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The aims of the two pieces of work are to study wheter any differences exist in the rates and characteristics of suicide by ethnicity, sex and alcohol abuse in South Tyrol, Italy.
Psychological autopsy interviews were conducted for suicides who died between March 1997 and July 2006.
332 individuals belonging to the three major South Tyrolean ethnic groups (Germans, Italians and Ladins, who speak a Rhaeto-Romance language) died by suicide.
Germans were 1,37 times more at risk to commit suicide than Italians (95% CI 1.04/1.80; z=2.26, p< .05). 69% of the suicides had attended school for less than 8 years, and Germans (OR 4,62; 955 CI:2.52/8.47; p< .001) were more likely to have lower education than Italians. A further comparison of 267 male victims with and without alcohol abuse in their history evidenced that alcohol abusers were 3,5 times more likely to have low educational attainment, 4,22 times more likely to have been unemployed or have employment instability and 2.29 times more likely to have job security than male suicides without alcohol use disorders.
The study indicates that suicide, an alarming health problem in South Tyrol, may require different preventive interventions for men and women, for those of different ethnicities and for people with and without alcohol use disorder.
South Tyrol is a province of Italy bordering on Austria with 500.000 inhabitants, comprising three different ethnic- linguistic groups (German, Italian and Ladin) whose suicide rate is two times higher than the Italian average.
Goal of the research: The following ecological research tries analyse the existence of some risk factors that differentiate South Tyrol from the rest of Italy explaining the greater number of suicides.
Between 1999 and 2006 almost 300 suicide cases were gathered and analysed with the descriptive interference method. The records have been elaborated considering different variables.
Among the results two records are of particular interest:
1. A significantly higher risk of suicide in the German speaking population compared to the Italian one (the records of the Ladin speaking population are not significant).
2. There is a higher suicidal tendency in the rural areas compared to the urban ones.
Such as in all epidemiological descriptive surveys there is no causal explanation for the instance that the German speaking group is characterized by a suicide risk which is 1,3 times higher than the Italian speaking group. It remains unanswered if the high number of suicide in the German speaking population is due to a selection variable; for example that the areas populated by the latter (mainly rural areas) present another variable (high alcoholism, different familiar cohesion, etc.) than the mother language. In this case the affiliation to a linguistic group would be considered a confusing variable among other causal factors.
To test the prognostic value of suicidal status in depressed patients for responses to antidepressant treatment.
We evaluated treatment response and covariates in depressed patients diagnosed with DSM-IV major depressive (n=50) or bipolar disorders (n=32) treated initially in a day-hospital for 2 weeks, followed by 4 weeks of outpatient treatment with antidepressants, with or without a mood-stabilizer. Being suicidal was based on an item-3 of the 17-item Hamilton Depression Rating Scale (HDRS17) scored at ≥3 and verified by baseline clinical assessment; morbidity and improvement were based on the total of the remaining 16 nonsuicidal items (HDRS16).
Suicidal (n=31) and nonsuicidal subjects (n=51) were similar in baseline ratings of depressive symptom-severity (HDRS16), but were depressed longer and less likely to be married. Suicidality ratings improved by 36% during 6 weeks of treatment among initially suicidal patients, but other depressive symptoms (HDRS16) improved (13%) only half as much as in nonsuicidal subjects (25%), independent of diagnosis and treatment. Fewer than half as many suicidal subjects showed ≥20% improvement in HDRS16 scores.
Findings, based on diagnostically complex and relatively treatment-resistant subjects, may not generalize.
Being suicidal may limit response to treatment in depressed major affective disorder patients, independent of diagnosis or overall symptomatic severity.
Attention deficit/hyperactivity disorder (ADHD) affects 5–6% of adults. Methylphenidate challenge is used to test functions such as concentration. Therapeutic drug monitoring (TDM) identifies optimal drug ranges in plasma.
We aimed to: assess the clinical impact of the drug challenge in adults with ADHD; analyze the relationship with the drug plasma levels after the challenge; identify predictors of the challenge's clinical impact.
In 2015–2016, we recruited 45 consecutive adult DSM-5 ADHD outpatients (mean age ± SD = 35.3 ± 2.1 years; females = 64.4%) at the Bolzano hospital department of psychiatry. Before and after administration of methylphenidate 10 mg, we measured concentration, impulsivity, tension, and general well-being with a VAS and an interview. After two hours, TDM was performed. Deltas were calculated for pre-/post-challenge measures. Correlations were measured with Pearson's r/point-biserial coefficient. A generalized linear mixed model estimated the size of association between tension/general well-being improvement and patient characteristics.
After the challenge, the mean improvement ± SD was 24 ± 22 for concentration, 17 ± 23 for impulsivity, 21 ± 28 for tension, 16 ± 24 for general well-being. The mean TDM ± SD was 4.6 ± 0.5 ng/mL. A negative correlation between TDM, tension (P = 0.009), and general well-being (P = 0.028) after the challenge emerged: higher drug plasma levels relate to less tension and greater general well-being. At the GLMM the main predictor for tension/general well-being improvement was psychopharmacological treatment (P = 0.011/P = 0.05, respectively). Older age and difficult tasks prevented improvement.
Methylphenidate challenge had a positive effect on all patients’ performance. TDM values were lower than literature ones, although the latter are usually obtained after the administration of methylphenidate 20 mg.
Disclosure of interest
The authors have not supplied their declaration of competing interest.
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