Anticonvulsants have been used for the treatment of affective and anxiety symptoms secondary to alcohol abuse as well as craving. In this open label study we investigated efficacy of topiramate as an adjunct in alcohol detoxification; end targets were anxiety, depression and in obsessive-compulsive drinking.

Two groups matched for age, alcohol consumption and demographic characteristics, were treated either with psychotherapy (n=43) or psychotherapy and topiramate (n=43). Subjects were assessed twice (baseline and after a 4-6 week detoxification period) by the Hamilton Anxiety Rating Scale, the Hamilton Depression Rating Scale, and the Obsessive Compulsive Drinking Scale. T-tests were used for comparisons between groups.

Following detoxification, psychopathology significantly subsided in both groups; however, improvement was more robust in the topiramate group (table 1).

Topiramate in conjunction with a short-term psychotherapeutic approach may help the alcohol detoxification process by minimizing craving and subjective physical discomfort. Moderate to severe anxiety and depressive symptoms with concomitant poor functioning were present in all subjects before treatment. Following 4-6 weeks of alcohol detoxification, a considerable improvement in terms of anxiety and depressive symptoms was observed in both groups. However, in our sample, a significantly more robust decrease was recorded in the topiramate augmentation group. Consequently, topiramate can be of potential help in this population and can be used as an alternative among other treatment options.

To evaluate the efficacy of three different strategies in the management of self-aggressive behavior (defined as repeated overdoses, explicit suicidal attempts or self-mutilation) observed in heroin dependent patients.

A group of 16 patients, mean age 26.2, diagnosed with heroin dependence, were treated as outpatients, with (1) oxcarbazepine (mean daily dose 900 mg), (2) cognitive behavioral therapy focused on coping strategies and cognitive restructuring (2 sessions per week) or (3) the combination of the previous two methods. All the included patients were monitored for 6 months using Inventory of Drug Taking Situations (IDTS), Clinical Global Impression-Improvement (CGI-I), Suicide Attempt-Self Injury Interview-Short Version (SAS II-B) and Global Assessment of Function (GAF). The randomization of the patients in the three groups was single blinded.

Oxcarbazepine was well tolerated and no drop out related to adverse events was registered. Patients that received combined therapy registered an improvement (p< 0.01) in all self-aggressive behaviors (33% to baseline), global functioning (25%) and clinical impression (24%). There was a significant difference between this group and the psychotherapy only treated group (p< 0.01 on SAS II-B, GAF, CGI), but not significant when it was compared to oxcarbazepine group (p=0.06). Regarding the impact of treatment strategies over the severity of addiction, only the combined therapy had some success, by decreasing with 11% the IDTS score.

The combined therapy, using CBT and oxcarbazepine, reduced the risk for self-aggressive behaviors on medium term in heroin dependent patients and mildly decreased the severity of the dependence.

To establish the frequency of self-image distorsions in alcohol dependent patients and if addressing them through a targeted psychotherapeutic approach would be beneficial.

A group of 45 patients, 32 male and 13 female, mean age 39.6, diagnosed with alcohol dependence (DSM IV TR), were evaluated for establishing the severity of self-image distorsions, using-baseline and endpoint- Rotter Incomplete Sentence Test (RIST) and Thematic Apperception Test (TAT); for the monitoring of the dependence severity and its associated impairments we used Inventory of Drug Taking Situations (IDTS)-alcohol focused version and Global Assessment of Function (GAF) every 4 weeks for 6 months. From the initial group, 38 (84.4%) patients have been found with moderate and severe self-image distorsions (feeling of insecurity and inferiority, external locus of control, frequent use of denial, regression and projection). They received cognitive-behavior therapy (CBT) focused on restructuring cognitive dysfunctional beliefs about self and experimenting new ways to relate to self and significant others.

The psychotherapeutic approach decreased the overall severity of alcohol dependence (-35.7 on IDTS, p< 0.01) and consequently improved the global functioning (+18.2 on GAF, p< 0.01) after 6 months. These results correlated with the improvement of self-image, reflected on the severity of P-Ego scale from RIST (-23.2%, p< 0.01) and on the improvement of defense system (more frequent use of anticipation, suppression and rationalization and less of denial and projection).

Patients with alcohol dependence have very often self-image distorsions and could, therefore, benefit from a psychotherapy that addresses specifically this phenomenon.

To evaluate diurnal preference and sleep patterns in relation to alcohol consumption.

The Alcohol Use Disorders Identification Test (AUDIT), the Sleep Disorders Questionnaire, the Pittsburgh Sleep Quality Index, the Pittsburgh Insomnia Rating Scale, the Multidimensional Fatigue Inventory, the Epworth Sleepiness Scale, the Beck Depression Inventory II and the Composite Scale of Morningness (all in Romanian translation) were used. Subjects, aged over 18, were recruited from the Psychiatric facilities of the Baia Mare County Hospital, Romania, as well as from patients’ families or acquaintances and from students attending the Faculty of Psychology in Cluj-Napoca. We excluded people suffering from certain conditions that impair sleep (e.g. sleep apnoea).

Three hundred and six people (age: 41.2±15.7) were included in this study. Based on AUDIT scores, we created three groups (low, medium and high alcohol use). We found that alcohol consumption influenced sleep and sleep quality: the higher the alcohol consumption was, the more disrupted the sleep and the more severe the sleep loss consequences (fatigue, daytime sleepiness, depression) were. About a half of the high alcohol consumers (48.5%) experienced insomnia, lasting more than a month and impairing their functionality (compared to 18% of the low consumers and 25% of the medium consumers; X=19.5, P=0.001). Individuals with evening or morning preference and moderate or high alcohol use tended to score higher in the AUDIT compared to those of intermediate preference.

These results indicate that alcohol consumption is linked with sleep disturbances and that diurnal preference may also influence alcohol intake.

The role of mental illness in the aetiology of suicide is well-recognised whereas the importance of personality and other enduring psychological characteristics has received relatively little attention in prospective studies.

Prospective cohort study of men and women aged 20+ years who participated in the Nord- Trøndelag Health Study, Norway, in 1984-86 (HUNT 1, n=74,977) and 1995-97 (HUNT II, n=66,140). State and trait psychological measures (personality traits, self-esteem and sense of coherence) along with sociodemographic, life style and physical health factors known to influence mental health and suicide risk were self reported by participants. Study members were followed up until 31st of December 2004.

There were 153 suicides amongst the study members included in the analyses. Traits of neuroticism and conscientiousness (dutifulness) were associated with a modest (30-80%) increased risk of suicide. Low self-esteem (hazard ratio 5.22 95% CI 0.90 to 30.42) and low sense of meaning in life (hazard ratio 4.88 95% CI 1.86 to 12.82) were associated with an increased suicide risk in the fully adjusted models even after controlling for common mental disorder.

Our results suggest that simple questions relating to markers of personality, self-esteem and meaningfulness (SOC) might be useful tools in clinical suicide risk assessment. However, findings need replication in future large scale prospective studies.

To identify factors associated with suicide attempts using data from a large, 3-year, multinational follow-up study of schizophrenia (SOHO study).

All baseline characteristics of 8,871 adult patients with schizophrenia collected in patients included in the SOHO study were included in a GEE logistic regression post-hoc analysis comparing patients who attempted suicide during the study with those who did not.

A total of 384 (4.3%) patients attempted or committed suicide. The risk factors that resulted statistically associated with suicide attempt were a lifetime history of suicide attempts (OR 3.6 [95% CI 2.8, 4.6; p< 0.0001]), suicide attempts in the last 6 months (OR 2.5 [95% CI 1.8, 3.4; p< 0.0001]), prolactin-related side effects (OR 2.0 [95%CI 1.4, 2.9; p=0.0002]), CGI depression (OR 1.2 [95% CI 1.1, 1.3; p=0.0004]) and history of hospitalization for schizophrenia (OR 1.4 [95% CI 1.1, 1.8; p=0.009]).

In view of the observational design of the study and the post-hoc nature of the analysis, the identified risk factors should be confirmed by ad-hoc specifically designed studies.

The cinema has been fascinated by madness and its manifestations. Psychiatric illnesses have enabled filmmakers’ immense material for their screenplays, and the issue of suicide is often addressed.

A literature search was made through research on Pubmed with the words “cinema and suicide”,”cinema and psychopathology”.

Thirty five American and European films where the theme of suicide had been addressed were randomly selected from a cinema database (http://imdb.com). A questionnaire with data about the films screened was developed specifically for the study, which was filled to the extent that each film was viewed. The psychiatric diagnoses related with suicide were made according to DSM-IV-TR.

The films selected deal with suicide in various ways, providing a more or less realistic overview about the mental disorder;

The profile from the suicide was: caucasian male, mid aged (< 45 yrs), committing suicide with a violent method (mainly fire gun), suffering from a psychiatric disorder (depression, personality disorders, substance abuse) after a significant life event. Just a small proportion (11%) was in psychiatric treatment. This profile matches with real data from the literature.

The characterization from the mental heath professionals was subjective coated as negative in the majority of the movies selected.

It is important to reflect on the vision that the movies provide in the general public about suicide, mental disease and in which way they shape the perception about the mentally ill and those who treat them.

This study examined specific risk factors discriminating psychiatric inpatients who were never suicidal from those who reported one or more suicide attempts, and compared characteristics discriminating first-time attempters from first-time and multiple repeaters (recent attempters with one or more previous attempts).

716 inpatients admitted to the Division of Psychiatry of a University Hospital were evaluated for their suicidal history, psychiatric diagnosis, current and past stressors, and other clinical and sociodemographic risk factors.

Of the 358 attempters, 86 were first-time attempters, 219 first-time repeaters, and 53 multiple repeaters. There were significant differences between the nonattempters and the attempters in sociodemographic variables, DSM-IV-TR diagnosis (attempters were diagnosed more frequently with eating disorders, and less frequently with DSM-IV Axis II disorders than nonattempters), and clinical history. First-time attempters had fewer lifespan stressors (M=1.86; SD=0.90) than repeaters (first-time repeaters: M=2.26 [SD=0.89]; multiple repeaters: M=2.28 [SD=1.13]). Furthermore, repeaters were more likely to have personality disorders (ORs=2.71-3.83), low social support (OR=4.96-6.88), and previous hospitalizations (ORs=37.23-556.69) than first-time attempters.

In repeaters, stressors may have a specific effect and a cumulative effect. They can predispose to attempts at an earlier age and, through a process of “kindling” start a “suicide career.” Alternately, an accumulation of stressors can produce a “last straw” effect. In repeaters hospitalization can be seen as another factor contributing to the kindling phenomenon, and brief intensive care in hospital settings must be weighed accurately for efficacy and for its possible negative effects.

Suicide is one of the major health problems today. The few available health economic studies have focussed on suicides. However suicide attempts, which are much more frequent, have been disregarded.

We made use of available data of the WHO-Euro-Multicentre study. During the year 2003, N=201 persons committing a suicide attempt in Basel could be accessed for health economic investigations. Due to the care structure in our region we started with the direct costs of inpatient treatment at the university (psychiatric) hospitals, which provide a wide majority of care for the people of the area, especially in emergency cases like suicide. Outpatient treatment was only calculated, if it was performed by these hospitals. This analysis included the overhead of the hospitals (staff etc.) was well as the costs provides for special services, consultation and liaison services, transports and emergency actions.

We assume that the direct costs make up only part of the total costs. For example the loss of working ability, health costs for family members, caregivers and friends affected are not included in our analyses. Against our assumption, we could not find major differences regarding the underling diagnoses. However, elderly suicide attempts were more costly. There were also gender differences. Further details will be discussed.

The data show, that suicide attempts are expensive. Health care planers should take these data into account when discussing and deciding investments in suicide preventions.

To quantify the prevalence of adverse pregnancy outcomes associated with gestational exposure to paroxetine before the FDA warnings on the risk of cardiac malformations in newborns associated with the use of paroxetine during gestation were issued in 2005.

Data on all pregnancies included in the Quebec Pregnancy Registry were analysed to estimate the prevalence of planned/spontaneous abortions and deliveries during 1998-2004, before the warnings were issued. All study outcomes including congenital malformations are physician-based, and made prospectively and routinely as part of health care management; exposure to paroxetine is based on automated prescription fillings. Trends in the frequency of gestational use of paroxetine during the study period were compared to the trends in the prevalence of cardiac malformations.

Among the 109,344 eligible pregnancies, 1,612 (1.5%) were exposed to paroxetine. Amongst paroxetine users, 49% had a planned abortion, 7% a spontaneous abortion, and 44% a delivery. Amongst those who delivered, 3% had a baby with a cardiac malformation. The most prevalent cardiac malformations were atrial and ventricular septal defects (74%). During the study period, an increase in the prevalence of paroxetine use during pregnancy was correlated with an increase in the rate of cardiac malformations.

Paroxetine use during gestation is associated with an important risk of adverse pregnancy events above baseline rates. Before the warnings on paroxetine were issued, the increase in the prevalence of paroxetine use during pregnancy was already correlated with an increase in the rate of cardiac malformations, excluding the possibility of detection bias.

Depression during pregnancy is associated to physical symptoms that can impair the functioning of women; furthermore some of the depression somatic symptoms (i.e., sleep disturbance, fatigue, weight change and appetite) are also features of pregnancy. The overlap of symptomatology can interfere with the identification and the diagnosis of the mood episode. Aim of this study is to compare the the depressive phenomenology and the presence of Axis I comorbidity between pregnant and non pregnant depressed women.

We diagnosed Major Depression (MD) using the Structured Clinical Interview for Axis I Diagnosis DSM IV (SCID I) in 32 pregnant women at third month of pregnancy and 87 non pregnant women and we compared the depressive phenomenology in the two groups. Then we administered the Mood Spectrum Self Repost Last Month (MOOD SR-LM) in the two group in order to study the mood spectrum symptomatology.

Pregnant depressed women have higher psychomotor retardation, higher levels of concentration and lower agitation than non pregnant depressed women.

The severity of depression symptoms was similar in the two depressed groups.

Our results agree with current litterature about the presence of psychomotor retardation in depressed pregnant women.

The higher level of concentration in pregnant women could be explained by the high comorbidity with Generalized Anxiety Disorder (GAD). In the pregnant depressed women the Obsessive-Compulsive Disorder (OCD) and Panic Disorder (PD) comorbidity are more rappresentated.