Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients.

The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in high-risk clinical populations.

Reliability and validity of the structured interview for personality disorders in adolescents.

The Structured Interview for the DSM-III Personality Disorders was administered to 23 currently affectively ill adolescents and their parents. Interviews were videotaped and rerated; interrater agreement was moderate (weighted K = 0.49; unweighted K = 0.59). Moreover, there was evidence of convergent validity for Cluster II traits and disorders (borderline, histrionic, narcissistic), insofar as these diagnoses were associated with higher scores on the novelty-seeking subscale of the Tridimensional Personality Questionnaire as predicted. Cluster II patients tended to have higher rates of attention deficit disorder and bipolar disorder, and higher rates of suicidal gestures among second-degree relatives. Some difficulty was encountered differentiating symptoms of affective illness from those of personality disorder and in deciding when personality traits were impairing enough to call them disorders. Reliability may be improved by: (1) interviewing patients when out of affective episode; and (2) using standardized functional impairment criteria for differentiating personality style from disorder. Additional work is advocated to learn if personality disorders are precursors, epiphenomena, or the consequences of affective disorder.

Adolescent psychiatric inpatients' risk of suicide attempt at 6-month follow-up.

Adolescent inpatients (of whom 48 were admitted for a suicide attempt, 33 were admitted for suicidal ideation, and 53 had no history of clinically significant suicidal ideation or attempt), were interviewed while in the hospital and then followed up 6 months later. Of the 134 patients followed up, 13 (9.7%) had made a suicide attempt. The vast majority of those who attempted suicide had been suicidal while in the hospital (12/13 or 92.3%). Other risk factors for suicidal behavior include major depression at intake, affective disorder with nonaffective comorbidity, a depressive disorder that continued through follow-up, death of a relative, and family financial problems. Suicidal inpatients, particularly those with chronic and recurrent affective illness, are at substantial risk for making a suicide attempt within 6 months of discharge. At follow-up, an even higher proportion showed attempts or suicidal ideation with a plan (N = 36 or 26.8%), with risk factors similar to those noted above. More intense outpatient or partial hospital interventions as a transition from the inpatient environment may be necessary to reduce the rate of recidivism among suicidal adolescents.

A simple method to identify alcohol and other drug use in pregnant adults in a prenatal care setting.

Identification of women who use alcohol and other drugs while pregnant must occur as early as possible during the course of prenatal care so that interventions can be applied that may decrease the effects of alcohol and other drugs use on the newborn infant. This method for screening pregnant adults (a separate method is used for pregnant teenagers) who come for prenatal care is designed to be incorporated into the routine medical history interview and physical examination performed in all new prenatal patients. It explains how to ask pregnant women directly about alcohol and other drug use and how to determine the significance of their use. Common risk factors for alcohol and other drug use in pregnant women are described. Use of a Risk Assessment Worksheet is suggested as a means to determine which women may need further evaluation for possible alcohol and other drug use. Ways to ask pregnant women about continuing use at subsequent prenatal visits are also mentioned. Finally, suggested criteria for referring alcohol- and other drug-using women identified by this method for treatment of chemical dependence are supplied.

Effects of daily interrupted nursing on body weight and survival of Fischer 344 rat pups.

The effects on Fischer 344 rat pup body weight and survival were investigated when the dam was separated from her litter and deprived of food and water, approximately 7 h per day, from day 5 to day 21 of the postnatal period. This separation procedure simulates an inhalation reproduction study in which only the dams are exposed to the test material during lactation. The dams and pups were observed daily for clinical signs, and the number of pups in each litter and their body weights were determined on days 4, 9, 14 and 21 after parturition. When pups and dams were so separated, there was no effect on pup survival, but the pup body weights were moderately lower for this group by the end of the postnatal observation period.

Assessment of the cough reflex caused by inhalation of sodium lauryl sulfate and citric acid aerosols.

Guinea pigs were exposed for thirty minutes to a particulate aerosol of sodium lauryl sulfate at concentrations of 17.3, 28.9 and 48.6 mg/m3. The exposure chamber in which individual guinea pigs were exposed was fitted with a microphone to record coughing. As the concentration of sodium lauryl sulfate increased, the combined number and severity of the coughs increased and a fade in the response was also observed with exposure duration. Citric acid, a tussigenic agent commonly used to test antitussive agents was also tested using the same experimental protocol and was found to be about an order of magnitude less potent than sodium lauryl sulfate. This model could be useful in assessing the irritating properties of various aerosols to the tracheo-bronchial tree.

Teratogenicity study of ethylene glycol in rats.

Ethylene glycol was administered in the diet to pregnant Fischer 344 rats on days 6 through 15 of gestation. Target dosage levels were 1.0, 0.2, 0.04, and 0.00 g/kg/day. There was no maternal toxicity, embryotoxicity, or increased incidence of malformations in fetuses from doses dams. Positive control dams received 500 mg/kg of hydroxyurea on gestation day 11 and had fetuses with numerous soft tissue and skeletal malformations. Results are interpreted as preliminary indication of lack of teratogenicity of ethylene glycol.

The presence and accessibility of firearms in the homes of adolescent suicides. A case-control study.

OBJECTIVE: The presence of guns in the home, the type of gun, and the method of storage were all hypothesized to be associated with risk for adolescent suicide. DESIGN: Case-control study. SUBJECTS: The case group consisted of 47 adolescent suicide victims. The two psychiatric inpatient control groups were 47 suicide attempters and 47 never-suicidal psychiatric controls, frequency-matched to the suicide victims on age, gender, and county of origin. SETTING: The cases were a consecutive community sample, whereas the inpatients were drawn from a university psychiatric hospital. MAIN OUTCOME MEASURE: Odds of the presence of guns in the home of suicide victims (cases) relative to controls. RESULTS: Guns were twice as likely to be found in the homes of suicide victims as in the homes of attempters (adjusted odds ratio, 2.1; 95% confidence interval, 1.2 to 3.7) or psychiatric controls (adjusted odds ratio, 2.2; 95% confidence interval, 1.4 to 3.5). Handguns were not associated with suicide to any statistically significantly greater extent than long guns. There was no difference in the methods of storage of firearms among the three groups, so that even guns stored locked, or separate from ammunition, were associated with suicide by firearms. CONCLUSIONS: The availability of guns in the home, independent of firearms type or method of storage, appears to increase the risk for suicide among adolescents. Physicians should make a clear and firm recommendation that firearms be removed from the homes of adolescents judged to be at suicidal risk.