An examination of DSM-IV borderline personality disorder symptoms and risk for death by suicide: a psychological autopsy study.

OBJECTIVE: To clarify whether certain Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), borderline personality disorder (BPD) symptoms are more prevalent among people who die by suicide, and thereby better predict suicide risk. METHOD: A psychological autopsy method with best informants was used to investigate DSM-IV BPD symptoms and suicide risk among people who died by suicide and met criteria for BPD (n = 62), and BPD control subjects (n = 35). RESULTS: BPD symptoms in people who died by suicide were less likely to include affective instability and paranoid ideation-dissociative symptoms. The negative association between paranoid ideation-dissociative symptoms and suicide was independent of all other BPD symptoms, Cluster B comorbidity, and alcohol dependence. CONCLUSIONS: We found that discrete DSM-IV BPD symptoms differentiate people with BPD who die by suicide and those who do not. People with BPD who go on to die by suicide appear to constitute a specific subgroup of those who meet criteria for BPD, characterized by different general clinical presentation, but also by different characteristics within BPD.

The incidence of first-onset psychotic symptoms and paranoid ideation in a representative population sample followed from age 70-90 years. Relation to mortality and later development of dementia.

BACKGROUND: Limited data are available on the incidence of psychotic symptoms in the elderly. OBJECTIVE: To elucidate the incidence of first-onset psychotic symptoms in the elderly and their relation to mortality and later development of dementia. METHOD: A population-sample (n = 392) born 1901-1902 was assessed from age 70-90 with psychiatric examinations, medical record reviews and from age 85, also with key-informant interviews. Individuals developing dementia were excluded. RESULT: The cumulative incidence of first-onset psychotic symptoms was 4.8% (8.0% including key-informant reports in the total sample) and 19.8 % in those who survived to age 85. Sixty-four percent of those with first-onset hallucinations later developed dementia, compared to 30% of those with delusions and 25% of those without psychotic symptoms. CONCLUSIONS: One fifth of non-demented elderly who survives up to age 85 develops first-onset psychotic symptoms. Hallucinations predict dementia, but most elderly individuals with first-onset psychotic symptoms do not develop dementia.

Antipsychotic medication and suicide risk among schizophrenic and paranoid inpatients. A controlled retrospective study.

A retrospective analysis of the psychotrophic medication, illness history and recent mental symptoms of 28 schizophrenic or paranoid inpatients who had committed suicide and the same number of matched control subjects was carried out. The groups were first compared separately for every variable, and 6 statistically most significant variables in the paired comparisons were then entered into a stepwise linear logistic regression model. Four statistically significant differences between the groups were found with the paired comparisons. The suicide group had more often previous suicide attempts, lower neuroleptic doses, more depressive symptoms and less positive schizophrenic symptoms compared to their controls. The results of the regression analysis suggested that the lower neuroleptic doses in the suicide group were more probably a consequence of the differences in the symptom profile than in a direct causal relationship to the suicides per se.

A preliminary study of excess mortality using a psychiatric case register.

Systematic screening of death certificates referable to residents of two health districts covered by a psychiatric case register allows the study of excess mortality in unselected psychiatric patients from a defined area of known population. Deaths among the case register patients exceeded those expected by 80%; the relative risk was maximal during the first year after registration and was significantly raised in both sexes and in patients of all age-groups. Patients may be selected by service use and by diagnostic group: the excess mortality of "inpatients" both in relative and absolute terms exceeded that of "outpatients". For dementia patients both the relative risk and more notably the absolute risk was high, and the excess mortality was significantly raised in both sexes and all age-groups. It was again greatest during the first year after registration. Deaths of patients with schizophrenia and paranoid psychosis exceeded those expected by 40 per cent and the excess was limited to the first year after registration and occurred predominantly among men.