Clinical evaluation of prior suicide attempts and suicide risk in psychiatric inpatients.

BACKGROUND: In practice psychiatrists rely on their own experience and intuition to evaluate the suicide potential of individual patients, but the algorithms for the decision-making process remain unclear. OBJECTIVES: (1) to establish models for the decision making process for evaluating suicide risk; (2) to simulate the impact of information concerning the number of previous suicide attempts on the clinician's ability to detect patients who performed medically serious suicide attempts (MSSAs). METHODS: Four decision models (linear, dichotomized, hyperbolic, and undifferentiated) depicting the influence of the number of previous suicide attempts on the clinician's recognition of MSSAs in 250 psychiatric inpatients were elicited and tested by a series of discriminant analyses. RESULTS: The dichotomized model ("all or none") was found to be the most efficient in detecting medically serious suicide attempts. CONCLUSION: The "all or none" paradigm seems to be the most appropriate way to evaluate the weight of previous suicide attempts in the decision-making process identifying medically serious suicide attempt patients.

Holocaust survivors hospitalized for life: the Israeli experience.

The Holocaust was the most traumatic experience to occur in the 20th century. The present study aims to assess elderly Holocaust survivors in a long-stay psychiatric setting. Data concerning hospitalized survivors were gathered from medical records, repeated interviews (Structured Clinical Interview for DSM-III [SCID]) with patients, and family interviews. Subjects were all inpatients at Israel's largest psychiatric hospital, Abarbanel Mental Health Center. Patients hospitalized in the same setting who did not undergo the Holocaust were the comparison group. Of the center's 670 beds, 74 (11%) are designated for psychogeriatric patients. Forty-four (59.5%) patients in the psychogeriatric section are Holocaust survivors. There were 41 women and three men in our series. Mean age of the group was 76.2 years (range, 54 to 92). The most frequent diagnosis was schizophrenia (22 of 44). Nearly 30% had been hospitalized chronically since the Holocaust. Mean current hospitalization time was 11.2 years (range, 1 to 45). The frequent diagnosis in the comparison group was also schizophrenia (20 of 30), but indexes of chronicity were more favorable. The severity and the chronic, deteriorating course of illness in this subgroup of survivors may be due to the massive life-long psychologic disintegration imposed by the Holocaust.

Sleep disturbances in children with attention-deficit/hyperactivity disorder: a comparative study with healthy siblings.

The sleep profiles of 13 children with attention-deficit/hyperactivity disorder (ADHD) who were treated with a fixed dose of methylphenidate for at least 1 month were compared with those of 16 healthy siblings. Sleep disturbances were assessed according to a structured sleep questionnaire, and the severity of ADHD was evaluated via the Conners Parents Teachers Rating Scale. The results indicated that significantly more children with ADHD demonstrated single or multiple sleep disturbances as well as higher rates of specific sleep disorders, such as initial and middle insomnia, compared with their siblings. No correlation was found between the severity of ADHD and disturbed sleep. Sleep duration and satisfaction with sleep were similar in the two groups. These findings raise important questions regarding the association between ADHD and disturbed sleep.

Prognostic and diagnostic value of endogenous erythroid colony formation in essential thrombocythemia.

Endogenous erythroid colonies (EECs), a typical characteristic of polycythemia vera (PV), could be observed in essential thrombocythemia (ET). Erythroid progenitors culture carried out in 34 previously untreated patients with unequivocal ET showed EECs in 35% of the cases. During a mean follow up of 4 years after the culture, the 12 EECs(+) and the 22 EECs(-) patients did not show any difference for a thrombotic or haemorrhagic complication, and the only one patient who showed an involvement of erythropoiesis was in the EECs(-) group.

First night effect in depression: new data and a new approach.

Polysomnography was performed in 20 depressed patients and 8 normal controls for 2 consecutive nights. A subset of patients had 3 consecutive nights. Patients were assigned to groups according to the presence (group I) or absence (group II) of a first night effect (REM sleep latency on the first night in the laboratory was at least 30 min longer than on the second night). The groups were equivalent with regard to gender distribution, age, and severity of depression. In group I, REM sleep latency on nights 2 and 3 was significantly shorter than in group II. REM sleep percentage on the second night in group I was increased compared to the first night. A shift of REM sleep to the first cycle was prominent on the first night only in patients with a first night effect. On average, delta sleep was preserved in group I compared to group II. We suggest that the first night effect reflects a physiological system with greater capacity to respond adaptively and to preserve homeostasis when confronted with environmental stressors.

REM sleep in depressed patients: different attempts to achieve adaptation.

Twenty-seven depressed patients and 10 healthy subjects were investigated in the sleep laboratory during two to three consecutive nights. Eleven of the 27 patients demonstrated the "first night effect" (group I) and 11 other patients demonstrated a clear absence of the "first night effect" (group II). Five of the 27 depressed patients were omitted from the study because they did not fit criteria for first night effect. The 10 healthy controls demonstrated a first night effect. In group I, the duration of the first rapid eye movement (REM) sleep episode was increased on the first night and on the second night the REM sleep latency was decreased, whereas REM sleep duration and eye movement (EM) density was increased. The number of the short sleep cycles (less than 40 minutes) was greater in group I versus group II and the percentage of slow-wave sleep (SWS) was also higher in group I. In depressed patients with the "first night effect" the enhanced REM sleep requirement is satisfied not only by an increased REM sleep duration but also by the improved REM sleep quality that is crucial for adaptation. The adaptive role of the increased first REM period and the increased EM density in this period is very limited.

Brief report: circadian melatonin, thyroid-stimulating hormone, prolactin, and cortisol levels in serum of young adults with autism.

An abnormal circadian pattern of melatonin was found in a group of young adults with an extreme autism syndrome. Although not out of phase, the serum melatonin levels differed from normal in amplitude and mesor. Marginal changes in diurnal rhythms of serum TSH and possibly prolactin were also recorded. Subjects with seizures tended to have an abnormal pattern of melatonin correlated with EEG changes. In others, a parallel was evidenced between thyroid function and impairment in verbal communication. There appears to be a tendency for various types of neuroendocrinological abnormalities in autistics, and melatonin, as well as possibly TSH and perhaps prolactin, could serve as biochemical variables of the biological parameters of the disease.

Factor analysis of schizophrenic symptoms and comparison of different rating scales.

This study examines the factor structure of persistent schizophrenic symptoms and compares factors derived from different rating scales. Forty stable chronic schizophrenic patients were assessed for positive and negative symptoms. In factor analysis, 3 factors could be detected: a negative factor which correlated with low drug dose and increased involuntary movements, a thought disturbance/paranoid factor which correlated negatively with extrapyramidal side effects and a delusion/hallucination factor which correlated negatively with involuntary movements. These findings support the existence of a negative factor but only partly the trichotomous division of schizophrenic symptoms. Positive symptom organisation is heterogeneous but thought disorder marks one clear dimension and non-paranoid delusions and hallucinations may mark another. The type of scale used has very significant effects on the findings.

Cyclic AMP second messenger signal generation in EBV-transformed lymphoblastoid cells from schizophrenic patients.

Several aspects of cyclic AMP second messenger signal generation were examined in EBV-transformed cell lines from 12 schizophrenic patients and 12 age- and sex-matched controls. No evidence was obtained suggesting a heritable abnormality in cyclic AMP synthesis in schizophrenia. Basal, forskolin, A1/NaF- and GppNHp-stimulated cyclic AMP synthesis in membranes from transformed cell lines was identical for schizophrenic and control subjects. In addition, no significant differences were observed for basal, forskolin-, isoproterenol- and prostaglandin E1-stimulated cyclic AMP accumulation in intact cell lines derived from ten of the schizophrenic patients compared with cell lines derived from ten of the control subjects.

Spontaneous cerebellar nuclei PGO-like waves in natural paradoxical sleep and under reserpine.

PGO-like spikes were described in chronically implanted cats at the cerebellar nuclei, dentatus, fastigii and interpositus, bipolarly and monopolarly recorded during natural paradoxical sleep. They showed close similarities with known PGO at occipital cortex and lateral geniculate nucleus: wave form, duration and amplitude were coincident. Moreover fast activity frequency increment in the last part of slow wave sleep also was observed at cerebellar loci. The peak-to-peak latency measurements demonstrated that the occipital cortex PGO lagged the nucleus dentatus PGO-like waves in 20-22 msec. The phasic cerebellar waves were not always related to eye movements. Acute experiments with a previous low dose of reserpine showed the PGO-like spikes when an exploring electrode penetrated a cerebellar nucleus. Chronically implanted cats, treated with reserpine, showed the phasic cerebellar waves during wakefulness and, after a few days, during the recovered paradoxical sleep. Based on electrophysiology and the reserpine experiments a common pontine generating mechanism for PGO and cerebellar PGO-like activity is proposed. It is also hypothesized that the cerebellum could participate in sleep physiology mainly related to phasic events without excluding a tonic function.