Health care contact prior to suicide attempts in older adults. A field study in Galicia, Spain.

INTRODUCTION: Older people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. Many studies have found greater health contact, especially with general practitioner, prior to suicidal behaviour in this age group. Less information is availbale about prior contact with other health services. OBJECTIVE: The objective of the study is to know the characteristics of contact with all levels of health services, prior to a suicide attempt in people over 65 years of age in a defined population. MATERIAL AND METHODS: Along the period January 2015 to December 2017, all persons over 65 years of age admitted by suicide attempt to emergency room in the health area of Santiago de Compostela were interviewed. The interview included a psychiatric evaluation and the collrection of relevant clinical and sociodemographic variables, in particular, data on prior contact with health services. RESULTS: 80 suicide attempts were recorded, which represents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. 61.3% had visited their general practitioner the month prior to the attempt, 72.5% had visited a health centre. On the other hand, 41.3% were not under the follow up of Mental Health services. CONCLUSIONS: The facts hat two out of three people over 65 years who commit suicide attempt in our area visit their general practitioner the previous month and 90% visit a health service along the previous three months, raise the question of wheter preventive measures of suicide could take place beyond the scope of Primary Care.

Contacto sanitario previo a intentos de suicidio en personas de edad avanzada. Un estudio de campo en Galicia, España / Health care contact prior to suicide attempts in older adults. A field study in Galicia, Spain

INTRODUCCIÓN: Las personas de edad avanzada presentan las tasas más altas de suicidio en todo el mundo. A su vez, tienen las menores tasas de intentos de suicidio. Muchos estudios coinciden en señalar que en este grupo de edad existe un mayor contacto sanitario previo a las conductas suicidas, especialmente con Atención Primaria. El contacto previo con otros niveles asistenciales es menos conocido. OBJETIVO: El objetivo del estudio es conocer las características del contacto con centros sanitarios, de todos los niveles asistenciales, previo a un intento de suicidio, en personas mayores de 65 años, en un área sanitaria bien delimitada. MATERIAL Y MÉTODOS: En el periodo de enero de 2015 a diciembre de 2017, todas las personas mayores de 65 años del área sanitaria de Santiago de Compostela atendidas en el servicio de urgencias por intentos de suicidio fueron entrevistadas. La entrevista incluyó una evaluación psiquiátrica y la recogida de distintas variables clínicas y sociodemográficas, así como datos sobre el contacto previo con centros sanitarios. RESULTADOS: Se registraron 80 intentos de suicidio, lo que supone una incidencia de 35,3/100.000. La edad media de nuestra muestra fue de 74,85 ± 7 años, la proporción entre hombre: mujer fue de 2:3. En las cuatro semanas previas a la tentativa, el 61,3% visitó a su médico de Atención Primaria y el 72,5% visitó algún centro sanitario. El 41,3% no estaba a seguimiento en servicios de Salud Mental. CONCLUSIONES: El hecho quedo de cada tres personas mayores de 65 años que cometen un intento de suicidio en nuestra área visitaron a su médico de Atención Primaria durante el mes previo y el 90% hubieran visitado algún centro sanitario durante los tres meses previos, plantea la posibilidad de que las medidas preventivas del suicidio pudieran llevarse a cabo más allá del ámbito de la Atención Primaria

INTRODUCTION. Older people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. Many studies have found greater health contact, especially with general practitioner, prior to suicidal behaviour in this age group. Less information is availbale about prior contact with other health services. OBJECTIVE: The objective of the study is to know the characteristics of contact with all levels of health services, prior to a suicide attempt in people over 65 years of age in a defined population. MATERIAL AND METHODS: Along the period January 2015 to December 2017, all persons over 65 years of age admitted by suicide attempt to emergency room in the health area of Santiago de Compostela were interviewed. The interview included a psychiatric evaluation and the collrection of relevant clinical and sociodemographic variables, in particular, data on prior contact with health services. RESULTS: 80 suicide attempts were recorded, which rep-resents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. 61.3% had visited their general practitioner the month prior to the attempt, 72.5% had visited a health centre. On the other hand, 41.3% were not under the follow up of Mental Health services

Perfil de los intentos de suicidio en personas mayores de 65 años del area sanitaria de santiago de compostela en el periodo de 2015 a 2017 / Profile of suicide attempts in people over 65 years of the sanitary area of santiago de compostela in the period of 2015 to 2017

Introducción: Las personas de edad avanzada presentan las tasas más altas de suicidio en todo el mundo. A su vez, tienen las menores tasas de intentos de suicidio. Este hecho responde a diversos factores, que hacen que la conducta suicida en el anciano sea de alta letalidad, consumándose el suicidio al primer intento en un gran número de casos. Objetivo: conocer el perfil sociodemográfico y clínico de las personas mayores de 65 años que son atendidas en el servicio de urgencias del Hospital Clínico de Santiago de Compostela por un intento de suicidio. Material y métodos: en el periodo de Enero de 2015 a Diciembre de 2017 todas las personas mayores de 65 años atendidas por intento de suicidio en el servicio de urgencias e Interconsulta de psiquiatría del Hospital Clínico de Santiago de Compostela fueron evaluadas y entrevistadas. Se recogieron distintas variables clínicas y sociodemográficas de interés. Resultados: se registraron 80 tentativas de suicidio, lo que supone una incidencia de 35,3/100.000. La edad media de nuestra muestra fue de 74,85±7 años, la proporción entre hombre:mujer fue de 2:3. La mitad de la muestra estaba casada y la mayoría vivían con familia. El 25% presentaba tentativas previas, siendo la mayoría mujeres (p<0,01). El diagnóstico mayoritario pertenecía al grupo de Trastornos afectivos y el método más utilizado fue el de sobreingesta medicamentosa. El desencadenante o estresante más frecuente estuvo en relación a conflictiva intrafamiliar. Se encontraron diferencias en los subgrupos por la edad del episodio índice superior o inferior a los 65 años en cuanto al sexo, diagnóstico, e ingresos previos. Conclusiones: Las personas de más de 65 años que intentan suicidarse en nuestra área presentan un perfil sociodemográfico similar a otras muestras de nuestro entorno. Las mujeres, con ingresos previos en psiquiatría, tentativas antes de los 65 años, y con algún diagnóstico de Trastorno de la Personalidad son una población de riesgo para presentar nuevas tentativas más allá de los 65 años

Introduction: Elderly people have the highest suicide rates in the world. In turn, they have the lowest rates of suicide attempts. This fact responds to several factors, which make suicidal behavior in the elderly a behavior of high lethality, committing suicide at the first attempt in a large number of cases. Objective: to know the sociodemographic and clinical profile of people over 65 years who are treated in the emergency department of the Clinical Hospital of Santiago de Compostela for an attempted suicide. Material and methods: from January 2015 to December 2017 all people over 65 years treated by suicide attempt in the emergency service and Psychiatry Interconsultation of the Clinical Hospital of Santiago de Compostela were evaluated and interviewed. Different clinical and sociodemographic variables of interest were collected. Results: 80 suicide attempts were recorded, which represents an incidence of 35.3 / 100,000. The average age of our sample was 74.85 ± 7 years, the ratio between male: female was 2: 3. Half of the sample was married and most lived with family. 25% had previous attempts, the majority being women (p <0.01). The majority diagnosis was the Affective Disorders group and the most used method was drug overdose. The most frequent trigger or stressor was related to intrafamiliar conflict. Differences were found in the subgroups by the age of the index episode above or below 65 years in terms of sex, diagnosis, and previous income. Conclusions: People over 65 who try to commit suicide in our area have a sociodemographic profile similar to other samples from our environment. Women, with previous income in psychiatry, attempts before the age of 65, and with some diagnosis of Personality Disorder are a risk population to present new attempts beyond 65 years

Insight assessment in psychosis and psychopathological correlates: Validation of the Spanish version of the Schedule for Assessment of Insight - Expanded Version

Background and Objectives: Lack of insight is a cardinal feature of psycho -sis. Insight has been found to be a multidimensional concept, including awareness of having a mental illness, ability to relabel psychotic phenomena as abnormal and compliance with treatment., which can be measured with the Schedule for Assessment of Insight(SAI-E). The aim of this study was to validate the Spanish version of SAI-E. Methods: The SAI-E was translated into Spanish and back-translated into English, which was deemed appropriate by the original scale author. Next, the Spanish version of the SAI-Ewas administered to 39 patients with schizophrenia or schizoaffective disorder (DSM-IV criteria)from a North Peruvian psychiatric hospital. The Positive and Negative Syndrome Scalefor Schizophrenia (PANSS) and the Scale of Unawareness of Mental Disorder (SUMD) were also administered. Specifically, internal consistency and convergent validity were assessed. Results: Internal consistency between the 11 items of the SAI-E was found to be good to excellent (α = 0.942). Compliance items did not contribute to internal consistency (A = 0.417,B = 572). Inter-rater reliability was excellent (ICC = 0.99). Regarding concurrent validity, the SAI-E total score correlated negatively with the lack of insight and judgement item of the PANNS (r = -0.91, p < 0.01) and positively with the SUMD total score (r = 0.92, p < 0.001). Conclusions: The Spanish version of the SAI-E scale was demonstrated to have both excellent reliability and external validity in our sample of South American Spanish-speaking patients with schizophrenia spectrum disorders (AU)

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A case with reversible neurotoxicity after 2 years of dementia secondary to maintenance lithium treatment.

Chronic neurotoxicity caused by lithium salts can be reversible or irreversible and may appear after years of treatment, even at serum levels considered within the usual therapeutic range. The authors present the case of a patient with bipolar disorder who developed dementia at the age of 54 after being treated with lithium carbonate at therapeutic levels for 4 years. Nevertheless, lithium treatment was continued. At age 56, the patient presented with an acute encephalopathy caused by toxic lithium levels, which resolved only after lithium carbonate was discontinued. Full recovery from the dementia, which had started 2 years earlier, occurred only after cessation of lithium. The authors conclude that when patients treated with lithium develop subacute cognitive impairment, the possibility of lithium toxicity should be considered, even if the serum levels are considered within the therapeutic range. A long duration of neurotoxicity associated with lithium treatment does not necessarily indicate an irreversible prognosis.

Vascular psychosis in the elderly: response to clozapine.

Cerebrovascular disease is a cause of late-onset psychosis in the elderly more frequent, accompanied or not, multi-infarct dementia. In many cases the patient has adequate preservation of cognitive functions or in any case, no criteria for dementia. In those that do, is in vascular dementia where psychotic symptoms are more frequent, occurring in over half cases, compared to one third of patients with Alzheimer disease. A case of a 92 year-old woman with no somatic background -except for a bilateral progressive hearing loss-, who debuted at this age with psychotic delusions structured injury and auditory hallucinations. The CT scan showed signs of cortico-subcortical atrophy. Neuropsychological examinations showed some cognitive impairment but no clinical criteria for dementia. Was refractory to first-line atypical antipsychotics, remitting symptoms after administration of low doses of clozapine. We discuss the clinical features of this psychosis, as well as its therapeutic approach.

Psicosis vascular en el anciano: respuesta a clozapina / Vascular psychosis in the elderly: Response to Clozapine

La enfermedad cerebro-vascular supone una de las causas de psicosis en el anciano de origen tardío más frecuentes, se acompañe o no de demencia multi-infarto. En muchos casos el paciente presenta una adecuada conservación de las funciones cognitivas o, en todo caso, no presenta criterios de demencia. En aquellos que sí, es en la demencia vascular donde los síntomas psicóticos son más frecuentes, presentándose en más de la mitad de los casos, frente a un tercio en los pacientes con demencia tipo Alzheimer. Se presenta el caso de una mujer de 92 años, sin antecedentes somáticos de interés -a excepción de una progresiva hipoacusia bilateral-, que debuta a esa edad con clínica psicótica aguda en forma de delirios de perjuicio estructurados y alucinaciones auditivas. La TAC cerebral mostró signos de atrofia córtico-subcortical. La evaluación neuropsicológica demostró cierto deterioro cognitivo, pero sin criterios clínicos de demencia. Fue refractaria a antipsicóticos atípicos de primera línea, remitiendo el cuadro tras administración de dosis bajas de clozapina. Se discuten las características clínicas de esta psicosis, así como su abordaje terapéutico (AU)

Cerebrovascular disease is a cause of late-onset psychosis in the elderly more frequent, accompanied or not, multiinfarct dementia. In many cases the patient has adequate preservation of cognitive functions or in any case, no criteria for dementia. In those that do, is in vascular dementia where psychotic symptoms are more frequent, occurring in over half cases, compared to one third of patients with Alzheimer disease. A case of a 92 year-old woman with no somatic background-except for a bilateral progressive hearing loss-, who debuted at this age with psychotic delusions structured injury and auditory hallucinations. The CT scan showed signs of cortico-subcortical atrophy. Neuropsychological examinations showed some cognitive impairment but no clinical criteria for dementia. Was refractory to first-line atypical antipsychotics, remitting symptoms after administration of low doses of clozapine. We discuss the clinical features of this psychosis, as well as its therapeutic approach (AU)