Death by suicide in Grampian 1991-1999: comparison with a previous study.

OBJECTIVES: To review the changes in suicide and undetermined death rates in Grampian between 1991-1999 and to make comparisons with a previous study on the same population. DESIGN: All suicide and undetermined deaths in Grampian recorded by the General Register Office for Scotland were included and linked with the psychiatric case records from Grampian Health Board. RESULTS: The high suicide and undetermined death rates in Grampian are accounted for by the excess of deaths in males. In males there has been a change in the method used to commit suicide with hanging now being the commonest method used. Firearm deaths have reduced dramatically since legislation was introduced in 1997 (RR = 021,95% CI [0.05,0.91). For those with previous psychiatric contact, a greater proportion were drug users than in 1974-1990 (OR = 3.75,95%CI [2.7, 5.2]). A higher percentage of suicides have a history of more than one previous attempt at suicide than in 1974-990. In Grampian there is a lower percentage of inpatient suicide than the rest of Scotland. CONCLUSION: There have been changes in suicide trends in Grampian and these are similar to elsewhere in Scotland Strategies to address this are discussed.

Ethics and aims in psychotherapy: a contribution from Kant.

Psychotherapy is an activity which takes many forms and which has many aims. The present paper argues that it can be viewed as a form of moral suasion. Kant's concepts of free will and ethics are described and these are then applied to the processes and outcome of psychotherapy. It is argued that his ideas, by linking rationality, free will and ethics into a single philosophical system, offer a valuable theoretical framework for thinking about aims and ethical issues in psychotherapy.

Psychosis de novo following temporal lobectomy.

A case report of a 61 year-old male with a long history of complex partial seizures is presented. Multiple psychotic symptomatology developed post-operatively. It is argued that these reflect continuing right temporal epileptogenic activity.

Death by suicide in Grampian 1974-1990.

OBJECTIVES: Examination of rates of suicide and undetermined deaths in one health board area between 1974 and 1990. Data are presented on contacts between decreased individuals and the psychiatric and clinical psychology services and general practice. DESIGN: Retrospective analysis of data from psychiatric, clinical psychology and general practice case records, and from the General Register Office for Scotland. SUBJECTS: Deaths by suicide, undetermined causes and accidental poisoning. RESULTS: Male suicide rates increased by 25% in the period studied. Rates in females declined by 65%. There was a small decrease in rates of death by undetermined causes in both sexes. 46% of those dying by suicide and 41% of those dying by undetermined causes had current or past contact with the Psychiatric Services. CONCLUSION: The study offers data on suicide to allow planning of measures to achieve national targets for reduction in suicide rates.

Non-progressive familial idiopathic intracranial calcification: a family report.

The clinical features and long term outcome of familial idiopathic intracranial calcification in three members of one family are described. The illness presented as psychiatric disorder in all patients, and in one patient, epilepsy and intellectual deterioration were later manifestations. Skull radiographs and CT were performed sequentially, in one patient, over a 22 year period and, in another, CT was carried out eight years apart. In neither patient was there any evidence of progression of calcification.

Long-term mortality in anorexia nervosa. A 20-year follow-up of the St George's and Aberdeen cohorts.

Two cohorts of anorexia nervosa patients were followed up for a mean of 20 years. All except 4% of each cohort was traced. The crude mortalities were: St George's, 4%; Aberdeen, 13%. The SMRs were: St George's, 136; Aberdeen, 471. If the untraced were assumed to be dead, crude mortalities were 7.6% and 15.9% respectively, and SMRs were 276 and 592 respectively. Causes of death were complications of the illness and suicide. Medical treatment may reduce early mortality, while comprehensive medical and psychotherapeutic treatment may reduce late mortality.

Psychiatric diagnoses in recovered and unrecovered anorectics 22 years after onset of illness: a pilot study.

Sixteen female anorectics, nine recovered and seven unrecovered, were interviewed 22 years after onset of illness. Concomitant psychiatric diagnoses were much more common among the unrecovered patients, but three recovered patients have had a major depressive episode occurring after recovery from their eating disorder. The findings point to a linkage between eating and affective disorders and the mechanisms of such a linkage are briefly discussed.

A comparison of anorexia nervosa and affective psychosis in young females.

In a retrospective case note study, 73 young females with anorexia nervosa were compared with 88 young females with affective psychosis. These groups of patients did not differ in terms of place of residence, birth order or social class. They differed very significantly, however, in terms of age at onset of symptoms, marital status, educational attainments and in the pattern of family histories of psychiatric illness. It is concluded that anorexics and young females with affective disorders are two quite distinct groups of patients.

Comparison of enalapril and atenolol in mild to moderate hypertension.

PURPOSE: Short-term therapy with angiotensin converting enzyme (ACE) inhibitors for hypertension is effective and well tolerated, and compared with beta blockers, may cause fewer adverse reactions. Furthermore, enalapril has been observed to have a greater effect on systolic blood pressure than beta blockers. We therefore decided to compare the ACE inhibitor enalapril and the beta blocker atenolol as monotherapy in a double-blind study of patients with mild to moderate hypertension. PATIENTS AND METHODS: After a four-week placebo run-in period, 162 patients were allocated randomly to receive atenolol (50 to 100 mg daily) or enalapril (20 to 40 mg daily) for 12 weeks. To assess the influence of these drugs on quality of life, a series of psychologic tests was performed, and a subset of patients also underwent treadmill exercise and pulmonary function tests. RESULTS: In 147 patients who completed the study, enalapril reduced supine blood pressure by 19/12 mm Hg, compared with 9/7 mm Hg for atenolol (p less than 0.001/p less than 0.005). The modest blood pressure response to atenolol was not due to poor compliance. A target blood pressure of 140/90 mm Hg or less was achieved by 35 percent of enalapril-treated atenolol (p less than 0.01). The frequency and severity of adverse effects with the two drugs were similar, and few important differences emerged from the quality-of-life assessments. CONCLUSION: At the doses used, enalapril induced a greater short-term blood pressure response than atenolol; long-term studies of its safety and efficacy are required.

Mood changes during captopril therapy for hypertension. A double-blind pilot study.

A small double-blind pilot study was carried out to assess whether captopril treatment in hypertension has a euphoriant effect. Eight patients were maintained on constant therapy of atenolol and bendrofluazide for at least 4 weeks before and throughout the study. Captopril 25 mg three times daily or matching placebo was administered double-blind for 6 weeks, with crossover to placebo or captopril from Weeks 7 to 12. Psychiatric assessment was made at Weeks 3, 6, 9, and 12. During the captopril phase, blood pressure was reduced, plasma angiotensin II lowered, and plasma renin raised. Mood was slightly, but significantly, lower during captopril administration; thus, there was no evidence of an euphoriant effect of captopril. This pilot trial also indicates the feasibility of the approach, and such studies of hypertensives under therapy should be usefully extended and refined.