New GABAA receptor alpha5 subunit gene polymorphism that may confound genotyping.

We report the discovery of a new GABAA receptor alpha5 subunit gene polymorphism close to the polymorphism described by Glatt et al. (GT)5GCGTGC(GT)21. This new polymorphism is of great importance, because it means that non-denaturing acrylamide gels used to separate the different alleles of the polymorphism described by Glatt et al. cannot distinguish an allele with the sequence: (GT)4GCGTGC(GT)n from another allele with the sequence: (GT)4(GCGT)4GC(GT)(n-6). These gel fragments are separated by size, which would be the same in these two cases. An alternative would be to use an analysis method that can detect base changes, for instance, single strand conformation polymorphism (SSCP) or denaturing gradient gel electrophoresis (DGGE).

Dimensions of suicidal behavior according to patient reports.

Five factor analyses with limitations explored the Suicidal Intent Scale (SIS) subscales reflecting suicidal behavior dimensions. This larger sample study conducts an exploratory factor analysis of the SIS. Two large samples of suicide attempters (N= 435 and N= 252) from a general hospital were studied. The validity of SIS subscales obtained from the factor analysis was investigated by examining the association between the subscales and clinical variables. There were two factors: expected lethality and planning. In both samples, male gender and depression tended to be associated with higher scores in both subscales (small to medium effect sizes). Hospitalization was associated with higher scores in both SIS subscales (medium to large effects) suggesting that these subscales were reasonably good predictors of suicide attempt severity. Clinicians assessing patient reports to establish the severity of suicide attempts need to ask questions regarding both dimensions: expected lethality and planning.

[Familiar history of suicidal behavior]. / Historia familiar de conducta suicida.

Suicide is such a serious public health problem that it has been proposed as an indicator of mental health of a society. Self-harm, a behavior related with suicide, is also a public health problem with a prevalence 8 to 15 times higher than suicide. Suicide behavior is the result of different social, cultural, biological and psychopathological factors and affects all the cultures. This clinical case of 4 brothers from a family of 8 siblings seen repeatedly due to suicide attempts make it possible to discuss these factors. The family and social report describes a low economical and cultural level. The family climate is marked by aggressive environment and inappropriate care of the children. Different members of the siblings initiated drug consumption as a teenager. It is interesting to point out the high frequency of suicide attempts in this family and the health resources used as well as the deterioration in the quality of life associated. The elevated weight of the fa m i ly factors in the development of the suicide behavioris observed and offers the opportunity of questioning if whether it is the environmental factors, genetic vulnerability to mental disorder or specific predisposition to suicidal behavior that is transmitted in the family.

[Sociodemographic features of suicide attempts]. / Aspectos sociodemográficos de los intentos de suicidio.

Suicide accounts for about 10% of deaths among psychiatric patients, and life-threatening attempts are much more common than fatalities. Despite progress in defining risk rates and predictive factors, knowledge on which to base sound clinical and public policies regarding suicide prevention and treatment remains remarkably limited. Social risk factors and psychiatry diagnoses are the main arguments to management the suicidal behaviour in emergency room. Female gender is associate with suicide attempts while male gander is associate with completed suicide. Risk of suicide is increased in young and elderly people. Age is a confounding factor in the relationship among suicide and widow, income and professional status. Emigration and anomie are related with suicide. Social factor, as a marker of suicidal behaviour, are a promising research question.

A prospective study of the paradoxical relationship between impulsivity and lethality of suicide attempts.

BACKGROUND: Biological studies suggest that lower serotonergic activity is associated with both greater suicide lethality and impulsive personality traits. These results may lead to the conclusion that impulsivity in the attempt should be associated with greater lethality. However, Klerman's review of epidemiologic suicide studies suggests an inverse relationship between impulsivity and lethality. This seemingly paradoxical relationship between impulsivity and lethality has not been explored in large representative clinical samples of suicide attempts. METHOD: During 1996 to 1998, 478 individuals who attempted suicide were studied in a general hospital in Madrid, Spain. Impulsivity was measured as described in the literature by combining 2 items of Beck's Suicidal Intent Scale (active preparation for attempt and degree of premeditation). Lethality of the attempt was assigned 1 of 4 levels according to the need for medical and/or psychiatric treatment. RESULTS: More than half of the attempts were impulsive (55%; 95% confidence interval [CI], 51% to 59%), approximately one fourth of the attempts had an intermediate level of impulsivity (28%; 95% CI, 24% to 32%), and approximately one sixth of the attempts were not impulsive (17%, 95% CI, 13% to 21%). There was an inverse association between the impulsivity and lethality of the suicide attempt (chi2 = 62.639, df = 6, p < .0001). The most impulsive attempts tended to result in less morbidity, while the less impulsive attempts tended to be more lethal. CONCLUSION: If the inverse relationship between impulsivity and lethality is replicated in other large and representative samples, new studies will be needed to clarify the complex interactions between the clinical dimensions (lethality, impulsivity as a state, and impulsivity as a personality trait) and the biological correlates (particularly serotonergic function) of suicidal behavior.

Assessment of reliability in the clinical evaluation of depressive symptoms among multiple investigators in a multicenter clinical trial.

The objective of this work was to determine the severity of depressive symptoms when multiple clinical examiners evaluate a single subject, as preparatory to their participation as evaluators in a clinical trial. Using the 17-item Hamilton Depression Rating Scale (HDRS), 37 psychiatrists independently assessed the videotape of a patient with symptoms of depression. A new measure for the detection of multiple examiners not in consensus (DOMENIC) was used to identify scale items with low reliability and raters with low inter-rater reliability, from among the remaining raters. Overall inter-rater agreement on the full HDRS was 'excellent' (97%). All raters but one showed adequate agreement both on individual items and on total scores. Two of the 17 HDRS symptomatology items had unacceptable levels of inter-rater scoring variability (<70% agreement). The use of DOMENIC allows for the detection of items of low inter-rater reliability and identification of raters that deviate from the group's ratings prior to the beginning of a clinical trial.

The relationship between menstrual cycle phases and suicide attempts.

OBJECTIVE: The validity of prior studies on the menstrual cycle and suicide attempts assumes that suicidal women accurately describe their cycles. The three objectives of this study were 1) to explore whether prior inconsistencies are due to the effects of sample selection and method of assessment of the menstrual cycle, 2) to assess the relationship between the menstrual cycle phase and suicide attempts, and 3) to establish the role of sexual hormones in suicide attempts. METHODS: The original sample included 134 women who came to the emergency room of a general hospital after a suicide attempt. One hundred eight female blood donors were recruited as control subjects. The menstrual cycle was divided into follicular, midcycle, and luteal phases using two clinical methods and serum hormonal assessment. Dividing the follicular phase into menstrual and nonmenstrual phases was also considered. RESULTS: Two of 11 previously used sampling methods produced a sample size similar to that of the hormonal assessment. kappa values between the two clinical and the endocrinological methods were low (0.40-0.50). The number of suicide attempts during the follicular phase (particularly during the menstrual phase) was significantly higher than expected. CONCLUSIONS: Despite the inability to control for other variables and limitations, the results of this study suggest that sample selection could introduce biases and that studies relating psychiatric symptomatology and menstrual cycle phases need to use hormonal determinations. New studies are needed to verify that suicide attempts are more frequent during the follicular phase (particularly during the menstrual phase).

[Attempted suicide and previous contact with health system]. / Demanda de asistencia previa al intento de suicidio.

INTRODUCTION: Suicide behavior is an important health problem. Several works found have reported that the majority of completed suicides visited to the general practitioner in previous days. METHOD: 219 suicide attempts attended in a General Hospital were asked about their previous contact with health system. RESULTS: The third part of the patients have visited the general practitioner in the previous month. 60% of the patients with personal antecedents of psychiatric diseases have visited to mental services in the previous month. CONCLUSIONS: It is necessary to find risk suicide markers that allow identifying these patients in primary attention. The increment of the consultation periodicity is proposed as efficient risk suicide marker.

[Analytical thyroid disturbances in psychiatric inpatients]. / Un estudio de la función tiroidea en pacientes psiquiátricos ingresados.

BACKGROUND: There is not an agreement about the screening for thyroid disease in psychiatric inpatients. METHODS, The thyroid status of 172 psychiatric inpatients was assessed at the beginning of their hospitalization. A logistic regression was performed lo find the factors related with abnormal levels of thyroid hormones. RESULTS: As many as 30.8% of the inpatients presented levels of thyroid hormones and 5.2% have thyroid disease. The model chi2 was excellent (chi2= 20.89; gl= 4; p< 0.0001), the sensitivity was de 0.38 and the specificity was 0.83. Five variables fulfilled the criteria to be entered and not removed from the model: sex, schizophrenia, previous mental disorder, treatment with lithium, current infectious illness. CONCLUSIONS: A screening for thyroid disorder in psychiatric inpatients, at the beginning of their hospitalization, is recommended in female patients, schizophrenics and patients in treatment with lithium.

[Predictors of behavioural disorders and consultation-liaison psychiatry in patients with HIV disorders]. / Predictores de trastornos de conducta e interconsulta psiquiátrica en hospitalizados por trastornos-VIH.

OBJECTIVE: The aim was to identify the features of patients admitted into an Infectious Disease Unit in a Hospital due to pathology related to HIV and/or addiction that originate the demand for consultation liaison psychiatry. METHOD: During the first six months of 1997, 232 admissions into the Infectious Disease Unit at Ramón y Cajal Hospital (191 patients) were systematically evaluated by the nursery staff. A specific questionnaire was designed for this interview. After having performed univariants analysis, a logistic regression was used to identify the most relevant variables in the claim for consultation liaison. RESULTS: The claim for consultation liaison was associated to: consume in the unit OR (yes/no)= 7.9, confusional syndrome OR (yes/no)= 5.6, social worker consultation liaison OR (yes/no)= 2.1. use of benzodiazepines OR (yes/no)= 2.4. No medical treatment respect to bad accomplishment OR= 3.6. Only taking into account the known features after the first examination: use of benzodiazepines OR (yes/no)= 2.1, use of cocaine OR (yes/no)= 1.8, recognized income (yes/no)= 2.2, no medical treatment due to bad accomplishment OR= 2.1. CONCLUSIONS: In our environment the demand for consultation liaison psychiatry is related to behavioural problems due to the use of substances and marginality. The variables which predict the demand and may be identified at the time of admission are: the use of benzodiazepines, cocaine, the lack of a recognized income and the absence of medical treatment for the HIV infection. Recognizing these features will allow us to identify patients who are going to have behavioural problems and demand psychiatric assistance.

[Limitations of the diagnosis of bipolar disorder]. / Los límites del diagnóstico del trastorno bipolar.

INTRODUCTION: It has been studied the possible confusion in the diagnosis of bipolar disorder when there are no clear mania symptoms and other psychiatric disorders, due to his clinic similarity. The diagnosis received from a group of patients admitted in a Psychiatric Unit of a General Hospital by manic episode were studied. METHODS AND MATERIAL: 84 admitted patients have been followed up along an average of 32 months. By means logistic regression, there were found the factors that explained the change in the diagnosis along the evolution. RESULTS: 87% of the patients after the follow up kept the diagnosis of bipolar disorder. However, 63.1% had received other diagnosis. Two factors predicted to receive other diagnosis: depressive clinic and not having stable couple. CONCLUSION: Bipolar disorder presents a proper stability once diagnosis have been made. It may be confused with psychotic sight, unipolar depression and B cluster personality disorders. It is checked that patients which start with manic psychosis phases are the ones that present biggest diagnosis stability.

[Assessment of clinical assessment reliability among researchers of a multicenter clinical trial]. / Valoración de la fiabilidad de la evaluación clínica entre los investigadores de un ensayo clínico multicéntrico.

INTRODUCTION: Interater agreement is a main aspect in the planning and conducting a clinical trial. The objective of this study is to show the application of assessing levels of interexaminer's agreement when multiple ratings are made on a single subject as an efficient method of evaluating the interater's reliability in planning a multicenter clinical trial. METHOD: 39 psychiatrist assessed videotape of a patient with depression. The use of any reliability statistics is failed in the analysis of multiple independent ratings of a single subject since we used the methodology proposed by Cichetti et al. This method is able to identify raters whose ratings differ significantly from the average ratings and is sensitive for different levels of agreement. RESULTS: Interarter agreement was between good and excellent. The raters show an adequate agreement in total and items scores. CONCLUSION: The design proposed permits evaluate the interater agreement in an efficient way (only in one session).