A quarter century of suicide in a major urban jail: implications for community psychiatry.

OBJECTIVE: The authors' goal was to identify factors that increase the risk of suicide in urban jails. METHOD: They examined and verified all suicides as of 1992 in a representative large jail in Detroit since the beginning of record keeping in 1967 to 1992. RESULTS: There were 37 suicides over this time period. Inmates charged with murder or manslaughter were 19 times more likely to commit suicide than were inmates with other charges. Thirty-nine percent of the suicides were committed by individuals charged with murder. All 37 suicides were by hanging, and most occurred at night within 31 days of admission. Many of the inmates who committed suicide had made previous attempts while incarcerated. Thirty-nine percent of the suicides were committed by individuals charged with murder, constituting 2% of the admissions (two per day). CONCLUSIONS: An important risk factor in jail suicide not previously identified is the charge of murder or manslaughter. Treatment and prevention programs should recognize these inmates as belonging in a very high-risk category.

Dexamethasone suppression test in depression with reversible dementia.

Depression with reversible dementia occurs frequently in the elderly and may be a diagnostic problem. The 1-mg dexamethasone suppression test (DST) was performed in 175 elderly psychiatric patients. Abnormal DSTs occurred in both patients with primary degenerative dementia (n = 43, 34.9%) and those with major depression without cognitive dysfunction (n = 59, 66.1%). This finding suggests the presence of common hypothalamic abnormalities in these two disorders. There was no difference in the incidence of abnormal DSTs among depressives with a reversible dementia (n = 28, 78.6%), cognitively intact depressives (n = 59, 66.2%), and depressives who also had primary degenerative dementia (n = 24, 70.8%). An abnormal DST is not clinically useful in predicting the outcome of dementia in depressed patients with cognitive dysfunction.

Depression in patients referred to a dementia clinic. A three-year prospective study.

Of 225 patients referred to a dementia clinic, depression occurred in 31 (70%) of 44 patients not thought to be demented, six (24%) of 25 with cognitive impairment not severe enough to warrant the label dementia, and 24 (15%) of 156 with various forms of dementia, including 19 (19%) of 99 with Alzheimer-type dementia. Follow-up over three years has shown that 16 (57%) of 28 of the depressed, nondemented patients went on to develop frank dementia. Thirteen of these 16 had some sign, often subtle, of organic neurologic disease. Depressed elderly patients with any of the following are at high risk to develop dementia: evidence of cerebrovascular, extrapyramidal, or spinocerebellar disease; a modified Hachinski ischemic score of 4 or greater; a Mental Status Questionnaire score under 8; a dementia behavior score of 7 or higher; or confusion on low doses of tricyclic antidepressants. Dementing illnesses can present as depression with relatively little cognitive impairment.

Follow up of patients referred to a dementia service.

Eighty-five patients referred to a dementia clinic in a prosperous suburban setting were followed for as long as 48 months. Progressive dementia occurred in 55 of the 56 patients in whose cases it was predicted. Three-year mortality rates were 83 per cent for multi-infarct dementia, 57 per cent for mixed vascular plus Alzheimer dementia, and 37 per cent for Alzheimer disease. The differences in death rates among the different diagnostic groups support the validity of the clinical distinctions drawn. A subspecialty clinic can accurately identify progressive intellectual impairment in the elderly. The data suggest that patients who have depression complicating organic brain disease are at risk for progressive intellectual impairment, even if not demented when first seen. Intellectual deterioration appears to be a poor prognostic sign in older people.

A simple, reliable clinical behavioral scale for assessing demented patients.

A behavioral rating scale for demented patients is described. The scale has proven easy to learn and shows high reliability and consistency. It correlates well with clinical impressions of disability and also with the older scale developed by Blessed et al.

Plasma immunoreactive beta-endorphin levels in depression. Effect of electroconvulsive therapy.

Immunoreactive (ir) plasma beta-endorphin level was assayed in ten symptomatic patients with a unipolar major depressive disorder and in 16 psychiatrically normal controls matched for age and sex. Plasma ir-beta-endorphin level in depressed patients was similar to that in controls. All depressed patients was similar to that in controls. All depressed patients had a transient, approximately threefold increase in ir-beta-endorphin after each use of electroconvulsive therapy (ECT). The increase of plasma ir-beta-endorphin level after ECT parallels the transient elevation of adrenocorticotropic hormone level reported by others and probably reflects a hypothalamic response to ECT.