Genome-wide scan in a nationwide study sample of schizophrenia families in Finland reveals susceptibility loci on chromosomes 2q and 5q.

We have previously carried out two genome-wide scans in samples of Finns ascertained for schizophrenia from national epidemiological registers. Here, we report data from a third genome scan in a nationwide Finnish schizophrenia study sample of 238 pedigrees with 591 affected individuals. Of the 238 pedigrees, 53 originated from a small internal isolate (IS) on the eastern border of Finland with a well established genealogical history and a small number of founders, who settled in the community 300 years ago. The total study sample of over 1200 individuals were genotyped, using 315 markers. In addition to the previously identified chromosome 1 locus, two new loci were identified on chromosomes 2q and 5q. The highest LOD scores were found in the IS families with marker D2S427 (Z(max) = 4.43) and in the families originating from the late settlement region with marker D5S414 (Z(max) = 3.56). In addition to 1q, 2q and 5q, some evidence for linkage emerged at 4q, 9q and Xp, the regions also suggested by our previous genome scans, whereas, in the nationwide study sample, the region at 7q failed to show further evidence of linkage. The chromosome 5q finding is of particular interest, since several other studies have also shown evidence for linkage in the vicinity of this locus.

Long-term risk factors for suicide mortality after attempted suicide--findings of a 14-year follow-up study.

OBJECTIVE: To determine the risk of suicide over a 14-year follow-up period, and to investigate the long-term risk factors for suicide using survival analysis. METHOD: Data were collected on all unselected deliberate self-poisoning patients (n=1018) treated during 1983 in the emergency unit of Helsinki University Central Hospital. RESULTS: By the end of the 14 -year follow-up period 222 (21.7%) of these patients had died. Sixty-eight (6.7%) had committed suicide; 44 (9.2%) men and 24 (4.5%) women. The long-term risk factors for suicide were male sex, previous psychiatric treatment, previous suicide attempts, somatic disease and a self-reported 'wish to die' motive for the index suicide attempt. CONCLUSION: The essential risk factors for suicide were being male and having previous suicide attempts. In addition, history of earlier psychiatric treatment, presence of somatic disease and genuine intent to die in the index suicide attempt suggest that the long-term risk has remained high for over a decade. The findings emphasize the need for long-term planning and treatment of suicide attempters met in the emergency room of general hospitals.

Mental disorders and comorbidity in attempted suicide.

The present study examined the prevalence and comorbidity of mental disorders according to DSM-III-R among male and female suicide attempters. A systematic sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki between 1 January and 31 July 1990 was interviewed. In 98% of the cases at least one Axis I diagnosis was made. Depressive syndromes were more common among females (85%) than males (64%), and alcohol dependence was more common among males (64%) than females (21%). A high proportion of suicide attempters (82%) suffered from comorbid mental disorders. Comorbidity appears to play an important role in parasuicide.

Suicide attempts in which alcohol is involved: a special group in general hospital emergency rooms.

Sixty-two percent of 1018 parasuicide patients treated in the emergency room of Helsinki University Central Hospital in 1983 for 1207 suicide attempts had recently consumed alcohol in addition to medical drugs: 46% were women and 54% men. High body alcohol levels were associated with young age and male gender. Alcohol consumption shortly before, or at the time of, parasuicidal acts was more common among young or lonely men with previous suicide attempts. Their suicide risk was assessed as less severe and they were less often referred to a psychiatrist compared with those who had not consumed alcohol. They were also more often left without arranged after-care. By the end of a 5.5-year follow-up period, 3.3% of these alcohol consumers had committed suicide, an annual suicide mortality of 598/100,000. In the year following the initial attempt, suicide mortality was 1809/100,000, a 51-fold risk compared to that of the total population in Helsinki. Sixty-seven percent of alcohol consumers during the initial suicide attempt also took it before actually committing suicide, and 30% of these revealed clear evidence of chronic alcohol consumption. Those who initially consumed alcohol were identifiable as a risk group for suicide, and thus improvement in their recognition and treatment in the emergency rooms of general hospitals is recommended.

Outcome of attempted suicide and psychiatric consultation: risk factors and suicide mortality during a five-year follow-up.

A total of 1018 self-poisoned patients were treated during the year 1983 in the emergency room of Helsinki University Central Hospital. By the end of a 5-year follow-up period, 3.2% of these had committed suicide, making annual suicide mortality 589 per 100,000. During the first year after the index attempt, suicide mortality was 1768 per 100,000, a 50-fold risk compared with that of the total population in Helsinki. Risk factors were being male of advancing age, having mental disorders, previous suicide attempts, a nonimpulsive index suicide attempt, moderate to very serious lethality and severe intention to die during the index suicide attempt. When the lethality was assessed as being very serious or intention to die as certain, 21% later committed suicide. The relative risk for those left without psychiatric consultation was 0.6 when the lethality was mild and 1.6 when it was severe. Results indirectly indicate that psychiatric consultation seemed to have a positive effect on the outcome of these attempted suicides.

Selection of patients who attempted suicide for psychiatric consultation.

A total of 1018 self-poisoned patients were treated during one year (1983) at the emergency room of Helsinki University Central Hospital for 1207 suicide attempts; 46% were left without psychiatric consultation. Women were consulted more frequently than men. Patients with previous psychiatric treatment were referred more often for psychiatric consultation. The use of alcohol was more frequently present in suicide attempts that did not lead to psychiatric consultation. Somatic seriousness was also less severe in this group. It was assumed that those left without consultation were not in mortal danger. There were no differences in the suicide mortality of these 2 groups during a 5-year follow-up.

Evaluation of attempted suicides: a comparative study of staff in a general hospital and consulting staff in a psychiatric hospital.

The study group consisted of medical staff (n = 53) working in the emergency department of the general hospital in Helsinki, Finland, which treats almost all self-poisonings in the area. Some of the staff in the Department of Psychiatry formed the comparison group (n = 30). The study method was an interview based on real cases of attempted suicide. The previous four cases taken for consultation by the Department of Psychiatry were chosen. The interview was based on the consultation form used in the Department of Psychiatry of Helsinki University Central Hospital. The answers of the original consultant were compared to the results from the two groups. The study group could well assess the somatic severity (lethality) of all suicide attempts, whereas the comparison group often assessed them to be more severe than the original consultant. There were no noteworthy differences between the groups concerning the assessment of the psychiatric severity (the intent to die) of the suicide attempts and the necessary after-care. The comparison group considered all suicide attempts as understandable acts, whereas there was a distribution in the results from the study group. In general, on the basis of the results, it can be said that the staff in the psychiatric hospital were significantly more cautious in their assessments than the staff at the general hospital.

Work stress has negative effects on the attitudes of emergency personnel towards patients who attempt suicide.

Many previous studies indicate that the attitudes of the staff towards patients who attempt suicide are often negative. Nevertheless, the attitudes of the staff working in different areas of an emergency department have not been studied. The purpose of this study was to explain the attitudes of emergency personnel (n = 184) towards patients who attempt suicide in the different stages of treatment in a general hospital by comparing the attitudes of the staff in the emergency room (n = 64), emergency ward (n = 47) and intensive care unit (n = 73). There were clear differences in attitudes of staff in the various units. The attitudes were most negative among emergency room staff, where all attempters are first treated. The intensive care staff, who treat the most serious cases, shared the most positive attitudes. It seems that specialized treatment of suicide attempters makes it possible to treat these patients in a more professional way in a general hospital.

The role of safety analysis in accident prevention.

The need for safety analysis has grown in the fields of nuclear industry, civil and military aviation and space technology where the potential for accidents with far-reaching consequences for employees, the public and the environment is most apparent. Later the use of safety analysis has spread widely to other industrial branches. General systems theory, accident theories and scientific management represent domains that have influenced the development of safety analysis. These relations are shortly presented and the common methods employed in safety analysis are described and structured according to the aim of the search and to the search strategy. A framework for the evaluation of the coverage of the search procedures employed in different methods of safety analysis is presented. The framework is then used in an heuristic and in an empiric evaluation of hazard and operability study (HAZOP), work safety analysis (WSA), action error analysis (AEA) and management oversight and risk tree (MORT). Finally, some recommendations on the use of safety analysis for preventing accidents are presented.