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.

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.