Prevalence and characteristics of suicide attempters and ideators among acutely admitted psychiatric hospital patients in northwest Russia and northern Norway.

BACKGROUND: More knowledge about suicidality and suicide risk profiles in acute psychiatric hospital patients (both first-time and chronic patients) is needed. While numerous factors are associated with suicidality in such populations, these may differ across cultures. Better understanding of factors underlying suicide risk can be informed by cross-cultural studies, and can aid development of therapeutic and preventive measures. METHODS: An explorative, cross-sectional cohort study was carried out. Acutely admitted patients at one psychiatric hospital in northwest Russia and two in northern Norway were included. At admission, demographic, clinical, and service use data were collected, in addition to an assessment of suicidal ideation and attempts, comprising five dichotomic questions. Data from 358 Norwegian and 465 Russian patients were analyzed with univariate and multivariate statistics. Within each cohort, attempters and ideators were compared with patients not reporting any suicidality. RESULTS: The observed prevalence of suicidal ideation and attempts was significantly higher in the Norwegian cohort than in the Russian cohort (χ(2) = 168.1, p < 0,001). Norwegian suicidal ideators and attempters had more depressed moods, more personality disorders, and greater problems with alcohol/drugs, but fewer psychotic disorders, cognitive problems or overactivity than non-suicidal patients. Russian suicidal ideators and attempters were younger, more often unemployed, had more depressed mood and adjustment disorders, but had fewer psychotic disorders and less alcohol/drug use than the non-suicidal patients. CONCLUSIONS: Rates of suicidal ideation and non-fatal attempts in Norwegian patients were intermediate between those previously reported for patients admitted for the first time and those typical of chronic patients. However, the significantly lower rates of suicidal ideation and non-fatal attempts in our Russian cohort as compared with the Norwegian, contrasted with what might be expected in a region with much higher suicide rates than in northern Norway. We suggest that suicide-related stigma in Russia may reduce both patient reporting and clinicians' recognition of suicidality. In both cohorts, overlapping risk profiles of ideators and attempters may indicate that ideators should be carefully evaluated and monitored, particularly those with depressed moods, alcohol/substance abuse disorders, and inadequate treatment continuity.

Is there a negative impact of winter on mental distress and sleeping problems in the subarctic: the Tromsø Study.

BACKGROUND: Prior studies have suggested that the darkness of winter impacts the level of mental distress and sleeping problems. Our study investigated whether people living in the sub-arctic had more sleeping problems or mental distress during winter. METHODS: The cross sectional population Tromsø Study was conducted in Tromsø, North Norway, at 69.4 degrees North and above the Arctic Circle. The study included entire birth cohorts and random samples of the population aged 30 to 87 years. Data was collected continuously from 1 October 2007 to the end of December 2008 except July. 8951 persons completed questionnaires including the HSCL-10 and the MCTQ. RESULTS: There were no significant differences in the reporting of current mental distress depending on season. Significantly more reported current sleeping problems in winter than in the other seasons, and less sleeping problems was found in spring. CONCLUSIONS: In this sub-arctic population, insomnia was most prevalent in winter, but there were no significant seasonal differences in mental distress. Although some people in the sub-arctic clearly are mentally negatively affected by the darkness of winter, the negative impact of winter on mental distress for the adult population is not conclusive.

Hypnotic drug use among 0-17 year olds during 2004-2011: a nationwide prescription database study.

AIMS: To (a) describe the prevalence, trend, and amount of hypnotic drug use, (b) determine the prevalence of chronic diseases among hypnotic drug users, and (c) determine levels of recurrent hypnotic drug use (2007-2011), among 0-17 year old Norwegians. METHODS: Data were obtained from the nationwide Norwegian Prescription Database (NorPD) in the period 2004-2011. RESULTS: Hypnotic drug use in 0-17 year olds increased during the period, from 8.9 to 12.3 per 1000, mainly owing to doubling of melatonin use. Hypnotic drug use peaked at 15 per 1000 among those aged 1-2 years. Melatonin use increased steadily from 6 to 12 years of age, most pronounced in males. Among females, hypnotic drug use increased threefold from 13 to17 years of age. Melatonin was dispensed in the highest annual amount of all hypnotic drugs; accounting up to a median of 360 defined daily doses in 9-13 year old boys. A total of 62% and 52% of all male and female hypnotic drug users were co-medicated with reimbursable drugs for chronic diseases. Levels of recurrent use (2007-2011) were 12% in boys and 8% in girls, of whom 76-77% were co-medicated with drugs reimbursed for chronic diseases. CONCLUSIONS: There is a trend of increasing use of hypnotic drugs among 0-17 year olds, mainly owing to increasing use of melatonin, used in high amounts. Still, melatonin is not recommended in Norway for use in this age group because of insufficient data on safety and efficacy. A threefold increase in hypnotic drugs among females from 13 to 17 years of age warrants attention.

Psychologists and coercion: decisions regarding involuntary psychiatric admission and treatment in a group of Norwegian psychologists.

Following the implementation of the new Norwegian law regarding mental healthcare in 2001, Norwegian hospital-based psychologists with clinical specialist qualifications can make legal decisions regarding the coercion of psychiatric patients. However, it has not been known which attitudes psychologists have towards coercing patients. In the present study, 340 psychologists responded to a questionnaire containing three cases with patients suffering from schizophrenia. They were asked in which cases they would admit involuntarily and treat the patients involuntarily with neuroleptics. A majority would coerce when the patient was violent. More than a third would coerce when the patient had problems coping with activities of daily life. The fewest would coerce a patient that was in an early schizophrenic development with few symptoms. In the cases involving non-violent patients, significantly more would accept involuntary admission than involuntary treatment with neuroleptics. Higher age, female sex and prior experience with coercion were positive predictors of willingness to coerce.

123I-beta-CIT SPECT demonstrates increased presynaptic dopamine transporter binding sites in basal ganglia in vivo in schizophrenia.

RATIONALE: The dopamine hypothesis for schizophrenia postulates overactivity of dopamine transmission in the basal ganglia. Most effective antipsychotic drugs block postsynaptic dopamine receptors, but in-vivo imaging studies have not been able to show changes in these receptors in drug-naive schizophrenics. OBJECTIVES: The presynaptic dopamine transporter (DAT) is thought to be an important regulator of synaptic dopamine concentration. We have used SPECT with (123)I-beta-CIT, which has a high affinity for DAT, in order to further examine the dopamine hypothesis for schizophrenia. METHODS: Six patients with chronic schizophrenia treated with classic dopamine D(2)-receptor blocking neuroleptics were investigated. The number of DAT binding sites in the basal ganglia was calculated and compared with five healthy volunteers and ten parkinsonian patients. RESULTS: The schizophrenic patients showed a 36-63% increase in DAT binding sites compared with the volunteers, whereas the parkinsonian patients showed a 57-96% decrease. The differences between the groups were highly significant (even after correction for different age composition within the groups). CONCLUSIONS: There was an increased number of DAT binding sites in the schizophrenic patients treated with dopamine D(2)-receptor blocking neuroleptics. This fits well with several recent reports that have shown increased volumes of basal ganglia in this patient category. It thus appears that there is an increased number of presynaptic dopamine releasing nerve terminals in the basal ganglia, possibly as a biological adaptation to counteract the postsynaptic dopamine D(2)-receptor blockade.

Micrometer-sized particles in cerebrospinal fluid (CSF) in patients with schizophrenia.

The etiology of schizophrenia is unknown, but the pathogenetic process involves organic changes in brain tissue, which may alter the composition of cerebrospinal fluid (CSF). For the present study, CSF was obtained by lumbar puncture from 22 schizophrenic patients and 38 control patients. We have used scanning electron microscopy combined with filtration techniques to search for pathogenic correlates and diagnostic biomarkers in the nano-micrometer range. Micrometer-sized spherical particles were isolated from CSF in 20 of the 22 patients with schizophrenia compared to only two of the 38 controls (P < 0.001). Reverse transcription-polymerase chain reaction analysis did not reveal bacterial DNA material in the particles. The particles have not replicated in culture. The micrometer-sized particles may serve as biological disease markers in schizophrenia. Hypothetically, they may be involved in development of the disease or may result from the disease process in brains of schizophrenic patients.

Alterations in serum melatonin and sleep in individuals in a sub-arctic region from winter to spring.

METHODS: In a sub-arctic region at 69 degrees N, seven individuals with self-reported insomnia during the 'dark period' and seven without, were followed with repeated measures of melatonin and questioned on ten different sleep variables, from the beginning of January to the vernal equinox in March. RESULTS: The distribution of melatonin over a 24-hour period (five time points) indicated an increase in melatonin levels in both groups in the middle of January and a decrease at the time of year when the sun first rises over the horizon (23rd-24th of January). Moreover, an indication of a delayed phase shift of melatonin secretion was found during the dark period, which returned to "normal" secretion during the night at the equinox in March. Individuals with sleep problems had a slower return to "normal" melatonin secretion than those without sleep problems. A positive correlation between morning tiredness and morning levels of melatonin was found among individuals with sleep disturbances, but not in controls. CONCLUSION: This study indicates changes in the internal circadian rhythm in humans at the end of the annual dark period of winter when there is a rapid increase in the number of hours of sunlight. For vulnerable individuals, the disturbance in sleep, and in particlar morning tiredness, lasts at least until the vernal equinox in March.

Optimal sleep duration in the subarctic with respect to obesity risk is 8-9 hours.

INTRODUCTION: Sleep duration, chronotype and social jetlag have been associated with body mass index (BMI) and abdominal obesity. The optimal sleep duration regarding BMI has previously been found to be 7-8 hours, but these studies have not been carried out in the subarctic or have lacked some central variables. The aims of our study were to examine the associations between sleep variables and body composition for people living in the subarctic, taking a range of variables into consideration, including lifestyle variables, health variables and biological factors. METHODS: The cross sectional population Tromsø Study was conducted in northern Norway, above the Arctic Circle. 6413 persons aged 30-65 years completed questionnaires including self-reported sleep times, lifestyle and health. They also measured height, weight, waist and hip circumference, and biological factors (non-fasting serum level of cholesterol, HDL-cholesterol, LDL-cholesterol, triglycerides and glucose). The study period was from 1 October 2007 to 19 December 2008. RESULTS: The optimal sleep length regarding BMI and waist circumference was found to be 8-9 hours. Short sleepers (<6 h) had about 80% increased risk of being in the BMI≥25 kg/m2 group and male short sleepers had doubled risk of having waist circumference ≥102 cm compared to 8-9 hours sleepers. We found no impact of chronotype or social jetlag on BMI or abdominal obesity after controlling for health, lifestyle, and biological parameters. CONCLUSIONS: In our subarctic population, the optimal sleep duration time regarding risk of overweight and abdominal obesity was 8-9 hours, which is one hour longer compared to findings from other studies. Short sleepers had 80% increased risk of being overweight, and men had a doubled risk of having abdominal obesity. We found no associations between chronotype or social jetlag and BMI or abdominal obesity, when we took a range of life-style, health and biological variables into consideration.

Lack of major seasonal variations in self reported sleep-wake rhythms and chronotypes among middle aged and older people at 69 degrees North: the Tromsø Study.

OBJECTIVE: Sleep timing and duration are influenced by outdoor light, but few studies have addressed these relationships in subarctic populations. We aimed to investigate how the extreme photic environment at 69 degrees north, with absence of daylight for 2months in the winter and constant light for 2months in the summer, would affect the sleep-wake rhythm. METHODS: 4811 people ages 35-70years, from the cross sectional study 'Tromsø 6' responded to the Munich Chronotype Questionnaire, in addition to socio-demographic and health-related information. The seasonal distribution of chronotypes was calculated based on the MCTQ at the participation dates. RESULTS: Late types had a 10min increase in sleep duration on free days from winter to spring, but had no seasonal variation in the average sleep duration; as well as no seasonal variations in mid sleep on free days was found. However, when chronotype distribution was adjusted for confounding factors e.g. age and sex, we found a significant advance in phase (8min) in the summer compared to the wintertime. This advance in MSFsc was significant both for the employed and the unemployed. CONCLUSION: Other factors may be more important than daylight exposure in the regulation of sleep patterns for people in the subarctic. Moreover, the use of stimulants or excessive indoor and outdoor light may have masked the seasonal effect of variation in daylight. Further prospective studies and more research on clock-gene polymorphism, photosensitivity and other biological variables among subgroups of subarctic populations are needed.

Treatment needs, diagnoses and use of services for acutely admitted psychiatric patients in northwest Russia and northern Norway.

BACKGROUND: We compared demography, diagnoses and clinical needs in acutely admitted psychiatric hospital patients in northwest Russia and northern Norway. METHOD: All acutely admitted psychiatric patients in 1 psychiatric hospital in north-west Russia and 2 in northern Norway were in a three months period assessed with HoNOS and a Norwegian form developed to study acute psychiatric services (MAP). Data from a total of 841 patients were analysed (377 Norwegian, 464 Russian) with univariate and multivariate statistics. RESULTS: Russian patients were more often males who had paid work. 2/3 were diagnosed with alcohol and organic disorders, and 70% reported problems related to sleep. Depression was widespread, as were problems associated with occupation. Many more Norwegian patients were on various forms of social security and lived in community supported homes. They had a clinical profile of affective disorders, use of drugs, suicidality and problems with activities involved of daily life. Slightly more Norwegian patients were involuntary admitted. CONCLUSION: Acutely admitted psychiatric patients in North West Russia and Northern Norwegian showed different clinical profiles: alcohol, depression and organic disorders characterised Russian patients, affective disorders, suicidality and use of drugs characterised the Norwegians. Whereas Norwegian patients are mainly referred from GPs the Russians come via 1.line psychiatric services ("dispensaries"). Average length of stay for Russian patients was 2.5 times longer than that of the Norwegian.