Smoking and cognitive deficits in schizophrenia: a pilot study.

The cross-sectional study assessed the associations among smoking status, number of cigarettes smoked per day, and psychiatric symptoms in 88 chronic schizophrenic outpatients with a stable psychic condition. Among the 49 smokers, the number of cigarettes smoked per day was associated with the severity of cognitive symptoms of the Positive and Negative Syndrome Scale. The authors suggest that smoking may alleviate cognitive deficits in schizophrenia by increasing dopaminergic neurotransmission in the prefrontal areas of the brain.

Contagion of deliberate self-harm among adolescent inpatients.

OBJECTIVE: To explore the quantitative importance and clinical features of deliberate self-harm (DSH) contagion in a closed adolescent psychiatric unit. METHOD: The authors investigated with statistical methods and a sociogram whether acts of DSH were clustered during a 12-month study period. Twelve subjects were involved in acts of DSH, and their mean length of hospitalization during the study period was about 90 days. Six adolescents with four or more contagion incidents were interviewed. RESULTS: DSH incidents were clustered during the study period (p < .05). Most DSH incidents were skin cutting committed by depressed female subjects with borderline personality disorder. The majority of DSH contagion can be understood in terms of small-group rites for feelings of togetherness. CONCLUSIONS: Even a majority of DSH events in closed adolescent units may be triggered by contagion, and DSH can spread to previously DSH-naive adolescents.

Citalopram as an adjuvant in schizophrenia: further evidence for a serotonergic dimension in schizophrenia.

There is increasing evidence suggesting that symptoms of depression and anxiety may also be associated with serotonergic dysfunction in schizophrenic patients. The effect of the adjuvant selective serotonin reuptake inhibitor citalopram was assessed regarding the symptom dimensions of schizophrenia measured with the Positive and Negative Syndrome Scale (PANSS) and with the Hamilton Rating Scale for Depression (HRSD). Citalopram alleviated symptoms of the depression/anxiety dimension of the PANSS, but not the symptoms of the four other PANSS domains or depressive symptoms measured with the HRSD. The results support the hypothesis of a serotonergic dimension in schizophrenia.

Depression Scale (DEPS) among suicide attempters.

The Depression Scale (DEPS), a new screening instrument for detecting depression in primary health care, was compared with the Hamilton Depression Scale (HDS) among 50 suicide attempters. Using the HDS as a gold standard, the positive and negative predictive values of the DEPS for the diagnosis of depression were 98% and 20%, respectively. The correlation between the total HDS scores and the total DEPS scores was 0.60. The DEPS may help general practitioners to detect depression among suicide attempters, but it should not be used to exclude depression.

Psychological responses to a marine disaster during a recoil phase: experiences from the Estonia shipwreck.

The sinking of the car ferry, Estonia, was one of the world's most devastating marine disasters that has ever occurred in peace time. Altogether 138 passengers and crew members were rescued, and 38 of them were taken to the Turku University Central Hospital in Finland. The present article describes the various psychological reactions among the survivors during the first three days of the recoil phase.

Alexithymia in suicide attempters.

Alexithymia seems to share some common features with psychological constriction, a phenomenon described in suicidal individuals. Fifty suicide attempters were interviewed within 24 h after arrival at a hospital, and measures of lethality of the attempt, suicidal intent, depression and alexithymia were carried out with structured instruments. Almost all the attempters were depressive, and about half of them were also alexithymic. However, alexithymia was not more prevalent in this population than in non-suicidal depressive patients. Depression and alexithymia correlated significantly with each other, but there was no correlation between alexithymia and lethality of the suicide attempt or suicidal intent. The authors conclude that alexithymia in suicide attempters seems to be associated with depression, but not with suicidality per se. Therefore, measurement of alexithymia may not yield extra information in suicide risk assessment.

Antipsychotic medication and suicide risk among schizophrenic and paranoid inpatients. A controlled retrospective study.

A retrospective analysis of the psychotrophic medication, illness history and recent mental symptoms of 28 schizophrenic or paranoid inpatients who had committed suicide and the same number of matched control subjects was carried out. The groups were first compared separately for every variable, and 6 statistically most significant variables in the paired comparisons were then entered into a stepwise linear logistic regression model. Four statistically significant differences between the groups were found with the paired comparisons. The suicide group had more often previous suicide attempts, lower neuroleptic doses, more depressive symptoms and less positive schizophrenic symptoms compared to their controls. The results of the regression analysis suggested that the lower neuroleptic doses in the suicide group were more probably a consequence of the differences in the symptom profile than in a direct causal relationship to the suicides per se.

Suicide clustering in a psychiatric hospital with a history of a suicide epidemic: a quantitative study.

To determine if the suicides in a Finnish psychiatric hospital with a history of a suicide epidemic were clustered and if the sex distribution of the suicides followed a random pattern, the authors conducted statistical analyses of the temporal distribution and sex distribution of 59 consecutive inpatient suicides over the years 1967-1992 in the hospital. They found no statistically significant temporal clustering and that the sex distribution of the suicides was random. They conclude that inpatient suicide epidemics seem to be rare and separate events, related more to temporary micro-social factors and to the psychopathology of individual patients than to permanent characteristics of a particular hospital.

Effect of psychopharmacotherapy on suicide risk in psychiatric inpatients.

A retrospective analysis of the psychopharmacotherapy of 25 inpatients who had committed suicide and the same number of matched control subjects was carried out comparing the quality and doses of medication. Two statistically significant differences between the groups considering the medication were found. The suicide group had lower neuroleptic doses and they more often used benzodiazepine medication than the control group. The presence of depression was documented in the hospital charts more frequently in the suicides, but no differences were observed between the groups in the amount of antidepressant medication used.

Projective identification and suicide contagion.

The effect of suggestion on suicide is well established. However, the intrapsychic mechanisms of the contagion of suicides are poorly understood. In this article I first present the literature about suicide clustering and about projective identification. In the following clinical vignette I try to understand a patient's suicidal behaviour, referring to William Goldstein's clarifying model of projective identification. I aim to illustrate that his model has heuristic value in the treatment of suicidal patients when the effect of suggestion or identification is suspected.