Prescribed Benzodiazepines and Suicide Risk: A Review of the Literature.

OBJECTIVE: To evaluate whether prescribed benzodiazepines affect one's risk of suicide. DATA SOURCES: A PubMed search of English-language publications from database inception until October 11, 2016, was conducted using the terms benzodiazepine and suicide. References and related articles were also searched to yield additional publications. STUDY SELECTION/DATA EXTRACTION: Studies were included if they addressed the relationship between suicidal behavior and the prescribed use of either specific benzodiazepines or benzodiazepines as a class. A total of 17 studies were included in this review. RESULTS: The majority of studies found that benzodiazepines were associated with increased suicide risk. This finding was consistent across various populations and different types of research, including a placebo-controlled crossover trial, a laboratory model of suicidal behavior, case-control studies regarding completed suicides on inpatient units, and large naturalistic studies. CONCLUSIONS: Benzodiazepines appear to cause an overall increase in the risk of attempting or completing suicide. Possible mechanisms of prosuicidal effects may include increases in impulsivity or aggression, rebound or withdrawal symptoms, and toxicity in overdose.

Bizarre Paranoid Delusions Associated With an Implanted Surgical Device.

We describe a case involving bizarre paranoid delusions following implantation of a sacral nerve stimulator, and review the literature regarding psychotic symptoms related to surgical implants. A 64-year-old female developed bizarre paranoid delusions regarding a sacral nerve stimulator that had been implanted two years previously for dysfunctional voiding. The patient believed that the wires from the sacral nerve electrodes had grown up her spine and were affecting her vision as well as controlling her thoughts. The delusions developed in the setting of profound anxiety and feelings of loss after the death of her mother. The patient initially demanded that the implant be removed emergently. The delusions gradually abated as she adjusted to the loss of her mother. Fortunately the symptoms abated entirely with supportive care. We suspect that given the frequency of surgical implants that the association with delusional thoughts might be much higher than suggested by a literature review.

Who is paying the price? Loss of health insurance coverage early in psychosis.

OBJECTIVE: Discontinuities in health insurance coverage may make it difficult for individuals early in psychosis to receive the services that are critical in determining long-term outcome. This study reports on the rates and continuity of insurance coverage among a cohort of early-psychosis patients enrolled in Specialized Treatment Early in Psychosis (STEP) at the Connecticut Mental Health Center. METHODS: Insurance status at baseline, six months, and 12 months was collected from 82 participants from a combination of self-reports, clinical chart review, clinician reports, and a database maintained by the state Department of Social Services. RESULTS: A total of 34 participants did not know whether they had health insurance or did not appear for follow-up assessments at six and 12 months. Among the remaining 48 participants, at baseline 18 had private insurance, 13 had public insurance, and 16 had no insurance. By the 12-month assessment, 13 (72%) privately insured and five (38%) publicly insured participants had lost coverage; less than one-third of the 48 participants (N=14) maintained continuous coverage. CONCLUSIONS: Specialty services for individuals experiencing early psychosis should address the difficulty of maintaining health insurance coverage during a period of illness in which continuity of care is critical to recovery.