Attempted and completed suicide in older subjects: results from the WHO/EURO Multicentre Study of Suicidal Behaviour.

OBJECTIVE: The authors present an analysis of findings for the 65 years and over age group from the WHO/EURO Multicentre Study of Suicidal Behaviour (1989-93). METHODS: Multinational data on non-fatal suicidal behaviour is derived from 1518 subjects in 16 European centres. Local district data on suicide were available from 10 of the collaborating centres. RESULTS: Stockholm (Sweden), Pontoise (France) and Oxford (UK) had the highest suicide attempts rates. In most centres, the majority of elderly who attempted suicide were widow(er)s, often living alone, who used predominantly voluntary drug ingestion. Non-fatal suicidal behaviour decreased with increasing age, whereas suicide rates rose. The ratio between fatal and non-fatal behaviours was 1:2, that for males/females almost 1:1. In the years considered, substantial stability in suicide and attempted suicide rates was observed. As their age increased, suicidal subjects displayed only a limited tendency to repeat self-destructive acts. Moreover, there was little correlation between attempted suicide and suicide rates, which carries different clinical implications for non-fatal suicidal behaviour in the elderly compared with younger subjects in the same WHO/EURO study.

Early natural course of transient encephalopathy after coronary artery bypass grafting.

OBJECTIVE: A decline of neuropsychological performance is an unwanted side effect of coronary artery bypass grafting (CABG) with extracorporeal circulation. There is little data on the neuropsychological changes during the first 2 wks after CABG. DESIGN, SETTING, PATIENTS: In this prospective observational study at our university medical center, a group of 67 patients who underwent routine CABG was selected for absence of comorbidity (such as carotid stenosis, previous stroke, dementia, and advanced general medical disorders) and examined. In this selected group of patients, no focal deficit was seen throughout the study. A total of 20 hospitalized patients with different types of peripheral neuropathy and free from drugs interfering with cognition served as a control group for the practice effects of the neuropsychological testing. MEASUREMENTS AND MAIN RESULTS: Seven standard tests covering different neuropsychological domains were used as a composite battery. Examinations took place before surgery and serially at days 3, 6, and 9 after CABG; general neurologic examination was done every day, including the first postoperative day. We observed a definite decline in all tests at day 3 (p < .01) and progressive recovery thereafter up to or even beyond preoperative values within 9 days (p < .01). Transient depression as indicated by self-rated scores occurred in some patients. CONCLUSION: We observed a uniform, but transient, deterioration in performance on a battery of frequently repeated standardized neuropsychological tests early after CABG. Our data on the early natural course may help to better evaluate treatment efforts aimed at preventing or reducing after-surgery neuropsychological alterations.

[Weight reduction in bulimia nervosa by abuse of thyroid hormones]. / Gewichtsreduktion bei Bulimia nervosa durch missbräuchliche Einnahme von Schilddrüsenhormonen.

We report on a 24-year-old female patient with an 8-year history of bulimia nervosa. Following high-calorie food intake the patient counteracts weight gain by massive abuse of laxatives and L-thyroxine. In addition to the abuse of slimming agents in patients with bulimia nervosa, which was recently reviewed by Krüger and Bräunig [3], abuse of thyroid hormones also has to be considered in these patients.

Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.

[Suicide rates, suicide methods and uncertain cause of death in the elderly]. / Suizidraten, Suizidmethoden und unklare Todesursachen alter Menschen.

The incidence of suicidal behavior among elderly people is difficult to determine, as it is probable that many suicides in this age group escape detection. This is attributable to the high incidence of "indirect" suicidal acts and the difficulty of detecting suicidal poisoning among elderly people, because deaths involving such methods are especially liable to be mistakenly classified under other categories of causes of death. Using the available statistics that record the causes of death for persons aged over 60 years in the Federal Republic of Germany, we examined co-variations between suicide figures and the occurrence of other categories of causes of death. The suicide rates exhibited a progressive increase with age for such age groups as a whole. However, the trends observed for individual 5-year age groups differentiated according to sex showed considerable differences, with the suicide figures increasing for some groups, but decreasing for others. Furthermore, these alterations were also found to be substantially dependent on the time periods selected. In general, the male/female suicide ratio altered to the disadvantage of women; increase in the suicide figures for women over 60 years exceeded the growth in the proportion of the population accounted for by this group. The latest available figures indicate that women over 60 years now commit 48% of all female suicides.(ABSTRACT TRUNCATED AT 250 WORDS)