Suicidal behavior--symptom or disorder?

This article examines the diagnostic status of suicidal ideation with and without additional signs of defined or subthreshold mental disorders. Data from the World Health Organization (WHO) study on Psychological Problems in General Health Care (PPGHC) show that 8.8% of all general practice patients report that they recently had a wish to be dead. Among patients with acute depressive episodes, the rate is 34.5%, as compared with 1.3% in persons without any sign of mental disorder. Rates of suicidal ideation in persons with subthreshold disorders (10.4%) are similar to the rate in persons with other, nondepressed forms of mental disorders (12.9%). Still, 30.1% of all persons with suicidal ideation do not have a defined mental disorder, and 21.5% do not even have subthreshold disorders. But in these persons also, suicidal ideation is associated with an increased rate of depressive complaints. Suicidal ideation therefore, in any case, can be seen as an indicator of mental problems. But it seems impossible to lower the thresholds of defined mental disorders so that all forms of suicidal ideation will be covered. Instead, suicidal thoughts must be regarded as a symptom with the status of a disorder itself which should be handled as a comorbid condition if other mental disorders co-occur.

Activated Borna disease virus in affective disorders.

BACKGROUND: Borna disease virus (BDV) is an animal pathogen that causes behavioral changes in animals. Previous studies have found a high prevalence of serum antibodies as well as Borna disease viral antigens (BDVAGs) and RNA in the white blood cells of psychiatric patients, especially those with affective disorders. The present study attempts to offer a better description of the BDVAG cohort using clinical parameters. METHODS: The prevalence of BDVAG was examined in the peripheral mononuclear leukocytes of patients with a major depressive episode. A subgroup of patients underwent further clinical analysis. RESULTS: In this pilot study, at least, there was a significant difference in the prevalence of BDVAG between psychiatric inpatients with a major depressive episode and control individuals. It also appeared that BDVAG is more frequent in patients with recurrent major depression or bipolar disorder than in those with any other psychiatric disorder studied. The number of previous depressive episodes, as well as symptoms involving fatigue and concentration difficulties were positively related to BDVAG. CONCLUSIONS: The high rate of BDVAG, especially in fatigued patients with recurrent major depression or bipolar disorder, may be a nonspecific aspect of immunosuppression. The question remains whether this neurotropic virus may contribute to the pathogenesis of some types of affective disorder.

Efficacy and tolerability of reboxetine compared with imipramine in a double-blind study in patients suffering from major depressive offsodes.

A 6-week, randomised, double-blind, multicentre study in 256 patients with a DSM-III-R diagnosis of major depression was carried out to compare the selective noradrenaline reuptake inhibitor (NARI), reboxetine, with the reference standard tricyclic antidepressant, imipramine. The efficacy of reboxetine, as measured by the extent of improvement of Hamilton Depression Rating Scale. Montgomery and Asberg Depression Rating Scale and the Clinical Global Impression Scale, was similar to that of imipramine. The improvement was observed in the overall population and in severely depressed and melancholic patients. Reboxetine tolerability compared favourably with that of imipramine. Frequency of discontinuation due to adverse events was lower in the reboxetine-treated group (10.0%) than in the imipramine-treated group (14.3%), and the cumulative risk of development (Kaplan-Meier analysis) of dry mouth, hypotension and/or related symptoms and tremor was significantly higher on imipramine than on reboxetine.

[The "Neuropsychological Screening Test (NST)": initial validation and reliability studies]. / Der "Neuropsychologische Screening Test (NST)": Erste Validierungs- und Reliabilitätsstudien.

Medical examinations only insufficiently measure cognitive impairment in neurological and neurosurgical patients. Due to costs an personnel shortages, adequate neuropsychological test methods are typically bypassed. Indeed, the very size and methodological problems of current tests impede their application in clinical practice. To resolve this dissatisfying state of affairs, we have developed a standardized, scored form of initial neuropsychological examination. The Neuropsychological Screening Test (NST) comprises 45 items, is easy to handle, and can be conducted in 15-20 min. The NST measures psychic performance along functional parameters such as orientation in place and time, primary and secondary language, visuospatial ability, attention, and memory skills. We have assessed the validity and reliability of the NST in a prospective study. 129 neurosurgical patients (60% malignant or benign cerebral tumors, 21% vascular malformations with and without subarachnoid hemorrhage, 6% traumatic brain injury, 3% hydrocephalus, 10% others) and 52 control subjects were included in the study. The difference in average total NST-scores was highly significant for the two groups (t = -7.84, DF = 177.93, p < .001). In addition, two chronologically separate subsamples of NCH patients (N = 81) and controls (N = 35) were tested using the Mini-Mental State (MMS). The correlation between total NST-score and MMS results was r = .49 (p < .001). Cross-tabulation was used to set a cut-off score, by means of which 80% of the neurosurgical patients were identified as true positive and 74% of the controls as true negative. A 24-hour retest confirmed the NST as reliable to .85 (p < .001).(ABSTRACT TRUNCATED AT 250 WORDS)

Double-blind multicenter study of paroxetine and amitriptyline in depressed inpatients.

Paroxetine is a new compound in the group of the selective serotonin-reuptake inhibitors. The results of several open and double-blind control-group studies demonstrate clear antidepressive efficacy of paroxetine. However, most data were collected in samples of outpatients. To overcome this restriction, a six-week double-blind control-group study, comparing 30 mg paroxetine with 150 mg amitriptyline per day, was performed in a sample of inpatients suffering from major depression. Generally speaking, the efficacy analysis of 160 patients was not able to demonstrate statistically significant differences in the antidepressive activity of paroxetine or amitriptyline, either with respect to the total score on the Hamilton Depression Scale (HAMD) and the Clinical Global Impressions or with respect to the subscores of the HAMD. One exception was the retardation subscore, in which amitriptyline showed a greater degree of reduction. Both drugs had a characteristic side-effect profile. Paroxetine was characterized by a lack of anticholinergic side-effects and a higher rate of nausea.

Follow-up study of patients with attempted suicide.

Patients with a suicide attempt were re-examined 3 to 8 years after treatment in a crisis intervention ward by use of a semi-structured interview and self-rating scales. Their psychosocial development during the study period was evaluated in regard to number and quality of life-events, coping-behaviour and self-concept, sociodemographic variables, the subjective evaluation of the treatment in the crisis intervention ward by the patients and their compliance in respect of the proposed aftercare. Conclusions for treatment and further rehabilitation of patients with suicide-attempt will be drawn.

Clinical experience with antidepressive infusion therapy: trazodone.

The tolerance and efficacy of trazodone were studied in subjects between 20 and 70 years of age. The first step was to conduct an open trial. Each patient (in- and out-patients) received increasing doses (range 25 mg-200 mg/day/2h) for a period of 10 days. Disorders diagnosed as depressive were classified by ICD-9. Blood-pressure and pulse rate were determined before and after infusion. The side effects (TWIS), Hamilton Depression Scale (HAMD), Depression Self Rating Scale (DS v. Zehrssen), and Clinical Global Impression (CGI) were assumed after medication. The results are demonstrated.

Baseline plasma cortisol and dexamethasone test in unselected psychiatric inpatients.

The plasma cortisol (PC) level at 08.00 a.m. was assessed in 250 unselected psychiatric inpatients suffering from various disorders, assorted in 8 diagnostic groups. Endogenously depressive patients showed a significantly higher rate of cortisol hypersecretion (PC greater than 560 nmol/l = 20 micrograms/dl) than the neurotically or reactively depressed patients and than schizophrenics or paranoid psychotics. The PC level after the midnight dose of 1 mg dexamethasone was examined in 125 patients at 08.00 a.m. (group I) and in 125 patients at 04.00 p.m. (group II). There was no statistical difference in the rate of dexamethasone test (DST) nonsuppressors (PC greater than 140 nmol/l = 5 micrograms/dl) in the separate diagnostic groups between group I and II, but in the postdexamethasone blood samples at 04.00 p.m., significantly more DST nonsuppressors were detected than in the samples at 08.00 a.m. in the total number of all patients, regardless of their diagnosis. DST nonsuppressors were found in all of our diagnostic groups with the exception of manic syndrome, and their various rates will be discussed and compared with the results of previous studies. The DST shows a high sensitivity in endogenous depression, but its diagnostic value is limited as a result of its relative lack of specificity.

Psychological and social disorders of Turkish women during an unaccepted pregnancy in a foreign country.

Up to 1976, legal interruption of pregnancy was only possible for medical reasons. During a 2-year period, 113 women, almost exclusively from the lower social class, presented for the legally prescribed examination. The problems arising from an undesired pregnancy, culturally, within the family and individually, are described in detail. The considerable problems in communication, the different ideas about morals and ethics, and the magical and mystical ideas in connection with contraception and pregnancy, have proven to be of the greatest importance. The indications for the interruption: psychiatric diagnosis, occupational possibilities, housing and the education of the women are examined. It is shown that the findings are of special importance in present-day West Berlin, since in certain districts the percentage of Turks already amounts to 10% of the inhabitants. To date little information has been gathered about the social and psychic background of these women, since the relevant legislation has only been recently liberalized.

[Diagnosis and psychiatric care.--First working report of the psychiatric outpatient hospital in the Steglitz Clinic (author's transl)]. / Diagnose und Versorgung. Erster Arbeitsbericht der Psychiatrischen Ambulanz im Klinikum Steglitz.

The article begins with a review of the geographically unfavourable distribution of psychiatric ward beds in Berlin. This unfavourable distribution hampers therapeutic efforts. The authors describe and examine the work done in the Psychiatric Outpatient hospital which forms part of a university clinic in the Steglitz district of Berlin. 1517 case records are subjected to statistical evaluation. The article concludes with the demand for a new plan for distributing the psychiatric ward beds according to a more reasonable key based on subsectors in line with the requirements of the different districts of the city of Berlin.