Relationship of suicide rates with climate and economic variables in Europe during 2000-2012.

BACKGROUND: It is well known that suicidal rates vary considerably among European countries and the reasons for this are unknown, although several theories have been proposed. The effect of economic variables has been extensively studied but not that of climate. METHODS: Data from 29 European countries covering the years 2000-2012 and concerning male and female standardized suicidal rates (according to WHO), economic variables (according World Bank) and climate variables were gathered. The statistical analysis included cluster and principal component analysis and categorical regression. RESULTS: The derived models explained 62.4 % of the variability of male suicidal rates. Economic variables alone explained 26.9 % and climate variables 37.6 %. For females, the respective figures were 41.7, 11.5 and 28.1 %. Male suicides correlated with high unemployment rate in the frame of high growth rate and high inflation and low GDP per capita, while female suicides correlated negatively with inflation. Both male and female suicides correlated with low temperature. DISCUSSION: The current study reports that the climatic effect (cold climate) is stronger than the economic one, but both are present. It seems that in Europe suicidality follows the climate/temperature cline which interestingly is not from south to north but from south to north-east. This raises concerns that climate change could lead to an increase in suicide rates. The current study is essentially the first successful attempt to explain the differences across countries in Europe; however, it is an observational analysis based on aggregate data and thus there is a lack of control for confounders.

CLINICAL EXPERIENCE OF LONG-TERM TREATMENT WITH ARIPIPRAZOLE (ABILIFY) IN CHILDREN AND ADOLESCENTS AT THE CHILD AND ADOLESCENT PSYCHIATRIC CLINIC 1 IN ROSKILDE, DENMARK.

The aim of this paper is to share the clinical experience of the treatment of aripiprazole (Abilify) in children and adolescents. The authors have done a cross-sectional study about Abilify's treatment in children and adolescents with severe conduct problems (high impulsivity, aggression, outward reaction, physical cross-border behavior), high restlessness with ADHD, psychotic and psychosis-like symptoms with autistic disorders, psychosis, and intensive tics with Tourette's syndrome. The authors studied and described patients at the Child and Adolescent Psychiatric Clinic 1 in Roskilde, Denmark, who were treated with Abilify and were patients of the clinic in June 2013. The target group consisted of 33 patients, aged 9-18 years, which were in Abilify treatment during this time. Indications for the treatment and effectiveness of Abilify, Abilify's common doses used in children and adolescents, and the most common adverse effects of Abilify are presented. Abilify was found to be effective, well tolerated and safe for children and adolescents. The dose depends on the complexity of diagnosis (higher doses used in cases of complex diagnosis), on the age (higher doses used in older children, but only in the case of noncomplex diagnoses). Statistical analysis shows that in cases of complex diagnoses, dosage does not depend on age but depends on other factors. It also shows that the effect of treatment is better for those who did not gain weight.

Resilience in a reborn nation: Validation of the Lithuanian Resilience Scale for Adults (RSA).

BACKGROUND: Resilience, as an ability to withstand or rebound from crisis or adversity, is becoming an increasingly significant concept in health promotion and well-being. Individuals exhibiting resilience use skills or resources flexibly to solve situational demands. The Resilience Scale for Adults (RSA) may be used to assess protective resources, and the aim of the present study was to validate the Lithuanian translation. METHODS: The translated RSA was administered to a clinical (n=125) and a non clinical sample (n=499) to examine the discriminant validity of the RSA items with a confirmatory factor analysis, the internal consistency as well as construct validity by correlating it with the Quick Psycho-Affective Symptoms Scan (QPASS). RESULTS: The internal consistency, the test-retest stability and the factor structure were replicated as adequate, thus indicating good psychometric properties and support of discriminant validity. Females reported more resilience resources for the domains of social competence, family cohesion and social resources compared to men. The RSA subscales correlated negatively with the QPASS scores, and patients reported significantly less resilience resources than non-patients, thus indicating construct validity. CONCLUSIONS: Valid psychometric tools for research purposes and routine every-day use are urgently needed in Lithuania, a young nation still under numerous challenges due to social, economic and political transitions. The RSA represents a reliable and valid tool for assessing protective factors. Assessing resilience factors may extend the understanding of factors relevant for mental health problems as well as treatment prognosis beyond the capabilities of mere symptom oriented approaches.

Relationship of suicide rates to economic variables in Europe: 2000-2011.

BACKGROUND: It is unclear whether there is a direct link between economic crises and changes in suicide rates. AIMS: The Lopez-Ibor Foundation launched an initiative to study the possible impact of the economic crisis on European suicide rates. METHOD: Data was gathered and analysed from 29 European countries and included the number of deaths by suicide in men and women, the unemployment rate, the gross domestic product (GDP) per capita, the annual economic growth rate and inflation. RESULTS: There was a strong correlation between suicide rates and all economic indices except GPD per capita in men but only a correlation with unemployment in women. However, the increase in suicide rates occurred several months before the economic crisis emerged. CONCLUSIONS: Overall, this study confirms a general relationship between the economic environment and suicide rates; however, it does not support there being a clear causal relationship between the current economic crisis and an increase in the suicide rate.

Translating the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM) into Lithuanian.

BACKGROUND: There are no standardized tools in Lithuanian feasible for ongoing routine use to measure the effectiveness of psychotherapeutic treatment. The CORE-OM is a widely used 34-item self-report measure for such purpose. AIMS: To explore the reliability, validity and sensitivity of the Lithuanian translation of CORE-OM questionnaire. METHODS: A validation study of the CORE-OM was conducted in the psychiatric clinic attached to Vilnius University. A Lithuanian translation of the English original CORE-OM was prepared by a team of translators. Then 39 psychotherapy outpatients and 187 students were asked to complete the Lithuanian version of the CORE-OM; 66 were tested twice to determine test-retest stability. Analysis included both internal and test-retest reliability, acceptability, influence of gender, principal component analysis and criteria for reliable and clinically significant change. RESULTS: Internal and test-retest reliability were good (0.61-0.94), though somewhat lower for the risk domain (α: 0.57-0.79, Spearman's rho 0.25-0.60). Differences between scores of the clinical and non-clinical samples were large and significant (P < 0.001). Some of the Lithuanian criteria for clinically significant change were a bit lower than those of the original UK criteria (e.g. well-being) and others higher (symptoms, functioning, overall score), illustrating the need for local exploration. CONCLUSIONS: In spite of small differences in psychometric properties from the original, the Lithuanian version of the CORE-OM was reliable and sensitive in both clinical and non-clinical settings. It has the potential to become a practical, sensitive and reliable tool for psychotherapists in Lithuania.

Prediction of response in cancer immunotherapy.

This review focuses on the relationship between pre-treatment immune parameter values and outcome of immunotherapy of cancer patients. The evidence presented in this review suggests that there is a relationship between pre-treatment immune parameter values and survival of cancer patients treated with immunotherapy. Tumour-infiltrating immune cells may have a predictive value for immunotherapy, but predictive power might be obtained from peripheral blood leukocytes. Use of peripheral blood may be preferable due to the convenience of collection and analysis compared to using tumour-infiltrating cells. In vivo numbers of cells of the immune system correlate better with clinical outcome than their functional activity ex vivo. This suggests that immunological antitumour mechanisms in vivo are not always related to generally accepted functional parameters of lymphocytes, such as cytotoxicity or cytokine production, ex vivo. The proliferative status of CD8(+) T lymphocytes seems promising for prediction of response in cancer immunotherapy.

Efficacy, tolerability, and preference of mirtazapine orally disintegrating tablets in depressed patients: a 17-week naturalistic study in Lithuania.

Mirtazapine is an established antidepressant with well-documented efficacy demonstrated in controlled clinical trials. However, the gap between the results obtained in controlled clinical trials and everyday clinical practice exists. Therefore, the importance of naturalistic studies in psychiatry is becoming recognized. The aim of present naturalistic study was to acquire data on efficacy, safety, and preference of mirtazapine orally disintegrating tablets during a 17-week treatment of depression. This prospective, open-label, multicenter study in patients with mild to severe depression was conducted at 47 mental health centers of Lithuania by 78 psychiatrists. Patients were initially given 15 mg or 30 mg of mirtazapine orally disintegrating tablets; the maximum allowed dose was 45 mg per day. The primary efficacy measure was the total score on the Hamilton Depression Rating Scale-17 (HAMD-17), the Clinical Global Impression-Severity (CGI-S), and Clinical Global Impression-Improvement (CGI-I) scales. Tolerability was primarily measured by assessing the incidence of treatment-emergent adverse events. Patients were evaluated at baseline, at weeks 1, 5, 9, 13, and 17. A total of 779 patients (595 women [76.4%] with a mean [SD] age of 50.2 [13.65] and 184 men [23.6%] with a mean [SD] age of 52.4 [14.6] years) were enrolled into the study; 687 (88.2%) patients completed the study. The mean (SD) daily dose of mirtazapine orally disintegrating tablets was 29.0 (3.8) mg. The mean total (SD) HAMD-17 score improved significantly from 25.7 (4.6) to 7.3 (4.3) (P<0.005). At each visit, the mean HAMD-17 score was significantly lower than that at the preceding visit. At week 17, remission (HAMD-17 score < or =7) was observed in 436 (56%) patients. The mean (SD) CGI-S score improved significantly from 4.9 (1.0) at baseline to 1.5 (0.6) at endpoint (P<0.001). According to the CGI-I assessments, 621 patients (89.4%) improved and improved very much. The vast majority of patients (80%) preferred the new formulation of mirtazapine - mirtazapine orally disintegrating tablet. Treatment-emergent adverse events occurred in 106 patients (13.6%). The most frequent adverse events were weight gain, sedation, dizziness, and dry mouth. In this study conducted in Lithuania with depressed patients, a significant improvement was shown in all efficacy measures. In addition, mirtazapine orally disintegrating tablet was a well-tolerated and preferable formulation for the treatment of depressed patients.

[Compliance in psychiatry: results of a survey of depressed patients using orally disintegrating tablet]. / Gydytojo nurodymu laikymosi problema: pacientu, serganciu depresija ir vartojanciu disperguojamaja burnoje tablete, apklausos duomenys.

As many as 60% of the patients do not follow the therapy recommended by their physicians. An important factor that can influence patient's compliance is the physician's opinion about the tolerability and safety of prescribed medication. However, the efforts of both parties, not only physician but also patient, have benefits on the outcome of treatment. Patient's opinion on choosing the form of medication is appropriate way ensuring better compliance. The aim of the survey was to ascertain the opinion of depressed patients towards a new formulation of antidepressant drug, mirtazapine - orally disintegrating tablet Remeron SolTab. The study was approved by Lithuanian State Medicines Control Agency and local Ethics Committee. A total of 453 depressed patients were included in the survey. Most of the patients used a 30-mg dose of Remeron SolTab (n=344, 75.88%). Most of the patients (n=189, 41.81%) had a positive opinion about the taste of medication ("very pleasant"). According to the results of the survey, 281 (61.95%) used Remeron SolTab regularly. However, 129 (28.54%) patients noted that the new drug formulation had no influence on the regularity of use. Statistically significantly more patients (81.86%) noted that they would choose Remeron SolTab compared to the patients who would prefer conventional form of the medication (2.21%). In 184 (40.71%) patients, a significant mood improvement was noted. Most of the patients (n=246, 54.20%) indicated that mood improved. Based on the results of the survey it can be concluded that patient will prefer the drug (or its new formulation) he/she liked and thus will follow physician's instructions and cooperate with physician more closely. A limitation of this study relates to the study design and questionnaire itself, since it was not validated in appropriate way. However, the results of the survey are in line with the results of the similar surveys from other countries and reflect the general tendencies towards antidepressant use.

[Schizoaffective disorder: clinical symptoms and present-day approach to treatment]. / Sizoafektinio sutrikimo klinikiniai simptomai ir siuolaikines gydymo galimybes.

During 20th century serious mental disorders were divided into two groups according symptomatology and course of disorder. Individuals with dominating disturbance of perception, thinking and cognition were basically diagnosed having schizophrenic. Individuals with mood disturbance were basically diagnosed having affective disorders. However, there were patients who did not fit neatly into either category. In 1933 Jocob Kasanin introduced the term "schizoaffective psychosis". Scientific discussions involved the possibility that schizoaffective disorder was conceptualized most accurately as following: a type of schizophrenia, a type of affective disorder, a unique disorder that was separate from both schizophrenia and bipolar disorder, an arbitrary categorization of clinical symptoms that marked a continuum between schizophrenia and affective illness, a heterogeneous collection of "interforms" between schizophrenia and affective disorders. However, diagnosis of schizoaffective disorder is included both in DSM-IV-TR and ICD-10. Schizoaffective disorder is listed in the category "schizophrenia and other psychotic disorders". The differential diagnosis includes basically either schizophrenia or affective disorder. The epidemiological status of schizoaffective disorder is somewhat uncertain compared with schizophrenia because of dilemmas related to diagnosis and classification of the disorder. Treatment of schizoaffective disorder comprises psychotropic medication, supportive psychotherapy, social care, rehabilitation. The most important groups of psychotropic medications are: antipsychotics, antidepressants and mood stabilizers. Atypical antipsychotics are the first-line medication for schizoaffective disorder due to their pharmacological properties. In the case of schizoaffective disorders combination of atypical antipsychotics with antidepressants seems to be useful. Novel antidepressants have priority for the combination mentioned above. Peculiarities of mechanism of action of antidepressant are important for combinations. Mood stabilizers seem to be useful for treatment of certain type of schizoaffective disorder as well.

[Present-day approach to pharmacological and clinical aspects of novel antidepressants]. / Siuolaikinis poziuris i farmakologines ir klinikines nauju antidepresantu savybes.

Depression is the most common illness that affects a large number of individuals in all countries. Recent evidence suggest that depressive episodes if left untreated may heighten severity of subsequent episodes and may increase need for more health care resources. The first antidepressants, tricyclics and monoamine oxidase inhibitors, became available in the late 1950s. A progressive tightening of requirements by drug licensing authorities has ensured that efficacy evidence is good for most antidepressants that are in use. Contemporary antidepressant classification system is based on the mechanism of action, which is presumed to be responsible for their antidepressant effects. A pharmacodynamic system of classification has advantages because it incorporates the current theories of disease pathophysiology. Understanding the basic aspects of mechanism of action of antidepressants is important for treatment of depressive episode, for development of augmenting strategies and combining antidepressants with other antidepressants or antipsychotics. Antidepressants as a class of psychotropic medication have the broad range of indications. The choice of initial antidepressant legitimately varies considerably among clinicians and countries. Referring to some differences of recommendations for the first line treatment of depressive episode we suppose that the choice of antidepressant medication must be individualized for a particular patient. Novel antidepressants (SSRI, SNRI, NaSSA, NARI, NDRI and other) are safe and better tolerated. Metabolism of novel antidepressants is much improved compared with MAOIs and TCAs. The combination of antidepressants is an important clinical issue. There are the following principles of combining antidepressants: 1. to combine mechanisms of action not just drugs, 2. to combine antidepressants and to promote pharmacological synergy and tolerability, 3. to use important synergies within the serotonin, noradrenaline and even dopamine monoaminergic systems. Adequate treatment of depression including modern treatment approaches has the potential to reduce suffering and disability substantially and minimise the risk of suicide.