[Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures]. / Suizid im psychiatrischen Krankenhaus : Ergebnisse, Risikofaktoren, therapeutische Maßnahmen.

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

[Coping and convalescence course after lumbar disk operations]. / Coping und Genesungsverlauf nach lumbaler Bandscheibenoperation.

BACKGROUND: Aim of the present prospective longitudinal study was the statistical foundation and thus further replication of recent findings of Hasenbring [13], who postulated a significant importance of specific, within the psychological pain research long neglected pain coping strategies as risk factors concerning pain chronification: appeals to "stick it out" on the cognitive level and endurance strategies on the behavioural level. METHODS: In contrast to Hasenbring's heterogeneous chronic pain patients sample (first plus repeated surgical or conservative treatment) the present 82 low back pain patients with acute radicular pain and simultaneous lumbar disc prolapse all underwent first time lumbar nucleotomy. Prior to treatment we conducted an extensive psychological and neurological examination. The psychological tests included a general depression scale (Allgemeine Depressionsskala; ADS) and the Kiel Pain Inventory (KPI). Based on these scales a cluster analysis was performed, which allocated patients to four distinct groups resembling the group structure ascertained by Hasenbring [12, 13]: A first group of patients characterized by a positive mood and marked endurance strategies (n=7); another cluster with depressive mood and simultaneous cognitive appeals to stick it out (n=10); a third group of emotionally depressed patients who preferably applied social and physical avoidance strategies in their coping with chronic pain (n=29), plus a last cluster without any psychological risk factors (n=26). RESULTS: As treatment outcome criteria to evaluate the quality of the convalescence process six months later we assessed the pain intensity (11-point self-rating scale), the ability to work, and whether the patients had applied for early retirement or not. Results showed no significant differences in pain intensity between the groups at the 6-month follow up. Concerning the two other outcome variables the two clusters characterized by cognitive or behavioural endurance tendencies turned out to be high risk groups: At the 6-month follow up patients of both groups seemed less likely to return to work. The patients typified by endurance strategies and positive mood had more often applied for early retirement than those patients without psychological risk factors. DISCUSSION: These results corroborate the finding that this subgroup of chronic low back pain patients might indeed carry a bad prognosis and call for further research into this area, especially with regard to rehabilitation potential and facilities of reintegration into working life.

Potential antisecretory antidiarrheals. 2. Alpha 2-adrenergic 2-[(aryloxy)alkyl]imidazolines.

Lofexidine, an alpha 2-agonist, has central hypotensive activity and peripheral intestinal antisecretory activity. Analogues were synthesized with increased polarity in an attempt to prevent penetration of the blood-brain barrier. The compounds were evaluated in the cholera toxin treated ligated jejunum of the rat and in the Ussing chamber with a rabbit ileum preparation. Active compounds were determined to be alpha 2-adrenergic agonists by yohimbine reversals of their Ussing chamber activities. The 2,6-dimethyl derivative of lofexidine, 4a, was as active as lofexidine in vivo, but derivatives with 2,6-substituents larger than ethyl were inactive. (Aryloxy)alkyl derivatives which have an imidazoline and a methyl or larger group as part of the alkyl exhibited the best antisecretory activity. Compounds with substituents in the para position of the phenyl ring were generally inactive. 3-Amino-2,6-dimethyl derivative 21 was twice as active as 4a. A 2-methyl substituent is required in the 3-amino series to retain good activity. 2-Methyl derivative 12a had activity comparable to that of 4a, while 6-methyl derivative 12f was inactive. Substituents on the 3-amino group did not affect the activity, but substituting a hydroxyl for the amino group produced an inactive compound. Replacing the phenyl moiety with a 4-indole resulted in retention of activity, but other heterocycles were inactive. Compound 12a was resolved and d isomer 32 was five times more potent than l isomer 33. The more active compounds in the rat cholera toxin assay (RCTA), when evaluated in the dog, exhibited antisecretory activity but also exhibited central nervous system (CNS) effects, sedation and ataxia, at 10 mg/kg, and in spontaneously hypertensive rats at 50 mg/kg. A measure of polarity, log P, was calculated for the (aryloxy)alkyl groups. Regression analysis showed no correlation of antisecretory ED50 to the calculated log P. The active compounds did not show a separation of the central CNS effects from the peripheral antisecretory activity by increasing the polarity.