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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.
Natural polyamines (putrescine, spermidine and spermine) are low molecular weight highly protonated aliphatic molecules that physiologically modulate NMDA, AMPA/kainate glutamatergic receptors and limbic dopaminergic neurotransmission. Previous studies had demonstrated that polyamine metabolism might be disrupted in schizophrenia, what could potentially be linked to glutamatergic dysfunction. In particular, polyamine levels in blood and fibroblast cultures from patients with schizophrenia had previously been found to be higher than in healthy controls. Indeed, a significant positive correlation between blood polyamine levels and severity of illness may exist.
In order to test potential differences in blood polyamine levels between drug-free schizophrenia in-patients (n = 12), and healthy controls (n = 26, blood donors), spermidine (spd), spermine (spm), and spermidine/spermine index (spd/spm) were determined using HPLC after dansylation.
No significant differences were found between groups (t = 0,974; df = 36; P = 0,337 for spd, t = l0, 52; df = 36; P = 0,959 for Spm, and, t = 0, 662; df = 36; P = 0,512 for spd/spm).
Though we couldn’t replicate previous findings suggesting disturbances in blood polyamine levels in schizophrenia, this issue may be a promising target. Future research should take into account possible factors such as sex, nutritional state, and stress.
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
Voluntary drug overdoses are an important part of psychiatric demand in the emergency service. Nevertheless, a protocolized attention for these cases does not exist. Therefore, its management only depends on doctors’ personal criteria. Many of these cases have been previously diagnosed as Personality Disorder.
Studying the differences in management of drug overdosing depending on previous diagnosis of personality disorder. Also, we look for associated factors that can influence the final decision.
We conducted a retrospective analysis of 112 drug overdoses attended from July to December 2009. Data were analyzed using SPSS software.
34 attended patients (30,4%) have previous diagnosis of personality disorder. In these, the most frequent diagnosis was parasuicide attempt in the Emergency Service. In contrast, the rest of the patients were diagnosed as suicidal attempt.
We found statistically significant differences (p < 0,05) in the destination after Emergency evaluation (ambulatory or hospitalization) depending on a previous personality disorder diagnosis.
The media of previous overdoses in personality disorder group was significantly higher (3,29 Vs 0,64; P < 0,01).
We found that humor and anxiety disease comorbility, associated toxicomany, alcohol or cocaine use during the overdose, were more frequent in the group with personality disorder.
Although drug overdoses in patients with personality disorder have less letal intention, these patients were hospitalized more frequently than the others. This finding could be explained because of the presence of other associated factors that contribute to the global risk of overdosing. Previous overdoses seem to have significant influence in final decision.
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.