Suicide attempts in major affective disorder patients with comorbid substance use disorders.

BACKGROUND: The widely accepted impression that substance abuse and dependence are associated with increased suicidal risk was evaluated by literature review and with new data. METHOD: Previous research on this association was reviewed, and clinical data on suicide attempts and substance use in 504 mood disorder patients hospitalized in 4 psychiatric units in Sardinia affiliated with the Italian mental health system were analyzed. RESULTS: The literature supports associations of alcohol and drug use comorbidity with major affective disorders, and of some substances (polyabuse, alcohol, heroin, cocaine, and even tobacco, but perhaps not marijuana or hallucinogens) with suicidal behavior. Our new findings generally supported these 2-way associations. Suicidal risks were similar in hospitalized men and women but were associated with bipolar II, bipolar I (mainly mixed), and unipolar depressive disorders as well as substance abuse, with little effect of type of agent. Substance abuse was more common in nonmixed bipolar disorders, men, and age below 30. CONCLUSION: The tendency for bipolar I, mainly nonmixed patients, to have a relatively high risk of substance abuse and low risk of suicide attempts indicates that mainly depressive or dysphoric (bipolar II, nonbipolar, and bipolar I, mainly mixed) mood disorders may be especially lethal. Differences in risks of substance abuse and suicidal behavior in men and in bipolar I patients further suggest that substance abuse and mood disorders may contribute to suicidal risk with at least partial independence or additivity.

[A social study of a group of depressed patients recovering in a private clinic]. / Studio sociale su un gruppo di pazienti depressi ricoverati in una clinica privata.

Depression is a widespread illness in Sardinia and is treated mainly in private clinics which accept National Health patients. The aim of the present study was to evidence socio-demographic and clinical characteristics of depressed subjects who turn to these clinics. Furthermore we will examine the reason which led to the choice of a private clinic on the basis of services provided by the same, of those available in public hospitals and of patients' psychopathological history and socioeconomic characteristics. We examined 122 depressed patients who had been admitted to a private clinic in Cagliari over a period of six months. By means of a data collection sheet the following parameters were studied: sex, age, place of birth and residence, marital status, family nucleus, profession, level of education, head of the family's occupation, receipt of pension or subsidy, geriatric or other forms of assistance, diagnosis, age at onset of illness, characteristics of current episode, previous hospitalizations, treatment received (public or private), structures usually applied to patients, social welfare aid and reason for the same, psychiatric structures available locally, persons who had requested current and previous hospitalization, reason which had led to choice of clinic. Examination of data collected revealed that females are hospitalized (94.27%) more than males (5.73%); this finding is in agreement with data reported in the literature which evidence a higher incidence of depression among females. The majority of patients were in the over-50 age group (56.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

Comparison between clinician-rated and self-reported depressive symptoms in Italian psychiatric patients.

The Inventory for Depressive Symptomatology is a new scale for measuring depressive symptoms. The reliability, validity and correlations between self-report and clinician-rated versions of the scale were examined in 86 Italian psychiatric patients. Results confirmed the validity and internal consistency of the scales. Self-ratings and clinician ratings were highly correlated. Total score on the self-rating scale was generally higher than the corresponding clinician scale score. Item analysis revealed that most items were rated slightly higher by self-report, with the items contributing most to this discrepancy being psychomotor agitation and retardation, self-outlook, and irritable mood. Both quality of mood and psychomotor agitation were more frequently endorsed by self-report than by clinician rating.

Double-blind evaluation of the safety and hypnotic efficacy of lormetazepam in general practice.

The efficacy and safety of lormetazepam (LMZ) and placebo were compared in 30 patients with sleep difficulties who were treated by general practitioners. During the three weeks of the study, each patient received placebo during either the first or last week and 1 mg/night of LMZ during the other two weeks. Neither patients nor physicians knew which week's medication was active drug and which was placebo. Twenty-three of the 30 patients completed the three-week trial. Both the quantity and the quality of sleep were significantly better during the weeks patients were given LMZ than during the week they used placebo. Physicians also rated the hypnotic performance as significantly better than that of placebo. Adverse reactions were evenly distributed among the LMZ and placebo treatment periods and were usually minor. Vital signs and laboratory values were unchanged during either treatment period. It is thus concluded that LMZ is a safe and effective hypnotic for use in general practice.