Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t-test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

Comparison of psychiatric inpatient suicides with suicides completed in the surrounding community

We compared main characteristics of 58 (22 male and 36 female) psychiatric inpatients that committed suicide in the psychiatric hospital with all 1261 suicides (956 male and 305 female) that occurred outside hospitals in the same health district of Slovenia, all these in the period between 1985 and 1993. The independent t -test and cross-tabulation were used to compare the two groups on age, sex, marital status and suicide method profile. It appeared that female suicide is much more frequent in the psychiatric inpatients' group than in others. Only male psychiatric inpatients' suicides are younger than other suicide victims. Psychiatric inpatients use methods like jumping from high places and drowning more often than do others, which goes in line with the availability of methods of suicide. Apparently, the studied hospital has some wards on the third floor and majority of acute wards are located by the river. However, psychiatric inpatients do not differ from other suicide victims on marital status. Higher suicide rates in men compared with women in the population, but not in psychiatric inpatients, could be explained by the presence of so-called atypical, clinically unrecognized depression in the male population.     

The 'afterthought' diagnosis: rehabilitating adjustment disorders

Although a common diagnosis, adjustment disorder has received little scientific attention, and instead the focus has been on major depression. It is likely that adjustment disorder and major depression have been conflated and the reasons for this are explored. Delineating one from the other clearly has crucial therapeutic and financial implications.     

Problems associated with the classification and diagnosis of psychiatric disorders.

Several methodological issues of classification of psychiatric disorders are addressed. Beside some historical aspects and basic characteristics of the classification of mental disorders, the advantages and disadvantages of the syndromatological and nosological classifications are broadly described. Finally the current situation of the international standardisation of psychiatric classification and particuarly the improvement of reliability by using operationalised procedures is discussed.     

Thyroid disorders in female psychiatric patients with panic disorder or agoraphobia

The authors interviewed 144 consecutive female psychiatric patients and found that those with a lifetime history of either panic disorder or agoraphobia with panic attacks (panic/agoraphobia) were more likely than other patients to report a history of hyperthyroidism or goiter in themselves and in their first-degree relatives. A personal history of hyperthyroidism or goiter was found almost exclusively in the subgroup of patients with panic/agoraphobia who also had a lifetime history of major depression.     

Characteristics of psychiatric emergency room patients with alcohol- or drug-induced disorders

Although emergency room psychiatrists are often faced with evaluating and planning treatment for patients who abuse substances, there is limited information about the characteristics of emergency room patients with alcohol- or drug-induced disorders. The authors describe the demographic and clinical characteristics of 343 consecutive patients referred to a general hospital's emergency psychiatry service. The 114 patients diagnosed as having an alcohol- or drug-induced disorder were younger and were more often male, unemployed, and homeless than patients with disorders not induced by substance abuse. They also demonstrated increased suicidality. Alcohol was the predominant substance that contributed to psychiatric emergencies, but a surprising number of patients were diagnosed as having amphetamine-induced disorders, possibly representing an important trend.     

Familial aggregation of psychiatric disorders and the consequences for the psychiatric diagnosis

Schizophrenic and affective disorders, anxiety disorders, and alcoholism show familial aggregation; the impact of familial aggregation on the classification and etiology of psychiatric disorders is discussed. Ideal diagnostic schedules should a) identify conditions with a substantially increased familial risk and b) reach diagnostic homogeneity in multiplex families. A review of the literature shows a) that age at onset, long-term course and comorbidity modify familial risks and should therefore be given more attention in diagnostic schedules and b) that the heterogeneity of disorders in multiplex families draws the validity of currently used diagnostic schedules into question. Against this background the hypothesis of "unitary psychosis" is discussed.     

Retrospective psychiatric assessment of 200 suicides in Budapest

Based on an interview with the closest family member, using the Schedule of Affective Disorders and Schizophrenia--SADS, a retrospective psychiatric assessment and diagnostic classification was carried out on 200 completed suicides. Eighty-one per cent of the victims had a recent psychiatric disorder, in 63% depression. The prevalence of psychiatric illnesses was similar to that of other studies from countries with lower suicide rates.     

Man or machine in psychiatric diagnosis.

The authors describe the previous studies of the stability of psychiatric diagnoses over time that have found such diagnoses to be unreliable, stating that the assumptions underlying these studies have been tested and disproved. On the other hand, the use of standardized interview techniques and categorization by computer yield reliable symptom ratings and precise diagnoses. The authors discuss the importance of these findings to the selection of the most appropriate treatment modality for individual patients.     

Autoantibodies associated with psychiatric disorders

Growing evidence suggests that autoantibodies to neuronal or endothelial targets in psychiatric disorders exist and may be pathogenic. This review describes and discusses the possible role of autoantibodies related to the psychiatric manifestations in autoimmune diseases, autoantibodies related to the psychiatric disorders present in post-streptococcal diseases, celiac disease, chronic fatigue syndrome and substance abuse, and autoantibodies related to schizophrenia and autism, disorders now considered of autoimmune origin.     

Dementia associated with psychiatric disorders

Functional psychiatric disorders are associated with a variety of cognitive deficits and, in some instances, severe cognitive impairment. This paper reviews the cognitive profile of patients with schizophrenia, depression, bipolar and anxiety disorders, as well as the longitudinal course and clinical outcome of the cognitive impairment associated with these conditions. The paper also discusses some of the mechanisms that may contribute to the expression of the cognitive deficits in these disorders and their potential relationship with common causes of dementia.     

Headaches associated with psychiatric disorders

Attributing the cause of headache to psychiatric disorders implies a direct causal relationship between the former and the later. According to the 2nd version of the IHS classification, headache can be secondary to psychotic disorders, somatisation disorders, undifferentiated somatoform disorders, depressive disorders, anxiety disorders (separation anxiety disorders, generalized anxiety disorders, panic disorders, social phobia, and post traumatic stress disorders, especially in case of head injury). Psychosocial functioning of these patients is severely impaired and their medical costs are high.     

Differential diagnosis and treatment of psychiatric disorders in children and adolescents with epilepsy

Behavioral problems, such as the inattentive form of attention-deficit hyperactivity disorder (ADHD), anxiety, and depression, are common in children and adolescents with epilepsy and especially associated with central nervous system damage, family dysfunction, and severe seizures. This article discusses the risk factors to be considered when focusing on the prevalence of behavioral problems, the family factors that influence their incidence, as well as the differential diagnosis of behavioral disorders commonly associated with epilepsy. It also considers the assessment of these behavioral disorders and their treatment with psychotherapy, education, and a variety of psychopharmacological agents.     

Adolescent eating disorders

Anorexia and Bulimia nervosa are common psychiatric disorders in adolescent girls. In discrepancy to ICD-10 and DSM-IV we would propose the 10th BMI percentile as weight criterium for anorexia nervosa. Both disorders have a high somatic and psychiatric comorbidity; the most severe complication at long term follow-up is osteoporosis. The most prevalent psychiatric disorders are affective disorders, anxiety and obsessive-compulsive disorder and substance abuse. There is undoubtedly a genetic predisposition and a range of general and personal environmental risk factors. Treatment of adolescent eating disorders mostly requires a multimodal approach which consists of several components, e.g. weight rehabilitation, nutritional counselling, individual and family psychotherapy, and treatment of comorbid psychiatric disorders.     

Tomographic cerebral blood flow scanning in diagnosis of psychiatric disorders

The paper summarises the role of tomographic cerebral blood flow SPECT scanning in psychiatric diagnostics, its' physical and radiopharmaceutical basis, pathological physiology of cerebrovascular circulation in psychiatric disorders and interpretation of cerebral blood flow scanning results by the clinician. Cerebral blood flow scanning is, to some extent, a functional equivalent of CT/MRI scanning. In psychiatry cerebral blood flow SPECT scanning's basic application is the differentiation of dementia and cognitive impairment, in particular Alzheimer's disease, frontotemporal lobar degeneration and multi-infarct dementia. The other indications for brain SPECT scanning involve the organic brain lesions and medico-legal diagnostics, including the sequelae of cranio-cerebral trauma. Contraindications and economical aspects are underlined.     

Children of low‐income depressed mothers: psychiatric disorders and social adjustment

Background: Although several studies have documented a higher prevalence of psychiatric disorders in children of depressed than nondepressed parents, previous research was conducted in predominantly White, middle, or upper‐middle class populations. Only limited information is available on psychiatric disorders and psychosocial functioning in children of low‐income depressed mothers. Methods: We report the findings in children of mothers with and without a lifetime history of major depressive disorder, who were recruited from a large urban primary‐care practice. Bilingual clinical interviewers assessed 58 children with structured diagnostic interviews administered to most children (90%) and to their mothers as informants. Diagnostic assessments and best estimate diagnoses of the children were blind to the mothers' diagnostic status. Results: The families were poor and predominantly Hispanic, more than half of them headed by single mothers. After adjusting for child age and gender, and for any possible sibling correlation, children of depressed mothers had significantly higher rates of lifetime depressive, separation anxiety, oppositional defiant, and any psychiatric disorders than children of control mothers, with a lifetime prevalence of any psychiatric disorder of 84.6 versus 50.0%, respectively. Children of depressed mothers also reported significantly lower psychosocial functioning and had higher rates of psychiatric treatment. Conclusions: We conclude that the risk for psychiatric disorders may be particularly high in children of low‐income depressed mothers. The primary‐care setting offers a unique opportunity for early intervention with this underserved group. Depression and Anxiety, 2009. © 2008 Wiley‐Liss, Inc.