Clinical and neuropsychological aspects of non-fatal self-harm in schizophrenia.

PURPOSE: To investigate demographic, clinical and neuropsychological aspects of self-harm in schizophrenia and identify which are independently predictive of and therefore the most relevant to clinical intervention. SUBJECTS AND METHODS: Eighty-seven patients with schizophrenia were interviewed regarding substance misuse, depression, hopelessness, negative/positive symptoms and illness insight. Neuropsychological assessment included premorbid IQ, continuous performance test, cognitive-motor and trait impulsivity. A prospective three-month review of medical records was also undertaken. RESULTS: Fifty-nine patients (68%) reported past self-harm (including attempted suicide). Those with past self-harm, compared to those without, were significantly more likely to report depression, hopelessness, impulsivity, a family history of self-harm, polysubstance abuse and had higher premorbid IQ. Logistic regression revealed that depression, higher premorbid IQ and polysubstance abuse were independently linked to self-harm. Five participants attempted self-harm during the 3-month prospective follow-up period. These all had a history of past self-harm and were significantly more likely to have been depressed at the initial interview than those who did not go on to self-harm. DISCUSSION AND CONCLUSIONS: Independent predictors of self-harm in schizophrenia are premorbid IQ and polysubstance abuse. In addition, depression was both independently associated with past self-harm and predictive of self-harm in the follow-up period.

Common carotid artery intima media thickness and post-stroke cognitive impairment.

BACKGROUND AND PURPOSE: Acute stroke and other forms of cerebrovascular disease are well-recognized causes of cognitive impairment. Common carotid artery intima media thickness (CCA-IMT) has been associated with certain forms of cerebrovascular disease, but its association with cognitive impairment of vascular origin has not been elucidated. The purpose of this study was to investigate whether CCA-IMT is associated with cognitive impairment 1 year after an acute ischemic stroke. METHODS: A total of 171 consecutive patients with the first ever stroke (mean age 66+/-11.5, 41% female) underwent carotid ultrasonography during hospitalization. Demographic data, vascular risk factors and presenting stroke features were also recorded. One year later, patients' cognitive performance and depression were assessed using the Mini-Mental State Examination (MMSE), and the Montgomery Asberg Depression Rating Scale (MADRS). RESULTS: Cognitive impairment (MMSE score<24) was found in 67 (39%) of the 171 patients. CCA-IMT was significantly associated with cognitive impairment, and this association remained unchanged (OR 1.94; 95% CI 1.19-3.18) after adjustment for demographic data, vascular risk factors, stroke features, other carotid ultrasonography measurements and depression. Older age, low education level, large hemispheric lesions, hyperdense carotid plaques and depression were also independently associated with post-stroke cognitive impairment. CONCLUSIONS: In this study, CCA-IMT was independently associated with cognitive impairment 1 year after an acute ischemic stroke, and thus, it might help with the screening of stroke patients at risk of cognitive impairment.

Family history of stroke in stroke types and subtypes.

Many studies have provided data showing that family history of stroke (FHS) is associated with an increased risk of stroke. The association of the FHS with the various stroke subtypes has not been adequately studied. The purpose of this study was to assess the association of the FHS with the two major stroke types (cerebral haematomas and ischaemic strokes) and the four stroke subtypes (cardioembolic, large artery disease, small artery disease, and undetermined) in a Greek population. The FHS was obtained from 421 consecutive acute stroke patients and from 239 matched control subjects. Positive FHS was observed in 49% of all stroke patients compared with 28% of the control subjects [adjusted OR=2.06 (95% confidence intervals (CI) 1.42-3.00)]. Haematomas, ischaemic strokes, and from the ischaemic strokes, both large and small artery disease strokes were strongly associated with positive FHS compared with the control subjects [adjusted OR=2.06 (95% CI 9-3.04), 2.07 (95% CI 1.09-3.91), 2.05 (95% CI 1.24-3.38), and 2.76 (95% CI 1.55-4.91), respectively]. There was no difference between maternal and paternal heritable contribution.In conclusion, FHS was found in this study to be an independent risk factor for all strokes combined, for each stroke type, and for the large and small-artery disease stroke subtypes, but not for the cardioembolic and undetermined stroke subtypes.

Nicotine, caffeine and alcohol use in high- and low-dose benzodiazepine users.

Cigarette smoking, coffee and alcohol use were investigated prospectively in 37 high-dose benzodiazepine (BZD) regular users (HDRU), 87 low-dose BZD regular users (LDRU), 50 low-dose BZD occasional users (LDOU) and in 37 non-BZD users (control subjects). The frequency of smokers was significantly greater in the HDRU than in the other three groups studied. Also, the HDRU consumed a significantly greater number of cigarettes and dose of caffeine per day than the other subjects investigated. Also, alcohol dependence was significantly more frequent in the HDRU. Regression analysis showed a significant positive correlation between the BZD dose and both the cigarettes and the caffeine consumed per day. The findings suggest that BZD should be prescribed with caution in individuals who are heavy smokers or are consuming large amounts of coffee and alcohol.

Smoking among suicide attempters.

One hundred suicide attempters, 100 matched controls, and 60 psychiatric controls with the same psychiatric disorders as diagnosed in the corresponding attempters were investigated. Significantly more female attempters were smokers when compared with the controls, whereas there was no difference among the males. Consumption of at least 40 and at least 50 cigarettes per day was significantly more frequent in female and male attempters, respectively, than in the controls. Also, the mean number of cigarettes smoked was significantly greater for the attempter versus the controls, particularly among females. Female attempters without a psychiatric disorder smoked more frequently than the corresponding controls. Likewise, female attempters with psychiatric disorders smoked more frequently than the psychiatric controls. The etiology of the relationship between smoking and suicide attempts remains uncertain.