Analgesic effect of nasal salmon calcitonin during the early post-fracture period of the distal radius fracture.

OBJECTIVES: To investigate the analgesic effect of nasal salmon calcitonin on the post-fracture period of distal radius fracture. METHODS: In this prospective randomized double-blind study, forty-one postmenopausal women with a recent distal radius fracture treated conservatively were randomly assigned to receive either 200 IU of intranasal salmon calcitonin or placebo daily for 3 months following fracture. The assessment of the patient's pain was recorded using the Visual Analogue Scale (VAS). RESULTS: The average age of the calcitonin group was 67.11 (SD, ±8.68) years and 64.91 (SD, ±7.48) of the placebo group. In the calcitonin group, the mean VAS score improved from 4.05 to 0.53 while in the placebo group from 3.36 to 0.32. A higher decrease of VAS score during the first post-fracture period was observed in the calcitonin group. CONCLUSIONS: In the study, there is a statistically significant calcitonin mediated analgesic effect in the immediate post fracture period (at 10 days) when compared to placebo group. These results are in accordance with literature referring to the analgesic effect of calcitonin in the acute osteoporotic vertebral compression fracture. Thus calcitonin administration could be recommended to a short term course in acute osteoporotic conservatively treated distal radius fractures.

Compulsory hospitalisation and optimal mental health care: A European perspective and the example of Greece.

Countries offering good psychiatric care which respects their clients' dignity and human rights can be expected to reflect this fact in their official health statistics. Given that European data on compulsory hospitalisation are currently inadequate, we propose that all Member States should collect at least a basic set of figures for calculating the rates or quotas of compulsory admissions and the rate of legally indefensible detentions; this will allow us to examine both the actual cost of freedom lost as well as the extent to which national mental health laws are delivered as prescribed. As shown here by the example of Greece, there is an urgent need to focus on possible infringements on the rights of the mentally ill, because Member States can nοt be compelled to accept international monitoring or to observe minimum standards of mental health care.

An epidemiological study of the factors influencing poisoning in children aged 0-5 years.

The aim of this cross disciplinary study was to identify the most significant variables related to childhood accidental poisoning. The study was carried out on a representative sample of families living in the Greater Athens Area comprising 1245 children aged up to 5 years. Data were collected by a team of researchers (paediatricians, psychologists and social workers) and involved a structured interview and a paediatric examination. The findings show that childhood poisoning is correlated with: (1) biological variables, such as skeletal anomalies, language disorders, number of recent infections and complications of pregnancy; and (2) social factors, such as father's educational level, monthly family income, and overcrowding. Sex of the child was not found to influence poisoning.

Estimating suicide risk among attempted suicides. II. Efficiency of predictive scales after the attempt.

We predicted that the closer the resemblance of attempted suicide to completed suicide, the greater the risk of patients later killing themselves after an unsuccessful attempt. Using two risk scales, one of 6 and the other of 18 socio-demographic and clinical items, weighted according to their value in discriminating between suicides and attempted suicides, and a rating of intent to die during the index suicide attempt, we followed up 1263 attempted suicides for two years. Ten of the twelve suicidal deaths in the first year occurred in patients scoring in the top quartile on the 6-item scale; and among high-risk scorers there was an excess of those defined as 'failed suicides' at the index attempt. The 18-item scale was superior to the shorter one, but both scales were improved by taking into account the rating of intent-to-die. The potential value of these findings is discussed in the light of some inherent problems of predicting suicide in the clinical setting.

Estimating suicide risk among attempted suicides: I. The development of new clinical scales.

A discriminant function analysis was carried out to separate a sample of 75 suicides from a sample of 146 attempted suicides, on which comprehensive clinical and social data were recorded on an identical schedule. Two sets of discriminating items (with 18 and 6 variables) correctly classified 91 per cent and 83 per cent of the two samples in their respective groups. The results provide a basis for examining the usefulness of these variables as predictors of future suicide in people who have attempted suicide.

Seriousness of suicide attempt in relation to personality.

From a sample of psychiatric referrals who had completed the MMPI the following three groups, matched for age and sex, were derived: 42 patients with a history of a serious suicide attempt, 42 patients with a history of a non-serious attempt, and 126 patients who had neither attempted nor contemplated suicide. Non-serious suicide attempters were shown to be the most deviant group and differed to a significant extent from each of the other two groups on the Dependency, Hostility and Unconventionality scales. Male non-serious attempters showed the most disturbed personality profile. This implies that there is, for males, a higher personality threshold for making a non-serious attempt, which may account for the fact that suicide attempts, most of which are non-serious, are commoner among females.

The value of assessing intent in attempted suicide.

Suicidal intent was assessed in a sample of 151 admissions to a general hospital for self-poisoning or self-inflicted injury. Severity of intent was associated with the act's medical seriousness and with the risk of suicide derived from a validated risk scale. Although high and low intent cases were comparable in respect of precipitating factors, patients rated high on suicidal intent were more likely to have experienced depressive symptoms in the previous month.

Personality and suicidal history in psychiatric patients.

The study sample comprised 575 psychiatric referrals for whom MMPI data were available. Patients were categorized according to suicidal history. The attempted suicide and nonsuicidal patients were differentiated significantly on the D, PD, MF, DY, ES, NE, EX, HO, SD, IP, ANX, and UNC scales. Important differences between the sexes emerged; whereas for men the profiles of the suicidal ideation and nonsuicidal patients were similar, for women those of the suicidal ideation and suicide attempt were similar. Male and female suicide attemptors correspond closely in the pattern and degree of deviation from the nonsuicidal patients of their own sex. The study indicates that patients who have a history of suicide attempts constitute a more psychologically disturbed group and points to a need for further examination of the meaning of suicidal ideation for men and women.

Excessive use of psychiatric services by suicidal patients.

The use of psychiatric services by patients with a suicidal history was examined to see if they placed a greater long-term burden on these services than other types of patient. Suicidal patients spent significantly more days in hospital and made more outpatient attendances; suicide attemptors in particular not only needed more emergency consultations but also spent more days in hospital. A more economical yet more effective treatment policy for the suicidal patient is needed.

Depression followed by suicide: a comparison of depressed suicides with living depressives.

The characteristics of 64 suicides with a retrospective diagnosis of depression and 128 depressives referred for psychiatric treatment were compared. The following items differentiated the suicide group: male sex, older age in females, single status, living alone, the symptoms of insomnia, impaired memory and self neglect, and a history of suicide attempts. The value of these items in assessing suicide risk in depressive illness is discussed.