Suicide mortality in people with mental disorders: a register-based study in north France.

INTRODUCTION: Suicide is very common among people with mental disorders. In addition, suicide mortality rates are stable in this group, while they are decreasing in the general population. METHODS: The vital statuses of adult inpatients admitted to French psychiatry departments in 2008-2009 were researched in death databases on 31 December 2013. Suicide probability was calculated using a Kaplan-Meier analysis, and standardized mortality ratios (SMRs) were calculated in relation to the population of the study area. RESULTS: Among the 13,979 patients included in the study, (7416 men and 6563 women; mean age 43.6 ± 14.6 years), 1454 died in total, among whom 286 died by suicide an average of 4.9 years after the date of their enrolment. The cumulative probability of suicide was 0.8% at 1 year, 1.3% at 2 years and 2.5% at 6 years. The SMR value, which was 1492 for the whole group of patients and was twice as high in women (2494) as in men (1220), decreased with age (from 2078 in patients aged 18-34 years to 1278 in patients aged 75 years or more). DISCUSSION: Our study confirms that suicide mortality is higher in inpatients admitted to French psychiatry units than in the general population and advocates specific prevention programmes for this group.

Mortality of people suffering from mental illness: a study of a cohort of patients hospitalised in psychiatry in the north of France.

BACKGROUND: The mortality of people suffering from psychiatric illnesses is far higher than that of the general population, all categories of diagnosis combined; mortality statistics can be used as an index of quality of care. The aim of this study was to assess the all-cause mortality in psychiatric patients covering all diagnostic groups. METHODS: The living or deceased status of 4,417 patients of majority age hospitalised in a public mental health establishment between 2004 and 2007 were requested from French National Institute for Statistics and Economic Studies on 1st January 2011. The cause of death of those people who had died was obtained from French National Institute for Health and Medical Research and comparative standardized mortality ratios (SMR) were established from the population in a region of northern France of the same age in 2006. RESULTS: The study population was made up of 54% men and 46% women, median age 41 and 45 years old, respectively. Four hundred and seventy-three people died during the period studied. The SMR were 421 for men (95% CI 378-470) and 330 for women (95% CI 281-388). The highest SMRs were found in patients aged 35-54, with a 20-time higher mortality risk than the general population of the same age. CONCLUSION: Our study confirms the considerably higher mortality in psychiatric patients than in general population, particularly in mean age and mostly due to an unnatural cause.

Alcohol dependence in women: difficulty of its assessment in general practice.

BACKGROUND: In France, women represent approximately 20% of alcohol-dependent subjects. Although general practitioners (GPs) are often these women's first medical contact, GPs may be reluctant to probe for alcohol dependence. METHOD: In this context, in 1996 and 2006 we conducted a cross-sectional survey using self-completion postal questionnaires sent to all GPs in a French département (administrative area), with the aim to explore and to compare after a ten-year time lapse, expectations and relational difficulties in managing alcohol dependence in women. RESULTS: A total of 300 GPs returned the questionnaire for the two data collection times. According to the GPs, comparing 1996 and 2006, there was less embarrassment among female patient to talk about alcohol consumption and a lesser tendency to break off medical care (33.7% vs. 47.3%, p < 0.001, and 13.3% vs. 23.0%, p = 0.002, respectively). In 2006, more GPs considered they were well informed about specialized care in alcohol dependence than in 1996 (76.8% vs. 59.9%, p < 0.0001), and more often reported referring their female patients to specialized centers (73.0% vs. 52.7%, p < 0.0001), rather than medical or psychiatric wards. Young GPs, aged under 40, seem rather to have had difficulty using the managed care network than lacking medical knowledge related to female alcohol dependence. CONCLUSIONS: The results suggest that over ten years there has been a decrease in the tendency among women to deny their alcohol dependence, and that they more readily accept specific care. In the same period, GPs have benefited from better information about specialized management.

Manic episode with psychotic symptoms in a patient with Parkinson's disease treated by subthalamic nucleus stimulation: improvement on switching the target.

Manic symptoms have been reported as adverse effects of bilateral deep brain stimulation (DBS) of the subthalamic nucleus (STN) in patients with Parkinson's disease. In previous reports, manic symptoms were described as transient, not associated with psychotic features, and improved spontaneously or with medical adjustments. The medial part of the STN seems to play a key role in the occurrence of these manic symptoms. We report the case of a manic episode with psychotic symptoms in a patient with Parkinson's disease treated by STN DBS, which improved with a change in the stimulated target. This case demonstrates the efficacy of switching the stimulation target against a manic episode with psychotic features secondary to DBS.