Association Between Selective Serotonin Reuptake Inhibitors Prevalent Use and COVID-19-Related Mortality: A Retrospective Cohort Study.

PURPOSE/BACKGROUND: Since the emergence of the coronavirus disease 2019 (COVID-19), many efforts have been made to prevent and to treat the disease. In this line, the anti-inflammatory effect of selective serotonin reuptake inhibitors (SSRI) as alternatives for treating chronic inflammatory diseases has been studied. There is previous evidence of the usefulness of these drugs for reducing COVID-19 impact. METHODS/PROCEDURES: We conducted a retrospective single-center cohort study of adult patients with a positive reverse transcriptase-polymerase chain reaction for COVID-19, evaluating the association between SSRI use and in-hospital mortality. FINDINGS/RESULTS: Of 1689 included patients, 182 (10.8%) were exposed to SSRI. A total of 291 patients died during the hospitalization, representing an in-hospital mortality of 17.2% (95% confidence interval [CI], 15.4%-19.0%): 44 (24.2%) of the exposed to SSRIs versus 247 (16.4%) of those not exposed to SSRIs (crude odds ratio [OR], 1.62; 95% CI, 1.12-2.34; P = 0.009). No independent effect of SSRIs on in-hospital mortality was found when applying either the inverse probability of treatment weighting (OR, 1.15; 95% CI, 0.71-1.89; P = 0.56) or with conventional multivariable analysis 0.81 (95 % CI: 0.28-2.31, P = 0.69). IMPLICATIONS/CONCLUSIONS: In the present retrospective study of patients hospitalized for COVID-19, prior use of SSRIs did not reduce mortality.

Epidemiologic Analysis of the Inpatient Psychiatric Unit at a General Metropolitan Community Hospital of Buenos Aires city, Argentina / Análisis Epidemiológico de la Sala de Internación de Psiquiatría de un Hospital General Metropolitano de Comunidad de la Ciudad de Buenos Aires, Argentina.

Objectives: To explore the frequency of sociodemographic, clinical, and therapeutic variables of the Inpatient Psychiatric Unit at the Italian Hospital of Buenos. Introduction: Considering that the Inpatient Psychiatric Unit functions within a General Metropolitan Community Hospital, referent both at the local and the international level, we deem it relevant to perform an updated characterization of the population admitted into our Unit. This is especially important given the changes presented since the approval of the National Mental Health Law N° 26.657. Materials and Methods: We performed an observational descriptive and analytic cross-sectional study, studying the patients admitted into the Inpatient Psychiatric Unit for a period of 12 consecutive months (from October 1st, 2018, to September 30th, 2019). Results: During the study period a total of 254 hospitalizations were registered. Mean Age: 51,85 years (S.D.=21,23), Median hospitalization time 22 days [IQR=14.00, 34.00], 31.5% of the admissions were involuntary. The most frequent cause of hospitalization was due to depressive episodes (32.7%), psychosis (22.8%), and dementia/behavioral symptoms (13%). 10.6% of the patients were admitted into our Unit after a suicide attempt. Discussion: The present study provides an updated analysis of the hospitalized population. It contributes to outlining the changes that have taken place over the last years, because of the new legislation. Conclusions: The description of the epidemiologic characteristics of the inpatient population in our setting is crucial to have a current situation diagnosis that allows us to develop health-policy strategies and an adequate allocation of resources.

Objetivo: Explorar la frecuencia de diferentes variables sociodemográficas, clínicas y terapéuticas en los pacientes internados en la Sala de Psiquiatría del Hospital Italiano de Buenos Aires (HIBA). Introducción: Considerando que la Sala de Psiquiatría del HIBA se encuentra emplazada en un hospital general privado metropolitano de comunidad, referente a nivel nacional e internacional, resulta relevante realizar una descripción actualizada de la población usuaria de dicho dispositivo a la luz de los cambios producto de la sanción de la Ley Nacional de Salud Mental N° 26.657. Materiales y métodos: Se realizó  un estudio observacional descriptivo y analítico de corte transversal de pacientes que fueron internados en la Sala de Psiquiatría del HIBA durante el período comprendido entre el 1 de octubre de 2018 hasta el 30 de septiembre de 2019 inclusive. Resultados: Durante el período del estudio se valoraron 254 internaciones. Edad promedio de 51,85 años (D.E.=21,23), Mediana de la duración de internación correspondió a 22 días [IQR=14.00, 34.00], siendo el 31.5% de las mismas de carácter involuntario. Los motivos de ingreso más frecuentes fueron: cuadros depresivos (32.7%), descompensación psicótica (22.8%) y demencia/síntomas conductuales (13%). El 10.6% de los pacientes ingresaron tras haber realizado una tentativa suicida. Discusión: El presente trabajo permite tener una noción actualizada de las características de los pacientes que atendemos en la Sala de Internación teniendo en cuenta los cambios en la legislación vigente y en la sociedad en su conjunto. Conclusiones: Caracterizar los determinantes epidemiológicos del patrón de internaciones psiquiátricas permite realizar diagnóstico de situación local y actualizado que favorecerá el desarrollar y repensar estrategias de planificación y gestión informadas.

[Antipsychotic prescription prevalence and metabolic monitoring of patients under chronic treatment]. / [Prevalencia en la prescripción de antipsicóticos y monitoreo metabólico en pacientes bajo tratamiento crónico].

INTRODUCTION: Antipsychotics agents increase morbidity and mortality due to their metabolic impact. Information on its prescription and follow-up is scarce. The objective of this study was to estimate the chronic antipsychotic prescription prevalence and to evaluate the metabolic monitoring of patients treated with these medications. METHODS: We examined a retrospective cohort of patients older than 18 years treated in the outpatient setting of a hospital in Argentina. The crude and adjusted prevalence of chronic antipsychotic prescription was estimated by indirect standardization of the World Health Organization population, with its confidence interval (95%). It was evaluated whether the patients had biochemical determinations, systolic blood pressure (SBP), and body mass index (BMI) at the beginning and at 12 months of their treatment. RESULTS: The crude antipsychotic prescription prevalence was 23.8 ‰ (95% CI 23.0 - 24.6) and the adjusted prevalence was 10.1 ‰ (95% CI 9.5-10.7). 3702 patients were evaluated. The male:female ratio was 0.6. Median age 77.5 years (IQR 25-75: 59.5-86.1). Quetiapine was the most frequently prescribed. Initial determinations: Lipid profile 1804 (48.7%), blood glucose 2034 (54.9%), SBP 2546 (68.8%) and BMI 1584 (42.8%). At 12 months: Lipid profile 680 (18.4%), blood glucose 898 (24.3%), SAT 1609 (43.5%), and BMI 1584 (21.7%). CONCLUSIONS: We observed a higher prevalence of atypical antipsychotic prescription in the elderly and female population and scarce registry of biochemical determinations for adverse effects follow-up.

INTRODUCCIÓN: Los antipsicóticos incrementan la morbimortalidad por su impacto metabólico. Es escasa la información sobre su prescripción y seguimiento. El objetivo fue estimar la prevalencia de prescripción de antipsicóticos crónicos y evaluar el monitoreo metabólico. MÉTODOS: Cohorte retrospectiva de pacientes ambulatorios mayores de 18 años de un hospital de Argentina. Se estimó la prevalencia cruda y ajustada de prescripción crónica de antipsicóticos mediante estandarización indirecta por la población de la Organización Mundial de la Salud (OMS), con su intervalo de confianza 95%. Se evaluó si los pacientes en tratamiento tenían determinaciones bioquímicas, tensión arterial sistólica (TAS) e índice de masa corporal (IMC), al inicio y a los 12 meses. RESULTADOS: La prevalencia cruda de prescripción de antipsicóticos fue 23,8‰ (IC del 95% 23,0 ­ 24,6) y la ajustada fue 10,1 ‰ (95% CI 9,5-10,7). Se evaluaron 3702 pacientes. La razón hombre/mujer fue 0,6. La mediana de edad 77,5 años (IQR 25-75: 59,5-86,1). Predominó quetiapina. Pacientes con determinaciones al inicio: lipidograma 1804 (48,7%), glucemia 2034 (54,9 %), TAS 2546 (68,8 %) e IMC 1584 (42,8%). A los 12 meses: lipidograma 680 (18,4%), glucemia 898 (24,3%), TAS 1609 (43,5%) e IMC 1584 (21,7%). CONCLUSIONES: Observamos una mayor prescripción de antipsicóticos atípicos en la población anciana y femenina, y un escaso registro de determinaciones clínico-bioquímicas para control de efectos adversos.

Encefalitis autoinmune seronegativa de inicio con síntomas psicóticos: revisión de la literatura a propósito de un caso / Seronegative Autoimmune Encephalitis with recent-onset psychotic symptoms: case report and literature review

Objetivo: En los últimos años, es creciente la evidencia que apunta al solapamiento entre procesos de desregulación inmune y subgrupos de pacientes con cuadros psicóticos. El objetivo del presente artículo es profundizar respecto a la caracterización de las encefalitis autoinmunes seronegativas de inicio con síntomas psiquiátricos. Caso clínico Describimos un caso de psicosis de probable origen autoinmune seronegativo (PPOAS) en un paciente que presentó sintomatología psicótica de reciente inicio. Resultados Las psicosis autoinmunes constituyen un diagnóstico diferencial a considerar tanto en pacientes con presentaciones psicóticas breves, como en aquellos comprendidos dentro del espectro esquizofrénico. Esto es particularmente relevante en aquellos que presentan síntomas psicóticos de inicio súbito y avanzan con deterioro cognitivo, trastornos del movimiento, convulsiones y alteraciones en el electroencefalograma (EEG), y disfunción autonómica. Conclusiones Teniendo en cuenta que los psiquiatras son consultados frecuentemente ante el debut sintomático, creemos que es importante tener presente el diagnóstico diferencial, a los efectos de instaurar el tratamiento inmunomodulador temprano. (AU)

Objectives: In recent years, there has been an increasing amount of evidence that emphasizes the overlap between immune dysregulation processes and subgroups of patients with psychotic symptoms. The purpose of this article is to further the description of Seronegative Autoimmune Encephalitis that present with psychiatric symptoms. Case report We describe a case of Possible Seronegative Autoimmune Encephalitis in a patient presenting with recent-onset psychotic symptoms. Results Autoimmune Psychosis represents a differential diagnosis in patients that have been diagnosed with acute psychosis or schizophrenia-spectrum disorders. This is particularly relevant in those cases that exhibit rapidly-progressing psychotic symptoms and evolve with disturbances of consciousness, movement disorders, seizures and EEG abnormalities, and autonomic dysfunction. Conclusions Since psychiatrists are frequently consulted in the initial stages of the disease, it is fundamental to make the correct diagnosis early, that enables specialists to start the immunomodulatory treatment. (AU)

Estimulación cerebral profunda: tratamiento para pacientes con diagnóstico de trastorno obsesivo-compulsivo resistente / Deep brain stimulation: treatment for patients diagnosed with disorder obsessive-compulsive resistant

El trastorno obsesivo-compulsivo (TOC) afecta al 2% de la población general, llegando en ocasiones a causar un deterioro funcional severo y de la calidad de vida de las personas afectadas. Entre el 10 y el 30% de los pacientes con este trastorno no responde a los tratamientos recomendados: farmacológicos y terapia cognitivo-conductual. La Food and Drug Administration de los Estados Unidos (FDA) aprobó en el año 2008 la Estimulación cerebral profunda (ECP) para pacientes con TOC resistente a tratamiento. La ECP, utilizada frecuentemente para el tratamiento de la enfermedad de Parkinson refractaria, es una opción viable para los pacientes con TOC resistente, con efectos adversos poco frecuentes y transitorios. (AU)

Obsessive-compulsive disorder (OCD) affects 2% of the general population, sometimes resulting in severe impairment of functional capacity and quality of life of affected people. Between 10 and 30% of these patients do not respond to recommended treatments: pharmacological and cognitive behavioral therapy. In 2008, the FDA approved Deep Brain Stimulation (DBS) for patients with OCD resistant to treatment. DBS, frequently used for the treatment of refractory Parkinson's disease, is a viable option for the treatment of patients with resistant OCD, with infrequent and transient adverse effects. (AU)

Interaction between polymorphisms in SLC6A4 and BDNF on major depressive disorder in a sample of the argentinean population / Interacción entre polimorfismos en SLC6A4 y BDNF en el trastorno depresivo mayor en una muestra de la población argentina

The dysfunction in the serotoninergic neurotransmission has been classically associated with major depressive disorder (MDD); however, other pathways and processes seem to have a role in this illness, such as neurogenesis and related molecules: the Brain-Derived Neurotrophic Factor (BDNF) and the Apolipoprotein E (APOE). There are many reports that indicate an association between certain polymorphism in these genes and MDD. The aim of our study was to analyze the possible association between MDD and polymorphisms in HTR2A (5-hydroxytryptamine receptor 2A), BDNF and APOE genes in a sample of the Argentinean population previously studied for 2 polymorphisms in SLC6A4 (Solute Carrier Family 6 Member 4) gene. Five polymorphisms were studied (rs6311 and rs6313 in HTR2A; rs429358 and rs7412 in APOE, and rs6265 in BDNF) in 95 MDD patients and 107 non-related controls. No statistically significant differences were observed between groups when analyzing the association with a single marker using logistic regression; however, when a possible combinatory effect of the polymorphisms (including previously studied polymorphisms in SLC6A4 gene) was analyzed using a dominant model for the risk alleles, the genotypes L/S_10/12_G/A (OR=3.57(95%CI=1.43-8.93); p=0.004, adjusted p-value=0.01) in SLC6A4 and BDNF genes and L/S_10/12_T/C_3/3_G/A in SLC6A4, HTR2A, APOE and BDNF genes (OR=5.99(95%CI=1.66-21.56); p=0.002, adjusted p-value=0.07), were more prevalent in patients than in controls (20%vs.6% and 15%vs.3%, respectively). Even though it is necessary to replicate these findings in a larger population, our results suggest a possible interaction between molecules involved in neurogenesis (BDNF and APOE), serotoninergic neurotransmission (SLC6A4 and HTR2A) and the pathogenesis of MDD. (AU)

La disfunción en la neurotransmisión serotoninérgica ha sido clásicamente asociada con el trastorno depresivo mayor (TDM); sin embargo, otras vías y procesos parecerían tener un rol en esta enfermedad, como la neurogénesis y moléculas asociadas: el factor neurotrófico derivado del cerebro (BDNF) y la apoliproteína E (APOE). Existen reportes en los que se establecen asociaciones entre polimorfismos en estos genes y el TDM. El objetivo de nuestro trabajo fue analizar la posible asociación entre el TDM y polimorfismos en los genes HTR2A (receptor 5-hidroxitriptamina 2A), BDNF y APOE en una muestra de la población argentina previamente estudiada para 2 polimorfismos en el gen SLC6A4 (transportador soluble familia 6 miembro 4). Se estudiaron 5 polimorfismos (rs6311 y rs6313 en HTR2A; rs429358 y rs7412 en APOE; rs6265 en BDNF) en 95 pacientes con TDM y 107 controles no relacionados. No se observaron diferencias significativas entre grupos al analizar la asociación por regresión logística con un único marcador; cuando se analizó el posible efecto combinatorio de polimorfismos (incluyendo los previamente estudiados para el gen SCL6A4) usando un modelo dominante para los alelos de riesgo, los genotipos L/S_10/12_G/A (OR=3,57(95%CI=1,43-8,93); p=0,004, valor-p-ajustado=0,01) en SLC6A4 y BDNF y L/S_10/12_T/C_3/3_G/A en SLC6A4, HTR2A, APOE y BDNF (OR=5,99(95%CI=1,66-21,56); p=0,002, valor-p-ajustado=0,07), fueron más prevalentes en pacientes que controles (20%vs.6% y 15%vs.3% respectivamente). Si bien es necesario replicar estos hallazgos en una población más grande, nuestros resultados sugieren una posible interacción entre moléculas involucradas en la neurogénesis (BDNF y APOE), la neurotransmisión serotoninérgica (SLC6A4 y HTR2A) y la patogenia de la depresión mayor. (AU)

Endocrine and inflammatory profiles in type 2 diabetic patients with and without major depressive disorder.

BACKGROUND: There is a high prevalence of depression in individuals with type 2 diabetes mellitus. Depressive disorders are associated with increased medical morbidity and mortality in individuals with diabetes. It has been demonstrated that there is a higher prevalence of diabetic complications among individuals with diabetes and depression compared to those without depression. Several biological alterations have been reported in individuals with depressive disorders, particularly abnormal levels of endocrine-inflammatory markers.This study aims to determine the prevalence of major depressive disorder (MDD) in type 2 diabetes patients, the prevalence of cardiovascular events in individuals with and without MDD and to compare the endocrine-inflammatory profile between groups. METHODS: The study was approved by the "Comité de Etica de Protocolos de Investigación del Departamento de Docencia e Investigación del Hospital Italiano de Buenos Aires" with the number "1262" and included only patients who provided written informed consent. The study was conducted in accordance with the Declaration of Helsinki and the Habeas Data law on protection of personal data (Law Nª 25326, Argentina).Type 2 diabetes patients (n = 61) were included and they were classified as having MDD or not according to DSM-IV. Macrovascular disease was obtained from the medical history. Additionally, the intima-media thickness of the common carotid, carotid bifurcations and internal carotid arteries was measured non-invasively by two-dimensional ultrasound imaging. Fasting glucose, fasting lipid profile, inflammatory (CRP, TNF-α) and endocrine (urine free cortisol and saliva cortisol) markers. Student t tests were used to compare means for normally distributed variables and Mann-Whitney test for variables without normal distribution. Relative frequencies were calculated and a chi-square analysis was conducted. Data were expressed as mean ± standard deviation (SD) or median and interquartile range. Multivariable logistic regression was used to determine the relative odds of clinical cardiovascular disease in individuals with compared to those without depression. Differences were considered significant using a two-sided p < 0.05. RESULTS: 21 patients (34%) had MDD and 40 patients (66%) didn't have MDD. Diabetic patients with MDD had significantly higher CRP levels (4.1(1.9-7.6) vs 1.5(0.5-4.4) mg/l; p = 0.02) and 24-hour urine free cortisol (71.4 ± 21.3 vs 59.8 ± 29.3 ug/24 h; p = 0.03). The other metabolic and inflammatory parameters were not statistically different between groups. There was a significantly higher prevalence of cardiovascular events in individuals with MDD: 38% for the depressive group vs 15% for non-depressive group, p = 0.04). Patients with MDD had a 3.5-fold greater odd of having cardiovascular disease. CONCLUSIONS: Diabetic patients with depression are more likely to have cardiovascular events, and different factors can determine this high association.

[Diabetes, alexithymia and depression]. / Diabetes, alexitimia y depresión.

Diabetes Mellitus and Depression are two increasing pathologies. Several articles indicate that Depression in Diabetes is twice as important as in the general population. Yet, Depression in diabetic patients is underdiagnosed. On the other hand, Alexithymia might be a factor associated to Depression. We therefore carried out a research in order to evaluate the relationship between Depression and Alexithymia in diabetic patients at the Italian Hospital of Buenos Aires. We performed psychiatric interviews, which led to diagnoses based on DSM-IV, and applied the following scales: HAM-D, TAS-26, DBI and M.I.N.I. We evaluated 59 patients who had been diagnosed Type II Diabetes. Crossing variables, we observed a negative correlation between the results of Beck's Depression Inventory and those of Hamilton's Depression Scale. On the contrary, these last results showed a positive correlation with results obtained through TAS-26, which reveals a significant relationship between Depression and the presence of Alexithymia. According to the link between Depression, Diabetes Mellitus II and Alexithymia and considering that Alexithymia has consequences on the illness evolution and the treatment of both pathologies, it seems important to determine when and how to include its evaluation.

Aspectos epidemiológicos de la población ambulatoria en el servicio de psiquiatría de un hospital general: [revisión] / Epidemiological aspects of ambulatory patient population consulting a general hospital's psychiatry service: [review]

En las últimas décadas, la aparición de las sucesivas versiones del DSM-IV y la CIE 10 han contribuído a una mayor coherencia diagnóstica en el ámbito de la psiquiatría, favoreciendo así la búsqueda de datos epidemiológicos alrededor de los trastornos mentales que afectan a nuestras poblaciones. En tanto numerosos trabajos se abocan a trastornos específicos, escasos trabajos reflejan la consulta ambulatoria que abarque todas las patologías de la salud mental. El objetivo de este estudio de carácter descriptivo y exploratorio es obtener datos epidemiológicos de la población consultante, los diagnósticos prevalentes y los factores estresantes asociados para orientar los posibles abordajes terapéuticos. La metodología utilizada fue el relevamiento de 1.928 historias clínicas de los pacientes evaluados por los médicos admisores, psiquiatras de larga trayectoria clínica y que comparten un marco teórico común.

Aspectos epidemiológicos de la población ambulatoria en el servicio de psiquiatría de un hospital general: [revisión] / Epidemiological aspects of ambulatory patient population consulting a general hospitals psychiatry service: [review]

En las últimas décadas, la aparición de las sucesivas versiones del DSM-IV y la CIE 10 han contribuído a una mayor coherencia diagnóstica en el ámbito de la psiquiatría, favoreciendo así la búsqueda de datos epidemiológicos alrededor de los trastornos mentales que afectan a nuestras poblaciones. En tanto numerosos trabajos se abocan a trastornos específicos, escasos trabajos reflejan la consulta ambulatoria que abarque todas las patologías de la salud mental. El objetivo de este estudio de carácter descriptivo y exploratorio es obtener datos epidemiológicos de la población consultante, los diagnósticos prevalentes y los factores estresantes asociados para orientar los posibles abordajes terapéuticos. La metodología utilizada fue el relevamiento de 1.928 historias clínicas de los pacientes evaluados por los médicos admisores, psiquiatras de larga trayectoria clínica y que comparten un marco teórico común.(AU)

[A comparative study of suicide notes in over 65 years old patients (preliminary data)]. / Notas suicidas en pacientes mayores de 65 años: estudio comparativo (datos preliminares).

OBJECTIVE: To determine, in older suicide attempt inpatients, differences between leaving a suicide note and not leaving it as regards age, sex, marital status, religion, living alone, level of education, present psychiatric treatment, severity of suicidal attempt, previous suicidal arousal, afterwards suicidal arousal, suicidal ideation, hopelessness, depression, dementia, narcissistic personality disorder, physical pain, previous suicide attempt, familiar history of suicide or suicide attempt. MATERIAL AND METHODS: This is a comparative, prospective, observational, transversal, single blind study. RESULTS: We studied 31 patients. Statistical significant associations were found between leaving a suicide note and hopelessness (p=0.03;OR=8.57;IC=1.19-95.33) and severe suicide attempt (p=0.022;OR=8.40;IC=1.28-63.88). DISCUSSION: Although associations between writing suicide notes and hopelessness have not been reported, our results are not surprising because, on one side, the severity of the suicide attempt is more related to hopelessness than to any other depressive parameter and, on the other side, leaving a suicide note is associated to severe suicide attempts. Finally, to feel hopeless and to leave a suicide note are associated to severe suicide attempts.

Notas suicidas en pacientes mayores de 65 años: estudio comparativo (datos preliminares) / [A comparative study of suicide notes in over 65 years old patients (preliminary data)]

OBJECTIVE: To determine, in older suicide attempt inpatients, differences between leaving a suicide note and not leaving it as regards age, sex, marital status, religion, living alone, level of education, present psychiatric treatment, severity of suicidal attempt, previous suicidal arousal, afterwards suicidal arousal, suicidal ideation, hopelessness, depression, dementia, narcissistic personality disorder, physical pain, previous suicide attempt, familiar history of suicide or suicide attempt. MATERIAL AND METHODS: This is a comparative, prospective, observational, transversal, single blind study. RESULTS: We studied 31 patients. Statistical significant associations were found between leaving a suicide note and hopelessness (p=0.03;OR=8.57;IC=1.19-95.33) and severe suicide attempt (p=0.022;OR=8.40;IC=1.28-63.88). DISCUSSION: Although associations between writing suicide notes and hopelessness have not been reported, our results are not surprising because, on one side, the severity of the suicide attempt is more related to hopelessness than to any other depressive parameter and, on the other side, leaving a suicide note is associated to severe suicide attempts. Finally, to feel hopeless and to leave a suicide note are associated to severe suicide attempts.

Notas suicidas en pacientes mayores de 65 años: estudio comparativo (datos preliminares). / [A comparative study of suicide notes in over 65 years old patients (preliminary data)]

OBJECTIVE: To determine, in older suicide attempt inpatients, differences between leaving a suicide note and not leaving it as regards age, sex, marital status, religion, living alone, level of education, present psychiatric treatment, severity of suicidal attempt, previous suicidal arousal, afterwards suicidal arousal, suicidal ideation, hopelessness, depression, dementia, narcissistic personality disorder, physical pain, previous suicide attempt, familiar history of suicide or suicide attempt. MATERIAL AND METHODS: This is a comparative, prospective, observational, transversal, single blind study. RESULTS: We studied 31 patients. Statistical significant associations were found between leaving a suicide note and hopelessness (p=0.03;OR=8.57;IC=1.19-95.33) and severe suicide attempt (p=0.022;OR=8.40;IC=1.28-63.88). DISCUSSION: Although associations between writing suicide notes and hopelessness have not been reported, our results are not surprising because, on one side, the severity of the suicide attempt is more related to hopelessness than to any other depressive parameter and, on the other side, leaving a suicide note is associated to severe suicide attempts. Finally, to feel hopeless and to leave a suicide note are associated to severe suicide attempts.