[Prescribing practice of psychotropic drugs in a psychiatric university clinic]

An investigation on the use of psychotropic drugs in a Swiss university psychiatric hospital shows that compared with other drug surveys drugs were prescribed to relatively fewer patients and polypharmacy was used in less than 50% of the patients. The most frequently administered drugs were neuroleptics, among which, surprisingly. Clozapine ranked first. Antidepressants were prescribed in relatively low doses. A drug survey like ours can provide a basis for the critical discussion of prescribing habits.

Suicide prevention: spreading the gospel to general practitioners

General practitioners were trained in the recognition and treatment of suicide risk either by written text alone or combined with a seminar meeting. They filled in questionnaires before and after training. In the seminar group, knowledge and attitudes changed significantly, while those doctors receiving written material only had similar results to those without training.

Parasuicide in Europe: the WHO/EURO multicentre study on parasuicide. I. Introduction and preliminary analysis for 1989

The WHO/EURO multicentre study on parasuicide is a new, coordinated, multinational, European study that covers two broad areas of research: monitoring trends in the epidemiology of parasuicide (epidemiological monitoring study); and follow-up investigations of parasuicide populations, with a view to identifying the social and personal characteristics predictive of future suicidal behaviour (repetition prediction project). This article provides background information on the development and organization of the multicentre study, and presents selected findings from the epidemiological monitoring project, based on a preliminary examination of data collected in 15 centres on parasuicides aged 15 years and over treated in health facilities in defined catchment areas during the year 1989. The overall parasuicide incidence varied considerably across the centres, from a high (event) rate of 414 per 100,000 males in Helsinki to a low of 61 among males in Leiden. The highest female event rate was 595 in Pontoise, and the lowest 95 in Guipuzcoa. The mean event rate across all centres was 167 among males and 222 among females. Parasuicide incidence tended to be elevated among 15- to 34-year-olds, with lowest rates among those aged 55 years and over. With one exception (Helsinki), the female parasuicide rate was higher than the male rate, the F:M ratio ranging from 0.71:1 to 2.15:1, with a median of 1.5:1 (events). Short-term repetition rates (as measured by the event:person ratio) differed between centres, from 1.03 to 1.30 (median = 1.12) among males, and from 1.07 to 1.26 (median = 1.13) among females. Although we warn against generalizing from our findings to make statements about differences in parasuicide between countries, we argue that the differences between centres are valid and should be addressed in further research.

[Attemoted suicide in the Bern region]

In a European multicenter study all the suicide attempts in the city and agglomeration of Berne which came under medical treatment during a 12-month period were surveyed. There were 243 females and 153 males, corresponding to a rate of 177.1 and 128.6 per 100,000 respectively. The investigated region can be regarded as representative of Switzerland. Comparison with other centers shows that the incidence of attempted suicide in Switzerland--unlike that of suicide--is approximately in line with the European average. The usual method is overdose of drugs, in particular benzodiazepines. Nearly all the drugs involved in the overdoses were obviously prescribed by physicians. The choice of drugs suggests that many suicidal people deliberately take anxiety-and tension-reducing agents, a fact which points to a relationship between anxiety states and attempted suicide. Both are to be regarded as the expression of acute emotional stress and require an appropriate therapeutic approach.

[Knowledge and attitude of the practicing physician about the theme of suicide]

A questionnaire was sent to general practitioners in order to evaluate their knowledge and attitudes about suicide and suicide prevention. Our hypothesis was that many physicians do not sufficiently recognize the medical dimension of this problem and that their knowledge is insufficient. The results show that the physicians are generally well aware of the medical dimension and thus of their potential role in the prevention of suicide. However, they do not feel competent in managing suicidal patients, and we found serious gaps in their knowledge. Most physicians showed interest in further training. In view of these results as well as the frequency of suicidal behaviour it appears clearly necessary to give more weight to the teaching of knowledge and skills of suicide prevention in medical schools.

Suicide risk factors: a comparison of suicide attempters with suicide completers

Fifty cases of attempted suicide were compared with 50 cases of completed suicide on variables reported to measure suicide risk: the seriousness of the attempt, and the circumstances in which the act occurred discriminated best. Depressive symptoms were more frequent in the suicide group and in the serious attempters' group than in the non-serious attempters' group.

[Suicide and suicide prevention. Could the physician do more? Results of a questionnaire of relatives of suicide attempters and suicide victims]

Relatives of 50 attempted and 50 successful suicides were interviewed with a semi-structured set of questions. This report presents the results of the questions which related to the role of the physician and his reaction to the event, and to the reaction of the relatives. 80% of all cases were seeing a doctor, and the physicians concerned reported that they were very surprised by the suicide attempts and suicides in 36% and 48% of cases respectively. Many patients had a history of suicide attempts and/or threats; earlier suicide attempts were not known to the physicians in 67% (attempted suicide) and 38% (successful suicide), and threats in 73% and 50% respectively. The author had the impression that the diagnosis of depressive illness and the indication for treatment with antidepressive medication was often missed. The practical implications of these results are discussed.

A survey of prescribing psychotropic drugs in two psychiatric hospitals

Of 511 patients in two psychiatric hospitals, one-fifth had no psychotropic drugs, but over one-third (nearly half of those receiving medication) had a combination of two or more psychotropic drugs. Hypnotics and minor tranquillizers were commonly prescribed together with neuroleptics and anti-depressants. One-fifth of day-patients treated with depot neuroleptics also has oral neuroleptics. Anti-parkinsonian drugs were prescribed for half of those receiving neuroleptics. Both minor tranquillizers and neuroleptics were commonly administered three or more times a day. Forty per cent of patients treated with neuroleptics had diagnoses other than schizophrenia, and one-third of those receiving antidepressants had diagnoses other than affective disorder. An analysis of prescribing could contribute to a more rational use of psychotropic drugs.