Comparative Epidemiology of Attempted and Fatal Suicide in a Defined Catchment Area in Israel.

BACKGROUND: Both attempted and fatal suicides are important public health issues and the relationship between these behaviors has great relevance to clinical practice. AIMS: To determine how the epidemiology of attempted and fatal suicide relate to each other over time. METHOD: In an 18-year period consecutive admissions for suicide attempts (n = 4,645) to the emergency room of the central hospital of a well-defined catchment area were assessed using a structured interview. Data were compared with records of 425 fatal suicides from the same catchment area. RESULTS: The relative rates of attempted and fatal suicide changed over time independent of both age and gender up to age 64. Rates of suicide and attempted suicide did not correlate over time in this age group. This was not true for the over 65 age group where attempted suicide and fatal suicide were significantly correlated over time in both men and women. CONCLUSIONS: In subjects over 65 attempted suicide is highly associated with eventual suicide. This relationship is much less clear in younger age groups. Thus age of attempt is of great importance when considering the prognostic import of a suicide attempt.

Deliberate Self-Harm in Older Adults: A General Hospital Emergency Department Survey.

BACKGROUND: Deliberate self-harm (DSH) increases the danger of future suicide death and the risk increases with age. Self-harm in older adults is often associated with greater suicidal intent and lethality. OBJECTIVES: To investigate clinical and psychosocial variables of older patients (age ≥ 65 years) assessed due to DSH, compared with younger adults. METHODS: Patients admitted to the Emergency Department following DSH during an 8 year period were included. RESULTS: Of 1149 participants, 187 (16.6%) were older adults (age ≥ 65) and 962 (83.4%) were younger adults (< 65). The older adults reported DSH closer to mid-day (P < 0.01) and suffered more frequently from adjustment disorder and depression. Personality disorders and schizophrenia were less commonly diagnosed (P < 0.001). Prescription medication (sedatives and hypnotics) were a more frequent means (88% vs. 71%) of DSH among older patients. Younger patients with DSH used over-the-counter medications (21.9% vs. 6.4%) three times more than did the older patients (P < 0.01). Past DSH was significantly more frequent in younger adults. Following DSH the older patients were frequently admitted for further general hospitalization (P < 0.001). CONCLUSIONS: Older adults with DSH are a unique group with different clinical characteristics. There is a need for targeted prevention strategies and education of caregivers regarding DSH in older adults.

Ultra-Low-Dose Buprenorphine as a Time-Limited Treatment for Severe Suicidal Ideation: A Randomized Controlled Trial.

OBJECTIVE: Suicidal ideation and behavior currently have no quick-acting pharmacological treatments that are suitable for independent outpatient use. Suicidality is linked to mental pain, which is modulated by the separation distress system through endogenous opioids. The authors tested the efficacy and safety of very low dosages of sublingual buprenorphine as a time-limited treatment for severe suicidal ideation. METHOD: This was a multisite randomized double-blind placebo-controlled trial of ultra-low-dose sublingual buprenorphine as an adjunctive treatment. Severely suicidal patients without substance abuse were randomly assigned to receive either buprenorphine or placebo (in a 2:1 ratio), in addition to their ongoing individual treatments. The primary outcome measure was change in suicidal ideation, as assessed by the Beck Suicide Ideation Scale at the end of each of 4 weeks of treatment. RESULTS: Patients who received ultra-low-dose buprenorphine (initial dosage, 0.1 mg once or twice daily; mean final dosage=0.44 mg/day; N=40) had a greater reduction in Beck Suicide Ideation Scale scores than patients who received placebo (N=22), both after 2 weeks (mean difference -4.3, 95% CI=-8.5, -0.2) and after 4 weeks (mean difference=-7.1, 95% CI=-12.0, -2.3). Concurrent use of antidepressants and a diagnosis of borderline personality disorder did not affect the response to buprenorphine. No withdrawal symptoms were reported after treatment discontinuation at the end of the trial. CONCLUSIONS: The time-limited, short-term use of very low dosages of sublingual buprenorphine was associated with decreased suicidal ideation in severely suicidal patients without substance abuse. Further research is needed to establish the efficacy, safety, dosing, and appropriate patient populations for this experimental treatment.

Treatment of hypertension with thiazides: benefit or damage-effect of low- and high-dose thiazide diuretics on arterial elasticity and metabolic parameters in hypertensive patients with and without glucose intolerance.

Thiazide diuretics may cause multiple metabolic abnormalities. The authors investigated the effects of varying doses of hydrochlorothiazide (HCTZ) on arterial elasticity and metabolic parameters in patients with hypertension (HTN), HTN and impaired fasting glucose (HTN+IFG), and HTN and type 2 diabetes mellitus (HTN+DM). The patients received low and high doses of HCTZ. Systolic and diastolic blood pressures declined significantly during the first 3 months in all patients, but no additional decrease was seen following the increase in HCTZ dose. In HTN, large artery elasticity index and small artery elasticity increased during the study. In HTN+IFG, large artery elasticity index increased without improvement in small artery elasticity index. In HTN+DM, both large artery elasticity index and small artery elasticity index did not improve during follow-up. Low-dose HCTZ improves arterial elasticity in hypertensive patients, but this effect is diminished with concomitant DM or IFG. The HCTZ dose increase worsened parameters of glucose metabolism and did not further decrease blood pressure or improve arterial elasticity.

Perceived parental care and control among Israeli female adolescents presenting to emergency rooms after self-poisoning.

Levels of perceived parental care and control among 24 female Israeli adolescents presenting at emergency rooms after a self-poisoning act of low lethality were compared to those found among 23 non-self-harming, community controls. Adolescents' perceived levels of parental care and control were measured via both adolescents' self-report and independent objective ratings of adolescents' unconstrained descriptions of their parents. Adolescents also completed a standardized psychological symptom checklist. Data from both measurement perspectives indicated that adolescents evidencing self-poisoning behavior perceived their mothers as less caring and more controlling--a parenting style characterized as "affectionless control"--than did the comparison group. Independent ratings of adolescents' descriptions of their parents suggested that those exhibiting self-poisoning also perceived their fathers as less caring. These effects were not moderated by level of psychological symptoms. The findings are consistent with those from previous research showing an association between perceived parental care and control and various self-harming behaviors among adolescents, and highlight the need for research on the potential clinical utility of employing family-based, attachment-promoting psychosocial interventions with this population.