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One of the most important prognostic factors in patients diagnosed with schizophrenia is the number of hospitalizations they need during their life. In this work we describe risk factors which determinate psychotic relapse.
Retrospective review of the clinical histories of patients diagnosed with schizophrenia who needed hospitalization during the year 2008 using Hospital Ramon Cajal's history software. Data were analyzed using the SPSS software 15.0 version.
- Socio-demographic: We collected a total of 57 patients, 60% were men and 77,2% were single who lived with their families. 52,8% only had Primary education and 14% had been to University. 38,6% were pensioner and 12,3% workers.
- Risk factors: 54,4% had abandoned their medication, 7% had had recent modifications in their medication, and 35,1% received long acting antipsychotic. 42,1% were identified as substance users.
- 40,4% had been diagnosed with schizophrenia more than three years ago; 57,9% had had less than 3 previous hospitalizations, and 54,4% need hospitalization the previous year.
Male under 30 years old have more risk of needing more hospitalizations. The main risk factor for suffering new psychotic episodes is the medication nonadherence, modifying medication only causes new episodes in few patients. Patients receiving long-acting antipsychotic agents suffer less psychotic relapse. Substance abuse among schizophrenia patients is a major complicating factor since almost half of the hospitalizations are related to it.
Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent.
To investigate the relation of substance related disorder and suicide attempt.
Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010.
We identified 85 cases.
Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%).
Previous attempts were found in 43″8% of the patients.
Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose.
Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient.
We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts.
- Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances.
- As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers
Suicidal behaviours are commonly found at increased rates among individuals with psychiatric disorders.
To identify risk factors of suicide among the population attended in our area, describe the characteristics of the attempt and the management.
Review of the drug overdosings attended in our Hospital from July to December of 2009.
We identified 112 drug overdosings. 80′4% of the patients had psychiatric history: Mood-Anxiety disorders 60′7%, Substance-Related Disorders 41′1%, Personality disorder 30′4% and Psychotic disorder 10′7. Previous attempts were found in 43′8% of the patients. The most common drug used were benzodiacepines (73% of the cases), followed by antypsychotics (17′9%). Up to 32′1% of the patients used non psychiatric drugs. 64′3% of the patients consumed alcohol and 13′4% cocaine. Moreover, 15′2% of the patients took other toxic substances such us bleach, soap and other chemical products.
We did not find significant differences when studying triggers (family, partnership, economical or others)
The most common diagnosis was suicide attempt (41′1%), followed by parasuicide attempt. 41′4% of the drug overdosings were not considered as self injurious behavior. 64% were referred to ambulatory services, 22′5% needed hospitalization in psychiatric units, and 5′4 were hospitalized in medical services. Although those diagnosed of personality disorder were more often diagnosed of parasuicide (50% Vs 32′1%), they needed more hospitalizations (41% Vs 21%)
- Self-injurious behavior is one of the most common causes of consulting in the emergency services.
- Patients diagnosed of personality disorder are more commonly hospitalized after making a suicide attempt.
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