagnoses covered by the LFP concept (paranoia, major affective disorder with psychotic features, and psychotic disorder not elsewhere classified) showed the same gradient, with the exception of paranoia, which showed a lower rate in the urban area. The prevalence of schizophrenia was higher among males, while for paranoia the prevalence was higher among females.     

Narcolepsy, paranoid psychosis, major depression, and tardive dyskinesia

This report describes a man with narcolepsy, paranoid psychosis, major depression, and tardive dyskinesia. The case illustrates the treatment difficulties such a patient presents and also raises questions about interactions between the putative neurotransmitters involved in each of these conditions. It is suggested that the presence of narcolepsy may facilitate the appearance of unwanted effects of antidepressants and neuroleptics such as psychosis and depression.     

Epilepsy, psychosis and schizophrenia

A connection between epilepsy, especially temporal lobe (psychomotor, limbic) epilepsy (TLE) and schizophrenia has been proposed by a number of investigators. The evidence both supporting and challenging this widespread idea is reviewed, and several hypotheses are considered that may account for the higher incidence of this form of epilepsy and of schizophrenic psychoses after adolescence.     

Suicide among psychiatric in-patients in Stockholm,Sweden

Abstract

The aim of this study was to analyse how sex, age, ethnicity and psychiatric disorders influence the suicide rate and to describe the methods used when committing suicide. The study was designed as a prospective follow-up study from 23 October 1984 to 31 December 1986. The study population was comprised of in-patients in psychiatric care from 23 October 1984 to 23 October 1985 living in the southern part of Stockholm, Sweden. Women had significantly higher standardised mortality ratios (SMR = 33.7. CI -31.6-35.8) of suicide (determined and undetermined) than men (SMR = 21.4, CI = 19.7-23.1), and the SMR of total mortality were 4.0 and 3.8 respectively. The suicide rate was 15.5 per 1000 patients and 2.6 during the hospitalisation period. For men and women aged under 50, suicide accounted for 60% and 75% respectively of the total mortality. Men had a higher (p < 0.0001) hospitalisation rate than women, 1082 and 1004 (per 100.000 and year) respectively. One-third of those who committed suicide died from an overdose and 35% were diagnosed as psychotic. Foreign-born individuals ran a twofold risk of committing suicide compared to Swedes. These findings are imponant and need to be further analysed in studies based on larger population samples.     

Cannabis and schizophrenia: a longitudinal study of cases treated in Stockholm County

By means of the Stockholm County inpatient care register we identified all cases treated with a diagnosis of cannabis dependence and psychosis, not necessarily at the same occasion, during 1971–1983. By scrutinizing medical records, we evaluated the diagnosis according to DSM-III-R and we assessed the history of substance abuse as well as the psychiatric history and clinical course. We identified 229 cases during the follow-up; 112 of these cases (49%) fulfilled the DSM-III-R criteria for schizophrenia. The majority of the schizophrenics had prominent positive symptoms and a sudden onset of disease, and 69% of the cases had a record of heavy cannabis abuse at least 1 year before onset of psychotic symptoms. The high number of verified DSM-III-R cases of schizophrenia in this cohort and the temporal relation between cannabis abuse and schizophrenia further support the hypothesis that cannabis abuse may be a risk factor for schizophrenia. We confirmed previous observations that cannabis-associated schizophrenia often has a sudden onset and prominent positive symptoms.     

Hemispheric functioning in paranoid and nonparanoid schizophrenia

Letter-naming and dot enumeration tasks, designed to elicit left and right hemisphere functioning, respectively, were presented tachistoscopically to paranoid and nonparanoid schizophrenics, nonschizophrenic psychiatry controls, and normal subjects. Types of information-processing used by paranoid and nonparanoid schizophrenics were also examined. All groups identified letters with greater accuracy with left hemisphere presentation. Group differences in the letter task disappeared once education was controlled. No hemisphere effect was found for dot enumeration but group differences emerged. As predicted, paranoids and controls processed the dots serially and hence decreased in accuracy over frame size. Nonparanoids processed in an automatic mode, revealing the same degree of accuracy over all dot sizes. The poorer performance of the nonparanoids in dot enumeration is discussed in terms of the task requiring bilateral processing and the nonparanoids' failure to integrate the processing of left and right hemispheres.     

Predictors of schizophrenia in patients with a first episode of psychosis

Early identification of schizophrenia in patients with a first episode of psychosis (FEP) may help to avoid inappropriate treatment and may enhance long-term outcome by addressing issues such as family network, treatment adherence and functional and symptomatic outcome. It was the aim of the study to determine baseline variables that significantly predicted a diagnosis of schizophrenia in patients with FEP. The sample consisted of 133 FEP patients hospitalized for at least 6 weeks, in whom a DSM-IV diagnosis was confirmed after 1 year follow-up. Patients were divided into two groups, those with a diagnosis of schizophrenia (Schizophrenia group, n = 63; 47.8%), and those with other psychosis, who were grouped under Non-Schizophrenic Psychosis (NSP, n = 70; 52.2%). Sociodemographic (marital status, educational level) and clinical variables were recorded for each patient. Substance use (alcohol, cannabis and cocaine) did not statistically differ between the two groups. Absence of characteristics defined as criteria for good prognosis, lack of ≥ 20% improvement in the total Positive and Negative Syndrome Scale score at 6 weeks, and a poor premorbid adjustment as determined by the Premorbid Adjustment Scale score significantly predicted the presence of schizophrenia. The regression model including these three variables achieved a predictive value of 76.3%, with a sensitivity of 74.6% and a specificity of 77.9%.     

分裂样精神病与首发精神分裂症临床特征比较

目的:比较分裂样精神病与首发精神分裂症的临床特征。方法:选取同期出院的分裂样精神病、首发精神分裂症患者各45例进行临床特征比较。结果:分裂样精神病与首发精神分裂症在思维贫乏、懒散、紧张恐惧和冲动破坏方面差异显著。结论:分裂样精神病与首发精神分裂症相比,某些症状有显著差异。