Comorbidity of axis I and axis II disorders in patients who attempted suicide

OBJECTIVE: The authors compared the characteristics of suicide attempters with and without comorbid psychiatric and personality disorders to identify factors that explain the high suicide risk associated with psychiatric comorbidity. METHOD: A representative group of 111 patients who had attempted suicide (72 female and 39 male) was assessed for psychiatric and personality disorders according to ICD-10 criteria. The characteristics of patients with both types of disorder were compared with those of patients without comorbid disorders. A semistructured interview schedule and standardized questionnaires were used to investigate patients' background characteristics, the circumstances of the suicide attempts, psychological characteristics, and outcome after 12-20 months. RESULTS: Comorbidity of psychiatric and personality disorders was present in 49 patients (44%). More patients with comorbid disorders had made previous suicide attempts (N=41 [84%] versus N=28 [45%]) and repeated attempts during the follow-up period (N=25 [51%] versus N=9 [15%]). Differences in precipitants and motives for the index episode were also found: patients with comorbid disorders were more depressed and hopeless, reported more episodes of aggression, were more impulsive, and had lower self-esteem and poorer problem-solving skills. Differences in self-esteem and problem-solving skills distinguished between the groups in a stepwise discriminant function analysis. More of the patients with comorbid disorders reported not being loved by their parents and parental suicidal behavior. CONCLUSIONS: Suicide attempters with comorbid psychiatric and personality disorders show marked differences from those without both of these disorders. Comorbidity may contribute to greater suicide risk. Some of the characteristics of patients with comorbid disorders pose major clinical challenges that should be addressed in an effort to reduce suicide risk.     

A review of medication administration errors reported in a large psychiatric hospital in the United kingdom

A retrospective analysis of reports of medication administration errors over a period of three and a half years was carried out in a UK psychiatric hospital. A total of 112 errors and "near misses" were studied. The reporting rate increased over time. Psychotropic, intramuscular, and as-needed medications were overrepresented in the error reports. Fifteen percent of the errors had the potential to cause moderate or severe harm to patients. The two most common factors cited by nurses as contributing to error causation were a busy, noisy environment and personal factors, such as feeling tired or unsupported. Physicians were cited as having contributed to some errors.     

Smoking and mental health nurses: a survey of clinical staff in a psychiatric hospital

There is a lack of evidence on the prevalence of smoking among mental health nurses, and the beliefs and attitudes they hold about smoking at work. This paper describes results from a cross-sectional survey of clinical staff working in a UK specialist charitable-status psychiatric hospital and focuses on the responses of registered mental health nurses. Questionnaires specifically developed for this study were sent to all 1371 clinical employees. Completed questionnaires were returned by 167 of 429 (38.9%) registered nurses (RNs), 300 of 842 (35.6%) nursing assistants (NAs), and 123 of 200 (61.5%) other health professionals (OHPs). Twenty-nine (17.4%) RNs, 93 (31%) NAs and eight (6.5%) OHPs reported themselves as current smokers. Differences in response to attitudinal questions between groups could not be attributed to age. RN smokers were significantly more likely than RN non-smokers to state that staff should be allowed to smoke with patients, and to report therapeutic value for patients in this activity. RN smokers were less likely than RN non-smokers to report that patients should be encouraged to stop smoking. RNs were significantly more likely than OHPs to report therapeutic value for patients in smoking with staff, even after controlling for the possible confounding effect of smoking status. Implications of the survey are discussed in the context of the international literature, including the disproportionately high smoking prevalence among patients living in psychiatric institutions and current guidelines to move towards no 'smoking allowed' areas for staff working in them.     

Cutaneous drug eruption from cetirizine and hydroxyzine

Topical application of the antihistamines commonly leads to sensitization for patients, but skin reactions provoked by their systemic use are very rare. The antihistamines cetirizine and hydroxyzine are piperazine derivatives, on the structural basis of an ethylenediamine, but the cross-reactions between the 2 have rarely been reported. A 44-year-old man visited because of the generalized morbilliform eruptions with pruritus over his whole body, after intake of hydroxyzine (Ucerax) and azelastine (Azeptine), administered during a 2-day period for chronic urticaria. Previously, he had presented the same cutaneous reactions after oral administration of cetirizine (Lotec). Oral challenge tests performed with cetirizine and hydroxyzine led to the same cutaneous reactions. He was given the diagnosis of drug eruption from cetirizine and hydroxyzine, which suggests that there were cross-reactions among cetirizine, hydroxyzine, and ethylenediamine.     

Lethal ventricular arrhythmias following one-step pacemaker reprogramming for rapid tracking of atrial tachyarrhythmias

An abrupt decrease in the pacing rate in patients with dual-chamber pacemakers tracking atrial tachyarrhythmias carries a high risk of malignant ventricular arrhythmia. The pacing rate should be reduced by multistep programming over several days.     

Recombinant strains of HIV type 1 in the United Kingdom

Twenty-five recombinant (mosaic) HIV-1 genomes were detected among 151 samples comprising 118 non-B subtype sequences and 33 samples containing subtype B sequences. Seven of the 25 mosaic patterns were similar to characterized circulating recombinant forms (two A/E, four A/G, and one D/F) and one was a MAL-like A/D recombinant. Eighteen of the recombinants had evidence of subtype A sequences in at least one region of their genome. One sample was found to contain a novel recombinant form (pol F, env K). Two samples could not be characterized unambiguously as recombinant forms and a further one appeared to be a complex C/J/D/A genomic form. The majority of the mosaic genomes were recombinants between gag, pol, or env, whereas the C/J/D/A mosaic had cross-over breakpoints within pol. These findings suggest that almost 20% of non-B subtype isolates of HIV-1 circulating in the United Kingdom have mosaic genomes. This shows the diverse origin of HIV-1 strains circulating in the United Kingdom and may have implications for antiretroviral drug resistance.     

Improving service systems for spinal cord injury patients in British Columbia: a survey of urologists

INTRODUCTION: A previous survey of individuals with spinal cord injury (SCI) in British Columbia (B.C.) reported some dissatisfaction in the services provided to treat this condition. We surveyed Urologists in B.C. to gather information about services provided and suggestions for future service development. MATERIALS AND METHODS: A 14-item questionnaire was developed and sent to all Urologists in B.C. Frequency analyses were done on responses. RESULTS: Fifty-one out of 62 questionnaires (82%) were returned. Seventy-five percent of Urologists saw 0-14 SCI patients per year. Urinalysis, culture, ultrasound, and electrolytes/BUN/creatinine were ordered by >80% of Urologists, and cystoscopy, urodynamic studies, and intravenous pyleogram were ordered by 22-64%. Seventy-five percent were satisfied with urological resources in their area. Regarding the need for development of centralized services 64% agreed. However, 100% indicated that they would use selected services typically provided from a centralized resource centre if available. CONCLUSIONS: Urologists in B.C. are relatively satisfied with their regional urological services but expressed a need for specialized resource development.     

Nutrition, immune function, and inflammation: an overview

The collective evidence suggests that nutritional insult to both cell-mediated and humoral immunity in the presence of protein-energy malnutrition contributes to abnormalities of inflammation. The primary goal of nutritional support in inflammatory disease is to provide adequate energy and protein to meet endogenous requirements for tissue repair, IL-1 production, and restored cellular function, thus preventing secondary infection. Substrate provision should aim at improving the acute phase of injury while avoiding immune dysfunction. This goal may be achieved by altering the eicosanoid pathway toward a more regulated inflammatory state. In the context of allograft response, macrophages are central to the initiation of allosensitization by virtue of their ability to present antigen to T-cells. Activated T-cells may further modulate macrophage function by the secretion of lymphokines. Manipulation of macrophage eicosanoid production by dietary omega-3 PUFA may reduce cellular immune response. (table; see text) Nutritional support should also focus on providing essential micronutrients, with their potentially immunomodulating role, as adjunctive therapy in order to protect the host from toxic effects of free-radicals and chemicals released during inflammatory events. (Feeding regimens currently under investigation and development are presented in Table 4.) By integrating dietary immunotherapy with the use of recombinant hormones, monoclonal antibodies, and various available monokines, an optimal outcome for each patient may be achieved. However, effective application of immunotherapy to nutritional supplementation will require accurate monitoring of immune function in individual patients in order to avoid inappropriate treatment.