Disproportionate suicidality in patients with comorbid major depression and alcoholism

Parasuicide and mental disorders

This study aims to provide a better follow-up of parasuicidal subjects, focusing on their diagnostic profile with regard to whether the parasuicide intention was death or not. A total of 235 parasuicidal out-patients (PS) and a comparison group of 235 non-parasuicidal out-patients (CG) were surveyed. A structured interview was applied to both groups. Parasuicide intention was appraised by means of the Suicide Intent Scale of Beck. The PS patients were divided into two groups, depending on whether their intention was death (PSD) or not (OPS), and they were matched with their CG counterparts. The diagnostic profile of each group was analysed and differences in diagnosis distribution were found. The rates of major depression, alcohol dependence and schizophrenia were higher among PSD than in OPS patients. The same was true for comorbidity of major depression and alcohol dependence. On Axis II, borderline personality ranks first among PSD patients. The diagnostic profile of PSD approaches that of completed suicide as shown in retrospective and prospective studies. The methodology employed here could therefore be recommended for estimating parasuicide intention. As well as the diagnosis, a detailed profile could also be obtained in the light of that intention. Bearing in mind such a profile among PSD patients could contribute to a drop in the suicide rate among these subjects.

Cocaine use associated with increased suicidal behavior in depressed alcoholics

The aim of this study was to determine whether depressed alcoholics who used cocaine would display a higher prevalence of suicidal behavior and suicidal ideation than depressed alcoholics who did not use cocaine. Forty-one depressed alcoholics participated in this prospective study of consecutively admitted inpatients. Seventeen patients (41.5%) had made a suicide attempt during their current depressive episode, and all but 1 of these attempts occurred during the week prior to their hospitalization. Ten patients used cocaine in the week prior to hospitalization, and 7 of these 10 (70%) had made a suicide attempt during that week. In contrast, only 32% of the depressed alcoholics who did not use cocaine made a suicide attempt during that week (p < .05). Suicidal ideation was also more prevalent in alcoholics who used cocaine. These data provide evidence that cocaine use is associated with an increased prevalence of suicidal behavior and suicidal ideation in depressed alcoholics.

Alcohol and cancer: a review for psycho-oncologists

Researchers have documented a link between alcohol consumption and the development of certain types of cancers. In addition, the prevalence of alcoholism and comorbid psychiatric disorders has been well-documented both the general population and medical settings. The role of the psycho-oncologist in the assessment and management of alcoholism and comorbid psychiatric disorders is crucial to improving both treatment adherence and the quality of life of the patient. This paper will provide psycho-oncologists with a review of: (1) the relationship of alcoholism to cancer; (2) psychiatric comorbidity frequently encountered in alcoholics, as a key to assessment and management; and (3) the goals and strategies of management of alcoholic cancer patient.

An investigation of adolescents' substance use behaviors, depressed affect, and suicidal behaviors

Data from a four-wave panel design of 975 adolescents were used to study inter-relationships among suicidal behaviors, depressive symptoms, and substance use behaviors. Persistently high levels of problem drinking and depressive symptoms were associated with higher levels of suicidal thoughts and attempts. Higher levels of depressive symptoms and greater cigarette and illicit drug use distinguished suicidal ideators from attempters. Adolescents attempting suicide reported lower levels of family social support, a greater use of substances to cope with stressors, and a higher density of substance-using peers. Implications of the findings for preventive interventions with high-risk teens are discussed.

Pharmacotherapy of affectively ill suicidal patients

The development of psychopharmacologic strategies for ameliorating the symptoms associated with major psychiatric disorders is relatively recent in the history of medicine. Regarding depression, the past 30 years have seen the advent of several clinically therapeutic antidepressant medication classes. With the advent of these newer and safer antidepressants, more primary care practitioners are prescribing these drugs, and as a result, more people are being prescribed antidepressant medication than ever before. This article reviews this psychopharmacologic revolution that has emerged as a consequence of a greater understanding of the neurochemical perturbations underlying major affective disorders.

Hopelessness, impulsiveness and intent among suicide attempters with major depression, alcohol dependence, or both

The present study examined differences in hopelessness, impulsiveness and suicide intent between suicide attempters with either major depression or alcohol dependence, comorbid major depression and alcohol dependence, and those without these disorders. A sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki was interviewed and diagnosed according to DSM-III-R. Suicide intent was measured by the Beck Suicide Intent Scale (SIS) and hopelessness was assessed by the Beck Hopelessness Scale (HS). Impulsiveness of the suicide attempt was measured by two items of the SIS. Suicide attempters with major depression without comorbid alcohol dependence had higher suicide intent and lower impulsiveness than attempters with non-depressive alcohol dependence. Suicide attempts may differ between subjects with major depression, alcoholism or both disorders in terms of impulsiveness and suicide intent.

Age effects on the clinical presentation of alcoholics at a psychiatric hospital

Little is known about the effects of age on the clinical presentation of alcoholism in various treatment settings, despite the clinical importance of this factor. This study evaluates the effects of age on the clinical profile of 604 alcoholics who presented for initial evaluation and treatment at a psychiatric hospital. Young alcoholics displayed the most prominent substance use, antisocial behavior, depressive symptoms (including suicidality), and impulsivity. Early middle-aged alcoholics displayed the highest levels of drinking. Elderly alcoholics displayed the highest levels of cognitive dysfunction, although some level of cognitive dysfunction was present among even the youngest alcoholics. These findings confirm and clarify the effects of age on the clinical profile of alcoholics presenting for initial evaluation at a psychiatric hospital.

Emotional distress and substance abuse as risk factors for suicide attempts

BACKGROUND

Both depression and hopelessness have been found to be closely related to suicide risk among adolescents and adults. Substance abuse has also been found to play a role in the suicide process with adults, but it is still unclear how much substance abuse influences suicide in adolescents.

METHOD

The present study examined the relationship between substance abuse, emotional distress, and suicidal intent among 115 adolescent psychiatric inpatients who had attempted suicide.

RESULTS

Measures of emotional distress, as well as the measures of substance abuse, were significantly intercorrelated. Correlations across domains (emotional distress versus substance abuse), however, varied by gender. Among adolescent females, both depression and hopelessness were significantly related to suicidal intent, whereas among adolescent males, only depression was related to suicidal intent. Also, alcohol abuse was significantly related to depression and hopelessness in adolescent males.

CONCLUSIONS

Hopelessness may not be as useful an indicator of suicide risk among adolescent males as it is with adolescent females. Intervention and prevention programs designed for adolescent females should identify and address feelings of depression and hopelessness. New intervention and prevention programs may need to be developed for adolescent males.

Mental disorders and comorbidity in attempted suicide

The present study examined the prevalence and comorbidity of mental disorders according to DSM-III-R among male and female suicide attempters. A systematic sample of 114 patients from consecutive cases of attempted suicide referred to a general hospital in Helsinki between 1 January and 31 July 1990 was interviewed. In 98% of the cases at least one Axis I diagnosis was made. Depressive syndromes were more common among females (85%) than males (64%), and alcohol dependence was more common among males (64%) than females (21%). A high proportion of suicide attempters (82%) suffered from comorbid mental disorders. Comorbidity appears to play an important role in parasuicide.