Differences in demographic and clinical characteristics between cannabis users and non-drug users: A retrospective study of patients at first hospitalization due to psychotic symptoms.

This retrospective, chart review, cohort study compared demographic and clinical characteristics of cannabis -users and non-drug users at first admission due to psychotic symptoms at Geha Mental Health Center, Israel, between August 2002 and December 2013. We assessed the role of current cannabis use as a risk for re-hospitalization during this period as well as the stability of psychotic diagnoses at re-hospitalization. A total of 318 patients were included in the study, of which 106 (33.3%) were cannabis -users. The cannabis-user group had a shorter duration of hospitalization than the non-drug user group but without a significant difference in 5-year re-hospitalization rates. The latter had a higher rate of severe mental illness (SMI) diagnoses at first hospitalization (53.3% vs. 20.3%, respectively), but the difference disappeared at the second hospitalization. The two groups demonstrated a 79-80% rate of conversion from a non-SMI to an SMI diagnosis between the admissions. The results indicate the instability of non-SMI diagnoses at first hospitalization due to psychotic symptoms, regardless of concurrent cannabis use. The high conversion rate from non-SMI to SMI in current cannabis-users may be due to under-diagnosis of SMI at first admission or an effect of cannabis on the development of SMI.

Levels of depression and satisfaction with life as indicators of health services consumption.

OBJECTIVE: To evaluate the correlation between depression, satisfaction with life, and primary healthcare services consumption. METHODS: A random sample of primary healthcare clinic patients agreed to complete self-report questionnaires on demographics and physical activity, the Geriatric Depression Scale (GDS), Satisfaction with Life Scale and the Visual Analog Scale for Happiness. Treating physicians completed the Cumulative Illness Rating Scale (CIRS) for each patient. The relationships among psychometric, medical, the number of visits to health maintenance organization (HMO)-physicians during the previous year was assessed. RESULTS: Positive correlation was found between visits to HMO-physicians and depression severity, as assessed by GDS (p = .049), and between visits/year and illness severity, as measured by CIRS (p < .001). Correlation was also found between depression and number of chronic medications used (p = .005). Physical activity correlated inversely with depression severity (p = .014). Gender and income had no impact on frequency of visits to HMO-physicians, depression, or satisfaction with life. CONCLUSIONS: The results indicate that there is a correlation between depression and healthcare service consumption, as represented by number of HMO-physician visits and medication use. Thus, early detection of depression, using tools such as GDS, and early initiation of antidepressive treatment may help to lower the burden on the health system.

The clock-drawing test as a possible indicator of acute psychosis.

The clock-drawing test (CDT) is used widely to evaluate cognitive disorders, but its role in the assessment of psychotic disorders has not been studied. We sought to examine whether the CDT plays a role as an indicator of psychosis and to establish its sensitivity to clinical improvement of psychosis. The CDT was administered twice to 53 hospitalized patients without dementia but with psychosis: once at admission and again before discharge. The CDT scores were calculated in a random order by two independent senior psychiatrists who were blinded to the patients' status (admission or discharge). The inter-rater reliability was high (0.89 at admission, 0.85 at discharge, P<0.01 for both). The severity of psychosis was assessed by the Positive and Negative Syndrome Scale (PANSS). Patients had significantly lower CDT scores at admission than at discharge (2.87±1.39 vs. 3.91±1.08, respectively, P<0.01). The PANSS-total score of the patients showed a significant improvement (84.90±17.77 vs. 69.18±16.23, P<0.01). An inverse correlation was found between CDT performance and psychosis severity, as reflected by the PANSS-positive symptom subscale at admission (R=-0.279, P<0.05). Our findings suggest that the CDT may aid in the assessment of psychotic states and in their clinical monitoring.

Possible Involvement of Avoidant Attachment Style in the Relations Between Adult IBS and Reported Separation Anxiety in Childhood.

Irritable bowel syndrome (IBS) in adults as well as separation anxiety disorder (SAD) and recurrent abdominal pain (RAP) in childhood are associated with anxiety and somatization. Our aim was to examine possible associations between IBS in adulthood and SAD in childhood. Patients with IBS and healthy subjects completed a demographic questionnaire, the Separation Anxiety Symptom Inventory (SASI), the Somatization Subscale of Symptom Checklist-90-R (SCL-90-R), the Attachment Style Questionnaire, and a retrospective self-report questionnaire regarding RAP. Compared with controls, patients with IBS were characterized by an avoidant attachment style and scored higher on the SCL-90-R scale regarding the tendency to somatization (25.35 ± 7.47 versus16.50 ± 4.40, p < 0.001). More patients with IBS (25% versus 7.5%) reported RAP in childhood, but contrary to prediction, also had significantly lower SASI scores. Adults with IBS were characterized by somatization, insecure attachment style and recalled higher rates of RAP and surprisingly less symptoms of SAD in childhood. Based on these results, an etiological model for IBS is suggested, in which an avoidant attachment style and a tendency to somatization play an important role in the development of IBS. Copyright © 2015 John Wiley & Sons, Ltd.

The Association in Elderly Hospitalized Patients, Between Psychotropic Drugs and Hip Fractures Resulting from Falls.

BACKGROUND/STUDY CONTEXT: Psychotropic drug treatment has been associated with increased risk for falls and hip fractures in elderly patients. The authors examined the association between drug treatment and hip fractures resulting from falls in elderly hospitalized patients, focusing on the medications' anticholinergic properties. METHODS: This retrospective case-control study was conducted in an acute geriatric ward in a general medical center. Medical records, including demographic, clinical, biochemical, and pharmacological variables, of elderly patients with hip fractures from falls (N = 185), admitted during a 2-year period, were reviewed and compared with a control group (N = 187) of patients matched for age and gender and without hip fractures. RESULTS: The usage rates of antipsychotics, antidepressants, mood stabilizers, and various nonpsychiatric medications were similar in the two groups, except for hypnotics-anxiolytics (higher rates in hip-fracture patients). The Cumulative Illness Rating Scale for Geriatrics (CIRS-G) and diastolic blood pressure constituted very modest predictors of falls (R(2) = .038, p = .004). There were no significant differences in the anticholinergic burden values, clinical dementia ratings, and comorbidity burden between the two groups. CONCLUSION: The rate of psychotropic drug use in general and their anticholinergic burden are similar in acutely admitted elderly patients with or without hip fractures. However, higher usage rate of anxiolytics found in the patients with hip fractures may indicate that this is a risk factor for hip fractures related to falls in elderly patients living in the community.

Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship.

Emerging evidence suggests that sexual dysfunction emerging during treatment with selective serotonin reuptake inhibitors (SSRIs) and/or serotonin-norepinephrine reuptake inhibitors (SNRIs) persists in some patients beyond drug discontinuation (post-SSRI sexual dysfunction [PSSD]). We sought to identify and characterize a series of such cases and explore possible explanatory factors and exposure-response relationship. Subjects who responded to an invitation in a forum dedicated to PSSD filled out a survey via online software. Case probability was defined according to the following 3 categories of increasing presumed likelihood of PSSD. Noncases did not meet the criteria for possible cases. Possible cases were subjects with normal pretreatment sexual function who first experienced sexual disturbances while using a single SSRI/SNRI, which did not resolve upon drug discontinuation for 1 month or longer as indicated by Arizona Sexual Experience Scale scores. High-probability cases were also younger than 50-year-olds; did not have confounding medical conditions, medications, or drug use; and had normal scores on the Hospital Anxiety and Depression Scale. Five hundred thirty-two (532) subjects completed the survey, among which 183 possible cases were identified, including 23 high-probability cases. Female sex, genital anesthesia, and depression predicted current sexual dysfunction severity, but dose/defined daily dose ratio and anxiety did not. Genital anesthesia did not correlate with depression or anxiety, but pleasureless orgasm was an independent predictor of both depression and case probability. Limitations of the study include retrospective design and selection and report biases that do not allow generalization or estimation of incidence. However, our findings add to previous reports and support the existence of PSSD, which may not be fully explained by alternative nonpharmacological factors related to sexual dysfunction, including depression and anxiety.

Psychosocial and medical aspects of older suicide completers in Israel: a 10-year survey.

OBJECTIVES: The rate of completed suicide among the elderly continues to be the highest of any age group worldwide. The aim of the present study was to investigate the sociodemographic data, mental and physical health characteristics, and suicide methods of the elderly population who completed suicide in Israel. METHODS: A national retrospective record-based case series study of consecutive elder (50 years or older) suicide completers who had undergone autopsy over a 10-year period was conducted. RESULTS: Three hundred and fourteen consecutive records of suicide completers, 69.6% males, and mean age 64.7 were analyzed. The largest group (38%) emigrated from the Former Soviet Union and 19% emigrated from East Europe. Immigrants from East Europe committed suicide at an older age. Hanging was the predominant suicide method. Jumping from height increased more than threefold in the 'old-old'(older than 75 years) group. Hanging and firearms were more frequently used by males. Females were more likely to employ poisoning and suffocation. A significant minority (30%) had been diagnosed as suffering from psychiatric morbidity. Most common diagnoses were depression and alcohol abuse or dependence. Physical disorders (mainly cardiovascular disease and malignancy) were present in 27% of cases. Subjects with psychiatric illness were more likely to complete suicide at a younger age compared with subjects with physical illness. CONCLUSIONS: Findings of male predominance, psychiatric morbidity, and physical illness are consistent with previously published studies. Immigrants from East Europe completed suicide at an older age and the older victims had used more lethal methods of suicide.

Clinical and psychosocial remission in schizophrenia: correlations with antipsychotic treatment.

BACKGROUND: Clinical and psychosocial remission amongst persons with schizophrenia is nowadays a defined goal of treatment. This necessitates incorporating quantifiable psychosocial variables with traditional symptomatic data. We aimed to assess clinical and psychosocial remission in schizophrenia in a large cohort of community dwelling persons with schizophrenia. We emphasized between-groups comparison of antipsychotic medications and administration methods on the outcome of remission. METHODS: Psychiatric case managers rated psychosocial remission using the PsychoSocial Remission Scale (PSRS) and clinical remission using the Remission in Schizophrenia Working Group symptomatic remission criteria (RSWG). Ratings were performed for persons with schizophrenia they have been treating for 6 months or more. Data as to gender, age and pharmacological treatment of each patient were also collected. RESULTS: Of 445 participants who completed the survey, 268 (60%) were evaluated by psychiatrists, 161 (36%) by nurses and 16 (4%) were evaluated by social workers. Patients mean age was 43.4 + 13.1 years; 61% were men and 39% were women. Antipsychotic treatments were as follows: Per-os (PO) 243 (55%), IM long-acting typical antipsychotics (LAT) 102 (23%) and IM long-acting risperidone (RLAI; Consta) 100 (22%). Overall, 37% of patients achieved symptomatic remission and 31% achieved psychosocial remission. Rates of symptomatic remission were significantly higher in patients treated by LAT and RLAI compared with PO (51% and 48% vs., 29% respectively, p = 0.0003). Rates of psychosocial remission were also significantly higher in patients treated by LAT and RLAI compared with PO (43%% and 41% vs., 24% respectively, p = 0.003). CONCLUSION: In a large national sample a third of persons with schizophrenia were in remission. IM long acting preparations were associated with higher remission rates. Treatment choice may thus influence rates of remission in persons with schizophrenia.

Switching to aripiprazole as a strategy for weight reduction: a meta-analysis in patients suffering from schizophrenia.

Weight gain is one of the major drawbacks associated with the pharmacological treatment of schizophrenia. Existing strategies for the prevention and treatment of obesity amongst these patients are disappointing. Switching the current antipsychotic to another that may favorably affect weight is not yet fully established in the psychiatric literature. This meta-analysis focused on switching to aripiprazole as it has a pharmacological and clinical profile that may result in an improved weight control. Nine publications from seven countries worldwide were analyzed. These encompassed 784 schizophrenia and schizoaffective patients, 473 (60%) men and 311 (40%) women, mean age 39.4 ± 7.0 years. The major significant finding was a mean weight reduction by -2.55 ± 1.5 kgs following the switch to aripiprazole (P < .001). Switching to an antipsychotic with a lower propensity to induce weight gain needs be explored as a strategy. Our analysis suggests aripiprazole as a candidate for such a treatment strategy.

Suicide attempts and burden of physical illness among depressed elderly inpatients.

There is little data on suicide among elderly depressed patients seeking psychiatric help. Recent studies have demonstrated that physical illness may increase this risk. We aimed to assess, retrospectively, the association between suicide and physical illness among depressed elderly psychiatric patients. All medical records of patients admitted during a 10-year period to an acute psychiatric ward, after having attempted suicide, were reviewed. Inclusion criteria were: age>65 years, diagnosis of a depressive disorder and intact cognition. The comparison group consisted of previous or subsequent admissions, closest (by date), of elderly patients, matching the inclusion criteria, but without previous record of attempting suicide, into the same ward. The cumulative illness rating scale (CIRS) score was calculated for each patient. 78 admissions of elderly depressed patients, who had attempted suicide before hospitalization, were examined. The comparison group (n=87) consisted of the subsequent admission of a similar but not suicidal pre-admission patient. The CIRS total score was significantly higher among suicidal patients (10.2 vs. 8.0; p=0.0008). Suicidal patients scored higher in the vascular and the respiratory sections of CIRS. Our results support reported findings of higher rates of illness among suicidal elderly patients. The CIRS may be considered an additional tool in assessing risk for suicide in elderly psychiatric subjects.

First-onset functional brief psychoses in the elderly.

BACKGROUND AND PURPOSE: The origin and nosological status of psychotic states first arising in late life remain uncertain. We aimed to evaluate the diagnostic stability of brief psychoses with late-life onset. METHODS: A 10-year retrospective analysis of all records of elderly patients with a first-ever episode of psychosis was undertaken. RESULTS: Of 2,072 admissions of elderly patients, 604 had their first brief psychotic disorder (International Classification of Diseases diagnoses). All "organic" psychoses were excluded. The study sample comprised 83 individuals (36 male, 47 female) with a mean ± SD age of 75.4±9.3 years (range: 65-92). Mean follow-up duration was 27.7 months (range: 6-120). Distribution of diagnoses was as follows: unspecified nonorganic psychosis (n = 71); persistent delusional disorder (n = 10); other nonorganic psychosis (n = 1); and acute and transient psychotic disorder (n = 1). At follow-up, diagnosis of very late-onset schizophrenia-like psychosis and switch to another brief psychotic disorder were the most frequent outcomes. CONCLUSIONS: The diagnosis of a nonorganic psychosis first manifesting in the elderly is not rare in tertiary care. Diagnostic shift at follow-up of these patients is more common than conceptualized, requiring flexibility on the part of treating physicians.

Is dementia preventable? Focus on Alzheimer's disease.

The prevention of dementia, and particularly of Alzheimer's disease, is a major challenge for researchers and clinicians. In this article, the mixture of evidence, observations and hypotheses in the current literature is categorized into four avenues for possible preventive interventions, as suggested by the NIH State-of-the-Science Conference. The main categories are: antihypertensive medications; nutrition; cognitive engagement; and physical activity. There is, as yet, no conclusive evidence, but each category may hold promise for the prevention of dementia. The robust findings are as follows: cognitive engagement and regular physical activity may reduce the risk of Alzheimer's disease; the Mediterranean diet and consumption of omega-3 fatty acids deserves further elucidation; and the meticulous management of risk factors, and especially hypertension, is the infrastructure of Alzheimer's disease prevention.

Psychosocial remission in schizophrenia: developing a clinician-rated scale.

BACKGROUND: There is a growing awareness of the importance of psychosocial factors incorporated in treatment goals in schizophrenic patients. Remission, both symptomatic and psychosocial, is now an achievable goal in a substantial proportion of patients. Thus, the development of handy tools to quantify outcomes is called for. OBJECTIVE: To develop a brief, clinician-rated scale for the assessment of psychosocial remission in schizophrenia (the Psychosocial Remission in Schizophrenia [PSRS] Scale). The scale is to match the quantification of symptomatic remission as delineated by the American Psychiatric Association task force. METHOD: A "bank" of 124 questions pertaining to psychosocial remission was derived from published scales reflecting 2 domains: quality of life and activities of daily living. Psychiatrists, residents, psychiatric nurses, and community nurses were presented with the questions. All were asked to choose the 8 items they considered as reflecting the essence of psychosocial remission. Interrater reliability of the final scale version was assessed among psychiatrists. RESULTS: The questions' bank was reviewed by 429 mental health professionals. The 4 items found to be most frequently sanctioned in the quality-of-life domain were (a) familial relations (endorsed by 78% of participants), (b) understanding and self-awareness (46%), (c) energy (58%), and (d) interest in everyday life (38%). The 4 items sanctioned in the instrumental activities of daily living domain were (a) self-care (86%), (b) activism (65%), (c) responsibility for medications (54%), and (d) use of community services (32%). Interrater reliability among 70 psychiatrists ranged from 0.67 to 0.83. CONCLUSION: The PSRS is an 8-item scale quantifying psychosocial remission in schizophrenia in a manner that complements symptomatic assessment of remission. The PSRS may be useful for both research and clinical evaluation.

Differences in audiovisual integration, as measured by McGurk phenomenon, among adult and adolescent patients with schizophrenia and age-matched healthy control groups.

BACKGROUND: McGurk effect is a perceptual phenomenon that reflects the integration of visual and auditory information during speech perception. Using McGurk effect, the authors examined the audiovisual integration in adolescents and adults with schizophrenia as compared with healthy volunteers. SAMPLING AND METHODS: Thirty hospitalized patients with schizophrenia and 20 age-matched healthy controls were examined for perception of ambiguous audiovisual stimuli. RESULTS: The mean of McGurk-positive responses was significantly lower in adolescent patients with schizophrenia than in healthy adolescents (3.13 +/- 2.09 vs 5.60 +/- 0.7, respectively; t = 3.591, P = .001). The McGurk-positive responses were significantly higher in healthy adolescents than in healthy adults (5.60 +/- 0.7 vs 3.60 +/- 1.43, respectively; t = 3.974, P = .001). No significant difference in McGurk-positive responses was found between adults with schizophrenia and healthy adult individuals, or between adolescent and adults with schizophrenia. Duration of schizophrenia, soft sign status, type of symptoms, and type of antipsychotic medication showed no influence on the audiovisual integration ability. CONCLUSIONS: (I) Age effect: It seems that the audiovisual integrative function increases from childhood to adolescence and decreases from adolescence to early adulthood. (II) Schizophrenia: Audiovisual integration is poor in adolescent and adult patients with schizophrenia. Thus, it seems that schizophrenia is associated with early and persistent impairment in the development of the audiovisual integration ability. (III) Reliance on visual cue stimuli: Although several previous investigations concluded that patients with schizophrenia rely less on visual cue stimuli than healthy controls, our data suggest that this is true only for specific types of visual cue stimuli.

Suicide attempts of schizophrenia patients: a case-controlled study in tertiary care.

BACKGROUND: Schizophrenia is one of the disorders in which suicide attempts and death by suicide are pronounced. However, there is paucity of data regarding suicide attempts by schizophrenia patients. The aim of the present study was to characterize a large sample of schizophrenia patients in tertiary care who had attempted suicide. METHOD: Over a 15-year period all computerized records of admissions of adult schizophrenia patients were examined. Patients who had attempted suicide were defined as the index group and the comparison group was comprised of the next admission of a patient suffering from schizophrenia who did not attempt suicide prior to hospitalization. RESULTS: There were 10,006 admissions of patients suffering from schizophrenia during the study period. Of these, 1094 (10.9%) records comprise the index group (patients who had attempted suicide), 380 women and 714 men, mean age for the group 39.6+/-12.9 years. The comparison group of patients matched for diagnosis (N=1094), consisted of 302 women and 792 men, mean age for this group was 42.9+/-13.7 years. Four variables significantly differentiated between groups. Patients who had attempted suicide were younger (39.6 vs. 42.9 years; p=0.00), higher percentage of females (34.7% vs. 27.6%; p=0.00), with increased rates of co-morbid physical illness (27.5% vs. 20.4%; p=0.00) notably cardiovascular and diabetes and with a higher rate of alcohol and drug abuse (32.1% vs. 12.4%; p=0.00). CONCLUSIONS: The present study emphasizes several significant factors associated with attempted suicide amongst schizophrenia patients notably physical co-morbidity and abuse of alcohol and drugs. These need be integrated into existing risk assessment schemes thus aiding in decreasing adverse outcomes in this vulnerable group of patients.

Breast cancer in women suffering from serious mental illness.

BACKGROUND: Breast cancer is a major public health concern and the most common cause of cancer-related mortality among women. Compared with the general population, schizophrenia patients have been reported to have lower or similar rates of breast cancer despite several risk factors such as excess smoking, obesity and hyperprolactinemia. However, it has been argued that psychiatric morbidity itself may be the confounding factor that affects cancer incidence and not particularly schizophrenia. OBJECTIVE: To evaluate the frequency of breast cancer in a large cohort of female schizophrenia patients utilizing tertiary psychiatric care and to compare it with that of female inpatients with other serious mental illness (SMI). METHOD: Data were analyzed from a cohort of 2011 female schizophrenia patients and 6243 female SMI patients. All patient's records in the database were meshed with records of the Israeli National Cancer Registry to identify pathologically confirmed cancer co-morbidity. Cancer incidence rates among patients were compared with the expected incidence in age matched general population for the same time interval. RESULTS: Among 2011 female schizophrenia patients, 51 (2.5%) developed breast cancer vs. 83 (1.3%) breast cancer cases amongst SMI patients. The standardized incidence ratios (SIR) for breast cancer were low for both patient groups; 0.63 (95% CI, 0.47-0.83) and 0.54 (95% CI, 0.43-0.67) (schizophrenia and SMI respectively). CONCLUSIONS: The findings emphasize that reduced risk of breast cancer is found in a tertiary care cohort of female schizophrenia patients. Yet, breast and ovarian cancer screening for all women who are on long term drugs that induce weight gain or hyperprolactinemia should not be neglected. Our study emphasizes the probable contribution of environmental factors to the mechanisms responsible for this lower risk.

Cardiac and cerebrovascular morbidity and mortality associated with antipsychotic medications in elderly psychiatric inpatients.

OBJECTIVE: To evaluate the rate of adverse medical outcomes for elderly exposed to antipsychotic treatment. METHODS: This was a retrospective evaluation of psychiatric inpatients records. Age, gender, diagnosis, treatment with antipsychotics, and duration of treatment were analyzed. An acute cardiac or cerebrovascular event necessitating transfer to a general hospital or resulting in death was the outcome measure. RESULTS: During 15 years (1990 to 2005), 3,111 elderly were hospitalized. Their mean age was 73.5 +/- 6.1 years, 1,220 were male (39%), and 1,891 were female (61%). Most patients (2,583 [83%]) were exposed to antipsychotics, of which 1,402 (54%) were exposed to second-generation antipsychotics (SGAs). Antipsychotic-treated patients did not have a higher rate of adverse medical outcomes compared with patients who had not received antipsychotics. No significant differences were noted between patients exposed to typical antipsychotics or SGAs. CONCLUSION: Treatment of elderly psychiatric inpatients with antipsychotics did not increase their risk of adverse medical outcomes. Thus, regulating the use of conventional antipsychotics or SGAs for all elderly patients in all indications may be premature.

Association between antidepressant prescribing and suicide in Israel.

The effects of antidepressants on suicide are controversial; on the one hand they decrease the incidence of death by suicide, as reflected in epidemiological studies, and on the other hand, there are claims that they increase the risk of impulsivity and suicide. In 1998, primary care physicians in Israel were not allowed to prescribe selective serotonin reuptake inhibitors and in 1999 this prohibition was lifted. We thus evaluated the association between patterns of antidepressant prescribing and the rate of death by suicide in Israel in 1998 compared with that in 2002. Data regarding deaths by suicide were obtained from the Central Bureau of Statistics. Annual rates of antidepressant prescribing were computed from the Intercontinental Marketing Services database. The Intercontinental Marketing Services data covers three out of the four Health Maintenance Organizations in Israel, encompassing 46% of all citizens. Prescribing of all antidepressants increased 2.6-fold between 1998 and 2002. This increase was significantly more pronounced for the selective serotonin reuptake inhibitors. A shift in prescription practices was noted, with a 1.37-fold increase in prescribing by primary care physicians. While the concomitant decrease in overall national rates of completed suicide did not reach significance (17-14 per 100,000), the incidence decreased significantly in men aged 55-74 years (33-22 per 100,000; P=0.029). An overall reduction in suicides, which was significant only in elderly men, was noted in association with increased rates of antidepressant prescription. This study is limited in scope but adds a unique viewpoint related to the possible positive effect of increased antidepressant prescribing in primary care on suicide.

Suicide attempts amongst elderly bipolar patients.

BACKGROUND: Bipolar disorder is associated with high risk of suicide. In the elderly suicide rates are the highest of all age groups. There is a paucity of data regarding suicide amongst elderly bipolar patients. Mood stabilizers and particularly lithium are established as "antisuicide" compounds. OBJECTIVE: We aimed to evaluate the association between exposure to psychotropic drugs and suicide attempts in a cohort of elderly patients suffering from bipolar affective disorder (BAD). METHOD: This was a preliminary, retrospective, matched, case-controlled evaluation over a 10-year period. All records of admissions of patients with BAD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The control group consisted of the next admission of a patient suffering from BAD, matched for sex and age who had not attempted suicide in the month prior to admission. RESULTS: The index group during the period 1995 to 2004 consisted of 16 patients, (8 men and 8 women.), mean age 74.8 +/- 1.3 years. The control group patients (N = 16) were matched for age (mean 74.3 +/- 1.5 years) and sex. The number of patients who had a history of a suicide attempt was significantly greater in the index group (7/16 vs., 2/16; p = 0.039). In the control group patients treated by both a mood stabilizer and an antidepressant were at a significantly lower risk for recent suicide attempt (p = 0.047). LIMITATIONS: Sample size is small, treatments were not standardized and data were collected retrospectively. CONCLUSION: Elderly BAD patients treated with mood stabilizers and antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.

Antidepressants reduce the risk of suicide among elderly depressed patients.

Treatment with selective serotonin reuptake inhibitors (SSRIs) may increase the risk of impulsive acts including suicide, while data from epidemiological studies suggest that the effect of SSRIs in the elderly may be beneficial. We aimed to evaluate the association between exposure to antidepressants and suicidality in a cohort of elderly patients suffering from major depressive disorder (MDD). This was a retrospective matched case-controlled evaluation over a 10-year period. All records of admissions of patients with MDD (ICD-10) were assessed. The index group comprised all patients who had attempted suicide in the month prior to admission. The case-controlled group was the next admission of a patient suffering from MDD, matched for sex and age who had not attempted suicide in the month prior to admission. The index group during the 10-year period (1995-2004) consisted of 101 patients suffering from MDD who were hospitalized following a suicide attempt. Mean age for the group was 76.5+/-6.6 years; there were 42 men and 59 women. The control group patients (N=101) were matched for age (mean 76.6+/-6.9 years) and sex. The proportion of patients exposed to an antidepressant was significantly greater in the control group, than in the group of patients who had attempted suicide (58 vs 42%, odds ratio 1.94 (95% CI: 1.1-3.4), p=0.019). SSRIs were prescribed in 29% of patients in the control group vs 21% of patients in the index group (p=0.03). It is of interest to note that concomitant prescription of benzodiazepines also conferred a protective effect. In conclusion, elderly depressed patients treated with antidepressants may be at reduced risk of attempting suicide. These findings need support from prospective randomized trials.