Suicide among physicians: Major risk for women physicians.

INTRODUCTION: The risk of suicide is related to professional activity. Preliminary data suggest that being in the medical profession increases the risk of suicide in women. The objective of this nationwide study is to compare the death rate of physicians due to suicide with that of the general population and to assess the differences based on gender. MATERIALS AND METHODS: All physicians and the general population who died by suicide in Spain between 2005 and 2014, both inclusive, were studied. Between these years, the Spanish population grew from 43,662,613 to 46,455,123 persons and from 199,123 to 238,240 number of doctors. The data relating to the deaths of physicians were extracted from the databases of the General Council of Official Medical Associations (CGCOM) and data related to the general population were obtained from the National Institute of Statistics (INE). The variables included in the analyses are gender, age, specialty, place of residence and death, and causes of death according to the ICD-10. RESULTS: The annual mean of physician deaths was 918, with an annual crude rate of 4.8 per 1,000 registered physicians. It is confirmed that physicians have a significantly higher suicide rate (average of 1.3%) than the general population (average of 0.8%) (p = 0.003). The comparison of suicide between men and women doctors is significantly higher in women (X2= 53.068, p<0.001). In addition, if we separate by gender, female physicians have a suicide rate 7.5% higher than women from the general population, although the difference is not significant (X2 = 2.614, p = 0.107). CONCLUSIONS: . Suicide is higher among physicians than the general population and affects female physicians significantly more.

Repercusiones de la retirada de la tioridazina / Repercussions of the withdrawal of thioridazine

Introducción. Como consecuencia de la retirada del mercado de la tioridazina, pacientes que habían sido tratados con este fármaco requieren un nuevo abordaje terapéutico. Observamos casos de ingreso en la unidad de agudos por descompensación tras la retirada de tioridazina y que presentan difícil manejo terapéutico. Se realiza una descripción de las características clínicas y de la pauta farmacológica que lleva a la estabilización del paciente. Resultados. La muestra obtenida en nuestra unidad es de 15 pacientes con una media de 20 años de estabilidad previa a la retirada de tioridazina. Representan un 6% de todos los pacientes en tratamiento con tioridazina durante2005 en nuestra región sanitaria. Presentaron un perfil psicopatológico común: patrón afectivo sobreañadido a la clínica psicótica, predominando labilidad emocional y tendencia a hipertimia de difícil manejo farmacológico. En un 27%se consiguió estabilidad con fenotiazinas piperazinas en monoterapia; en un 60 % requirieron la asociación con eutimizante y/o a antipsicótico atípico. Un 20% se estabilizaron con antipsicóticos atípicos en monoterapia. En un 40% pauta moseutimizante para manejar la inestabilidad afectiva y un 27 % presentaron respuesta a tratamiento con terapia electroconvulsiva (TEC), que se prescribe de segunda elección debido a la resistencia al tratamiento farmacológico asociado a gravedad. Conclusiones. Proponemos iniciar un tratamiento con el grupo de fenotiazinas piperazinas valorando la introducción de un eutimizante y/o TEC. Se ha producido un 33% de reingresos; un 40 % de los casos han requerido centros demedia/larga estancia y registramos un suicidio consumado. Observamos un elevado coste tanto de recursos asistenciales, económicos como de calidad de vida (autonomía, habilidades sociales y nivel cognitivo) en nuestra muestra tras la retirada de tioridazina (AU)

Introduction. As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. Results. The sample obtained in our unit included15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our healthcare area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27% of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60% of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. Conclusions. We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril® (thioridazine) withdrawal of the market (AU)

[Repercussions of the withdrawal of thioridazine]. / Repercusiones de la retirada de la tioridazina.

INTRODUCTION: As a consequence of the withdrawal of thioridazine from the market, patients who have been treated with this drug require a new therapeutic approach. We have observed patients who require admission to acute unit due to decompensation resulting from the withdrawal of thioridazine who present a difficult management of therapeutic regime. The clinical characteristics and drug treatment needed to stabilize the patient are described. RESULTS: The sample obtained in our unit included 15 patients with a mean of 20 years of stability prior to withdrawal of thioridazine. This represents 6% of all the patients treated with thioridazine in 2005 in our health care area. They had a common psychopathological profile: affective pattern in addition to the psychotic symptomatology with predominance of emotional lability and hypomaniac tendency which is difficult to control pharmacologically. Clinical stabilization was obtained in 27 % of patients by means of piperazine phenothiazines in monotherapy. An association with mood stabilizer and/or an atypical antipsychotic in 60 % of patients was needed. In 40 % we prescribed a mood stabilizer to manage affective instability and 27% responded to electroconvulsive therapy (ECT) treatment, which is indicated as a second option due to resistance to pharmacological treatment and/or presenting a serious condition. CONCLUSIONS: We propose starting treatment with a group of piperazine phenothiazines, evaluating the introducing of mood stabilizers and/or ECT in each case. There have been 33% re-admissions, 40% of which required medium/ long-term stay centers and one of which committed suicide. We demonstrate a high cost in terms of care, economic resources and of quality of life (autonomy, social skills and cognitive level) in our sample as a result of Meleril (thioridazine) withdrawal of the market.