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The article presents a study which investigates the relation between creatine phosphokinase (CPK) and psychiatric illness. The researchers examines previous studies about creatine phospokinase, including that of H. Meltzer and others. Meltzer and company, have investigated a large group of psychiatrically heterogeneous patients characterized as acutely psychotic. They found out that many of the patients have unexplained elevations of CPK. Attempts to confirm the findings of Meltzer and others that a large proportion of acutely psychotic patients have an elevation of CPK was not successful because of the presence of non-psychiatric factors which might have the levels of the enzyme.

Previous large studies of completed suicides have not considered sexual orientation in their data analyses. In this study, data from the known homosexual subpopulation (13 males, aged 21-42) in a series of 283 suicides were examined. They were compared with all other aged male suicides 21-42 (n = 106). Both groups showed considerable substance abuse plus a variety of other psychiatric diagnoses. Both also had a high frequency of relationship difficulties near the time of death. Gays who committed suicide did not have a history of more police trouble and were no more likely to be living alone than the comparison group. They did not have more prior suicide attempts or previous psychiatric treatment. We conclude that, among the factors examined here, there appears to be little difference between gay and heterosexual male suicides. [ABSTRACT FROM AUTHOR]

The data accumulated so far suggest several tentative conclusions. First, thyroid and adrenal gland disease unquestionably can produce severe mental disturbances. Most of these are "organic" in nature, but depressive symptoms are common as well. A connection between these diseases and suicide has not been established, however. Research cannot really address this possibility adequately, since these studies are difficult, if not impossible, to do in the postmortem state at this time. Ways should continue to be sought to overcome this problem. Clinically, it seems advisable to treat all depressed, suicidal persons with the same caution, whether they have diseases of these endocrine systems or not. The differences in responsiveness of the thyroid and adrenocortical systems among depressed and perhaps truly suicidal persons are of greater theoretical as well as practical clinical interest. The TRH-TSH test and the DST may not be as specific as once thought. Nonetheless, the abnormalities do occur with regularity in specific subgroups of depressed patients. It is far too early to stop research on the DST or the TRH-TSH test. Clinically, however, it is premature to make important management decisions about suicidal patients based on these test results. At this time, we really have no means of pinpointing the persons who will eventually suicide. The hope that they may someday provide valid data for assessing real suicide potential is there, and clinicians should stay informed in this arena. Until that day comes, though, we must continue to exercise caution regarding our clinical judgments and to live with their uncertainties. [ABSTRACT FROM AUTHOR]

This article summarizes the results of the Ohio University Sexual Assault Risk Reduction Project, which is a program designed to reduce college women's risk for sexual assault. The program was evaluated at 2 separate universities with 762 women. Participants were randomly assigned either to the program or to the no-treatment comparison group, and they completed measures that assessed sexual victimization, dating behaviors, sexual communication, and rape empathy at the pretest and at the 2-month and 6-month follow-ups. At the 2-month follow-up, there were no differences between the groups on any of the outcome measures. However, those women who were moderately victimized during the 2-month follow-up were significantly less likely to be revictimized during the 6-month follow-up period if they participated in the program.

The goal in this study was to assess if there is any constancy in detections of psychoactive substances in consecutive suicides. Toxicologic findings in 179 suicides in San Diego County, California, between 1981 and 1982, and 333 suicides in Mobile County, Alabama, between 1990 and 1998, were compared. Alcohol was detected in about 30% of suicides in both samples. Abusable prescription psychoactive substances, i.e., benzodiazepines and opiates, were detected in one fifth of cases in both locations. Nonabusable prescription psychoactive substances, mainly antidepressants, were found in more suicides in Mobile than in San Diego. Detection rates of different classes of psychoactive substances have not changed much in the past decade. Detection of alcohol, cocaine, or cannabis in about 40% of suicides supports the clinical practice of discouraging consumption of these substances in depressed patients. Another challenge is the low rate of detection of antidepressants in suicide, which suggests undertreatment of depression in suicides. Continued reporting of routine, comprehensive, toxicologic findings in suicides is useful to monitor patterns of use of psychoactive substances in this group and to guide suicide prevention in clinical practice and public health policy.

Toxicological studies have reported the presence of alcohol in about a third of suicides. Some have suggested that the presence of alcohol might predispose suicidal people to use particular methods, e.g., guns, although, in general, this does not appear to be the case. More recently, comprehensive toxicological studies have provided data on the detection of all intoxicating abusable substances (IAS) among suicides. The purpose of this report is to examine the presence of two samples of suicides to see if any relationships between presence of IAS at post mortem toxicology and any specific suicide method. The samples included 179 suicides from San Diego, California (1981-1982), and 225 suicides from Mobile, Alabama (1990-1995) for which comprehensive toxicological examination had been conducted. Methods were grouped into more immediately fatal (MIF) and less immediately fatal (LIF) categories. The most common method in each category (guns and overdoses respectively) were examined separately as well. The same proportions of men (51%) and women (65%) were positive for any IAS in both locations. There were no significant differences in the proportions of suicides that were positive for IAS between the sample totals or by gender or age groups (under age 30 and age 30 and over) for any of the methods or categories examined. Significantly more of the Mobile suicides were by MIF methods than in San Diego for both genders, almost totally attributable to the use of guns. The use of guns for suicide in Mobile (and the state of Alabama) was also significantly higher than the rest of the U.S. in the early 1990's. Nonetheless, the suicide rates for men and women in Mobile (and Alabama) were no higher than for the overall U.S. rates. We conclude that potentially suicidal people should be advised to avoid intoxicating abusable substances of any kind. We also suggest that physicians should avoid prescribing such substances to depressed or suicidal patients.

Fifty-eight consecutive suicides between 15 and 29 years of age occurring in Göteborg, Sweden, were assessed in accordance with DSM-III Axis V (highest level of adaptive functioning in the past year). The levels of adaptive functioning were compared to principal Axes I and II disorders. Subjects with a borderline personality or schizophrenic disorder as the principal disorder tended to have poor to very poor adaptive functioning and were frequently associated with substance abuse (19 of 24 subjects). Subjects with adjustment disorder or major depressive disorder as the principal disorder generally had very good to fair adaptive functioning. Clinicians are reminded that apparently higher functioning as defined by DSM-III Axis V is no insurance against suicide.

Objectives: To see if selected clinical factors characterize suicides over the age of 60 differently from younger suicides and to ascertain if those factors characterize female and male suicides over the age of 60 differently., Design: A group of consecutive suicides aged 60-88 was compared with groups of consecutive suicides aged 31-59 and 16-30. The female suicides aged 60-88 were also compared with the male suicides in that age group. Data were gathered from a variety of informants using a structured interview format., Setting: The sample was gathered in San Diego County, California, between November, 1981 and September 1982., Participants: The sample consisted of 204 consecutive suicides. These included 49 cases aged 60-88, 94 cases aged 31-59, and 61 cases aged 16-30. The older group consisted of 20 females and 29 males., Measurements: Comparisons were made in demographic, diagnostic, and other clinical characteristics., Results: There were no significant differences between female and male suicides over age 60 on any of the variables examined. Only minor differences were found among the groups in patterns of mental disorders diagnosed. Older suicides were significantly more likely to be married or, if not married, widowed than either of the two younger groups. They were also significantly more likely to be stressed by medical illness. They were significantly less likely to have financial problems as stressors. They were significantly less likely to have talked about suicide or made prior suicide attempts than either of the two younger groups., Conclusions: Patterns of certain characteristics of suicides are very similar regardless of age. However, specific age-related differences occur that need to be considered when assessing suicide risk. Older suicides may be harder for clinicians to predict and, therefore, prevent.

Although clinical experience points to the frequent use of sedatives and hypnotics in suicide, remarkably few data are available to characterize the demographics of the population involved. The San Diego study, in which toxicological examinations were performed in over 90% of 204 consecutive suicides seen by the San Diego County Coroner during 1981-1982, provides an opportunity to examine suicide victims who were taking various medicines and drugs of abuse. Drugs were detected in 68% of tested subjects. Anxiolytics and hypnotics were found in 10.7% and 12.3% of the cases respectively. Women were more than 4 times as likely as men to have tested positive for an anxiolytic or hypnotic. Antidepressants were found in 5.9%. Alcohol had been ingested by 28.3% of subjects. Barbiturates and benzodiazepines were found in approximately equal proportions, although nationally the number of barbiturate prescriptions filled in drugstores was only one-sixth that of benzodiazepines. Major depression was found in 22.5%; among cases with positive histories of major depression, only a small proportion ranging from 4-10% were positive for antidepressants, anxiolytics or hypnotics. Interestingly, approximately equal proportions (4.8% and 6.2%) of depressed and non-depressed patients were positive for antidepressants. Among subjects whose deaths were attributed to drug ingestion, benzodiazepines, barbiturates and antidepressants were found in approximately one-third each, with little overlap. Although benzodiazepines were found in less than 10% of the group as a whole, they were found in one-third of subjects who committed suicide by overdose.(ABSTRACT TRUNCATED AT 250 WORDS)

Objective: Relationships between stressors and suicide might be expected to vary with stages of the life cycle. The purpose of this study was to examine this possibility., Method: The authors examined the first 204 consecutive cases from the San Diego Suicide Study, a federally funded investigation of 283 suicides, for possible relationships between suicide and age and the frequency of specific stressors. Information was gathered from family members, spouses, acquaintances, employers, other witnesses, physicians, and other professionals by trained interviewers using a structured format. Hospital, physician, therapist, school, and police records were also included when available. DSM-III diagnoses were made by consensus of two investigators. Life events information was also reviewed independently by the investigators to determine stressors (if any) for each case., Results: Of the 202 subjects for whom data were available, 195 (97%) had one or more stressors; 137 male subjects had a total of 272 stressors, and 58 female subjects had a total of 115 stressors. The authors found predictable patterns of the three most common stressor groups--conflict-separation-rejection, economic problems, and medical illness. The majority of the stressors among subjects 80 years old or older were illnesses. The only significant difference between the sexes was that more men than women had economic problems as a stressor., Conclusions: The variations in the patterns of stressors found in this study of suicides coincide with adult development theory. The lack of population comparison subjects and stressor scoring validation, however, limits the predictive value of these data in assessing suicidal persons.

Post-mortem psychiatric diagnoses are compared in two cohorts of male suicides from St. Louis (1956-1957) (Robins, 1981) and San Diego (1981-1982) (Rich et al., 1986). Similar structured interviews and diagnostic criteria had been used in both assessments. Substance/alcohol abuse has remained the major diagnosis in suicides under age 60. Rates of depressive disorder alone have decreased overall, due mostly to decreased rates in the elderly. Thus, depression occurs more frequently in younger ages. Comorbid depression and substance/alcohol abuse has also increased in younger ages. Implications in terms of the so-called 'cohort effect' are discussed.

The San Diego Suicide Study involved psychological autopsy and toxicological examination of 283 suicides. Of the 133 consecutive cases under age 30, 14 were under age 20. In this paper, detailed data on the 14 adolescent cases are presented and the findings compared to other studies.

We examined the records of 33 patients who had 70 inpatient admissions with a diagnosis of bipolar affective disorder, depressed. During 14 of these admissions, a switch occurred from depression into mania. We compared the treatment patients were on at the time of their switch to treatment during the 56 admissions where there was no switch. We conclude that clinicians must be prepared for depressed bipolar patients to switch to mania regardless of treatment status.

The authors describe suicide rates in Toronto and Ontario and methods used for suicide in Toronto for 5 years before and after enactment of Canadian gun control legislation in 1978. They also present data from San Diego, Calif., where state laws attempt to limit access to guns by certain psychiatric patients. Both sets of data indicate that gun control legislation may have led to decreased use of guns by suicidal men, but the difference was apparently offset by an increase in suicide by leaping. In the case of men using guns for suicide, these data support a hypothesis of substitution of suicide method.

The usefulness of RDC and DSM-III diagnostic subtypes as predictors of response to ECT was examined in a multi-observer, multi-factorial study of 44 depressed patients. Most of the patients met criteria for "endogenous" and/or "melancholic" subtypes of major depressive disorders. None of the RDC or DSM-III subtypes (reactive, secondary, nonpsychotic) identified the least responsive patients. Thus, the presence of "reactive" factors, the absence of psychotic symptoms, or the presence of other illnesses did not reduce the likelihood or degree of immediate response to ECT in patients with major depression.

Thirty primary unipolar depressives were studied to determine whether depressed patients with psychotic symptoms respond better to ECT than those without such symptoms. Psychotic (N = 9) and nonpsychotic (N = 21) patients showed equal therapeutic benefit in similar periods of time. Thus, the presence of psychotic symptoms did not enhance the degree of response to ECT in patients with primary unipolar major depression.

The authors studied the effect of Pennsylvania's 1976 Mental Health Procedures Act on the hospital course of involuntarily detained patients. They found that more court hearings to extend commitment were requested, held and approved under the modern law. There was a decrease in the number of schizophrenic patients who signed in voluntarily. They found no change in the mean length of hospitalization under the new law whether patients were voluntary or involuntary. They found that patients did not often sign in voluntarily or go to court within the legally prescribed periods.

The authors studied 31 cases with psychotic diagnoses from a consecutive series of 204 suicides in San Diego. They were compared to 25 similar cases from 134 suicides gathered in the city of St. Louis and St. Louis county 25 years earlier. The proportion of psychotic subjects (less than 20%) in the two samples was similar. The San Diego psychotics were younger on the average than those from St. Louis and had more polysubstance abuse than alcoholism. Only rarely did psychotics in either sample commit suicide by particularly "crazy" methods. In the San Diego suicides, the psychotics without a depressive syndrome had as many depressive symptoms as those with a depressive syndrome. Schizophrenics in the San Diego sample made suicidal communications just as often as the other psychotics and the nonpsychotics. Fewer schizophrenics than other psychotics or nonpsychotics had stressors identified at the time of death, but over half of all the subjects did have them.

In the past few years, the finding of elevated serum levels of creatine phosphokinase in some acutely psychotic patients has commanded a great deal of interest. Although structural abnormalities in nerve and muscle of some of these patients have been described, the cause remains obscure. Physical stress will raise CPK, but the role of psychological stress has been unclear. CPK levels of medical students were measured before and after an academic examination, but no relationship between examination stress and changes in CPK was found. A significantly higher number of CPK elevations were reported in association with vigorous exercise. These findings are consistent with a hypothesis that psychological stress plays an insignificant role in the CPK elevations seen in some acutely psychotic patients. The importance of physical activity in elevated CPK values was reconfirmed.

Because of possible teratogenicity, lithium should be used during the first trimester only if clinically essential. Lithium levels should be monitored throughout pregnancy and dosage adjusted as necessary. Sodium-restricted diets and diuretics should be used with caution. Lithium dose should be reduced with the onset of labor. Mothers who choose to breast-feed should watch for signs of toxicity in their babies. With their consent, pregnant women on lithium should be reported to the American Register of Lithium Babies.

The suicide rate among people under 30 years of age has nearly tripled in the past several decades. We compared 133 suicides under the age of 30 years with 150 aged 30 years and over. After gathering and reviewing extensive clinical information and postmortem toxicologic data, we assigned diagnoses using DSM-III criteria. A major diagnostic finding was the occurrence of more drug abuse than had been previously reported, significantly more often in the young people. Few other differences were found either between our total sample and previous studies or between our younger and older groups. We conclude that a closer look at the young group is necessary to see what other differences might occur between the drug abusers and other young suicides.

Men have persistently had a several-fold higher suicide rate than women. In this study of 204 consecutive suicides, the authors examined three areas in which the men differed from the women. Men used more violent, immediately lethal methods of suicide, were almost three times more likely to be substance abusers, and were more likely to have economic problems as stressors. The authors conclude that while the difference in suicide rate between men and women is complexly determined, the weight of the evidence suggests that more men than women intend to commit suicide.

The mean suicidal ideation scores of 37 patients receiving ECT improved significantly earlier than energy items. However, caution is recommended in prematurely dismissing clinical wisdom regarding suicidal risk during treatment for depression.

Brief general anaesthesia has added to the safety and comfort of electroconvulsive therapy (ECT). While usually a simple procedure, there are several areas in which ECT differs from other procedures requiring brief anaesthesia. These differences call for even more collaboration between psychiatrist and anaesthetist than is customary. This review details the areas where the anaesthetic management may affect the outcome of ECT for both an individual treatment and a treatment series. These include the patient evaluation, the patient preparation, the sequence and doses of anaesthetic agents, and the recovery period. Because each patient receives a series of treatments, an optimum regimen from both the psychiatric and anaesthetic standpoints can ultimately be achieved.

Interpretation of serum creatine phosphokinase (CPK) levels is frequently difficult because of complicating circumstances known themselves to raise CPK; for instance, intramuscular injections. One such circumstance among psychiatric patients is said to be administration of electroconvulsive therapy (ECT). In a series of 22 patients who received drug modified ECT, four had CPK elevations beyond the normal range. These findings indicate that CPK elevations among patients receiving ECT should be interpreted cautiously.