Suicidal ideation, post-traumatic stress and suicide statistics in Kosovo. An analysis five years after the war. Suicidal ideation in Kosovo

The substantial impact of the war in Kosovo has been documented by earlier research performed shortly after the war, but only limited data on the long term mental health impact have been published so far, mostly limited to posttraumatic stress (PTSD). The present study is aimed at extending the focus to a major question so far neglected in most post-conflict zones, namely that of depression and suicidal ideation.

METHODS

The present study was based on a representative country-wide survey (n=1161) , using subscales for suicidal behaviour in the General Health Questionnaire (GHQ), comparing results with the corresponding Hopkins Symptom Checklist (HSCL-25) items and the Harvard Trauma Questionnaire (HTQ) to assess war related experiences and PTSD symptomatology. Irrespective of age, gender or education, subjects in rural areas had higher suicide ideation scores, 41.7% of respondents met criteria for moderate to severe depressive symptomatology, 41.6% for clinical anxiety. Unemployment (83.7%), and high PTSD scores were associated with suicidal ideation scores, the last contingent on depressive mood. It is concluded, that suicidal ideation linked to both past stressful experience and present social stressors is a question to be considered in mental health care plans in post-conflict zones. Under-recognition could be expected to result in increasing suicidal behaviour. Ideation also indicates, especially in the context of high post-traumatic stress and depression rates, exhaustion and despair that need to be addressed by more general interventions than individual Psychotherapeutic treatment.

Morphogenetic variability of faradiol monoesters in marigold Calendula officinalis L

The main compounds of lipophilic extracts of flower heads of marigold (Calendula officinalis L.) are triterpendiol esters, mainly faradiol laurate, faradiol myristate and faradiol palmitate. These faradiol-3-O-monoesters have been quantified for the first time by means of reversed phase HPLC with internal standardisation in different parts of C. officinalis plants, namely ray florets, disk florests, involucral bracts, receptacles, levaes and seeds. The amounts of the esters were highest in ray florets, approximately 10 times lower in disk florets than in the ray florets, and approximately 10 times lower in involucral bracts than in the disk florets. In the leaves only traces of the esters could be detected, and in the receptacles no esters could be detected at all. Quantification in the seed was not possible using this method because of interfering fatty compounds. Concerning the faradiol esters, the dried ray and disk florets only should be preferred as primary products for remedies as demanded in the recently published supplement of the Pharmacopoiea Europaea (1999). Breeding work should focus on varieties with a greater number of ray florets in order to improve the quality of herbal medicinal products derived from marigoid.

Memory deficits in patients with DSM-IV obsessive-compulsive disorder

Neuropsychological testing provides increasing evidence that certain memory deficits might play an essential role in the emergence of doubts and, as a result, in perpetuating checkers' rituals. Another account of doubting implicates meta-cognitive factors, such as confidence in memory. The present study examined mnestic functioning and self-perception of memory ability in a group of 27 nondepressed patients with obsessive-compulsive disorder (OCD) and 27 normal controls. All patients met DSM-IV and ICD-10 criteria for OCD, displayed prominent behavioral checking rituals and had to show a score on the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) of at least 16. Significant deficits in intermediate (Lern- und Gedächtnistest; LGT-3) and immediate (Corsi Block-Tapping Test) nonverbal memory were identified in the patients with OCD compared to normal controls. Contrary to predictions, OCD patients also showed a significant deficit in general memory and verbal memory (LGT-3). With respect to meta-cognition, OCD patients reported less confidence in their memories than controls. These findings suggest that obsessional doubt reflects a deficit in memory as well as a deficit in memory confidence. Depending on which dysfunction predominates, different therapeutic procedures seem to be required.

Naturalistic course of obsessive compulsive disorder and comorbid depression. Longitudinal results of a prospective follow-up study of 74 actively treated patients

Seventy-four patients who met DSM-III-R criteria for obsessive compulsive disorder (OCD) were studied in a prospective follow-up study in order to investigate course and prognosis of OCD with or without comorbid depressive symptomatology. Subjects were examined three times: at admission (baseline), 6 months later (follow-up 1) and 12 months after follow-up 1 (follow-up 2). At admission, 51 (72.9%) OCD patients were assessed as depressive by the Hamilton Depression Scale score. Between admission and follow-up 1, all patients received behavior therapy and a serotonin reuptake inhibitor, between follow-up 1 and follow-up 2 they received different kinds of treatment in order to maximize therapeutic effects. A 25% Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) score reduction from admission to follow-up 2 and in addition, a total Y-BOCS score of below 16 at follow-up 2 was defined as 'good prognosis course'. The results obtained showed that OCD patients who followed a good prognosis course, showed no significant depressive symptomatology at follow-up 2 (p = 0.001). These results imply that patients with a diagnosis of OCD may present depression at admission and/or follow-up 1; however, if OC symptomatology decreases longitudinally, depressive symptoms disappear too. We may assume that OCD is dominant over depression, and it seems that a comorbid depression does not have any major influence on the prognosis of OCD.

Efficacy of fluoxetine in Austrian patients with obsessive-compulsive disorder

In an 8-week double-blind placebo-controlled trial we studied the efficacy of fluoxetine (FLX) in 53 Austrian patients with obsessive compulsive disorder (OCD) diagnosed according to DSM-III-R. The dosage of FLX was fixed at either 20, 40, or 60 mg per day. Response was prospectively defined as an at least 25% reduction on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) and an improvement on Clinical Global Impression (CGI) rating to at least "much improved" at the endpoint. Patients treated with at least 40 mg FLX per day showed significantly higher response rates than did those receiving either placebo or FLX 20 mg/day. Compulsions were more reduced than obsessions and we also observed a strong placebo effect which is largely attributable to an improvement in the Y-BOCS compulsion subscore.

Obsessive compulsive disorder and depression--first results of a prospective study on 74 patients

1. Seventy-four patients who met DSM-III-R criteria for Obsessive Compulsive Disorder received a serotonin reuptake inhibitor and cognitive behavior therapy for 6 months (baseline to follow-up I). 2. In order to maximize therapeutic effects, different kinds of treatment were applied between follow-up I and follow-up II (12 months). 3. Patients were followed-up twice with respect to long-term outcome of obsessive compulsive disorder and depression. Forty % of the sample showed marked improvement at follow-up. No specific variant of treatment could be identified to be significantly more effective. 4. Cross-sectional investigations showed significant correlations between extent of depressive and obsessive compulsive symptomatology (admission, follow-up I and II).

[Nuclear magnetic resonance tomography findings in obsessive-compulsive disorder]

Eighteen patients with a DSM-III-R diagnosis of obsessive-compulsive disorder (OCD) were imaged by MR and compared to a control group of 18 patients with clinically diagnosed unspecific headaches. Weighted spin-echo sequences were carried out with a 1.5T unit in both axial and coronal planes T1 (TR 700/TE 15 ms) and T2 (TR 2500/TE 15.70). The ferritin distributions in the basal ganglia and in the midbrain were evaluated; in addition, the width of the pars compacta in the midbrain on the basis of the criteria of Braffmann et al. 1988, the widths of the inner subarachnoid spaces on the basis of the ventricular index quotient VIQ (TerBrugge, 1986), and the widths of the outer subarachnoid spaces were conducted. The latter was undertaken by three independent investigators whose results were in agreement with one another. In 12 of the OCD patients (n = 18) there was a total of 25 pathological MRI findings; in the control group there were 6 pathological MRI findings in only 6 of the patients (n = 18). In conclusion pathological changes were found at different locations, but a connection between a specific neuroanatomic system and obsessive-compulsive disorder could not be demonstrated.

A double-blind, placebo-controlled study of fluoxetine in patients with DSM-III-R obsessive-compulsive disorder. The Lilly European OCD Study Group

We have studied the effect of three fixed daily doses of fluoxetine in patients with obsessive-compulsive disorder (OCD) diagnosed according to DSM-III-R. Two hundred and fourteen patients were evaluated in an 8-week double blind, placebo-controlled study. A statistically significantly greater number of fluoxetine-treated patients achieved the prospectively defined criteria for clinical response when compared to placebo treatment. There was a statistically significant overall difference in the PGI rating of symptom change (P = 0.045) and a marginally significant difference (P = 0.089) in the CGI severity rating between groups. Pairwise comparison against placebo showed a marginally statistically significantly greater improvement (P = 0.059) in Y-BOCS-Total score for patients receiving fluoxetine 60 mg daily, and a significantly higher response rate in patients receiving fluoxetine 40 mg or 60 mg daily (P < 0.05). One hundred and sixty one patients continued to a 16-week extension evaluation. There was no significant difference in the rate of reporting of any individual adverse event between placebo and fluoxetine, and the rate of discontinuation due to adverse events was low (< 6% in each study phase). This study supports the growing evidence for the safety and efficacy of fluoxetine in the treatment of OCD.

Obsessive-compulsive disorder and depression. A retrospective study on course and interaction

In a retrospective study 62 patients, who fulfilled the ICD-8/9 criteria for obsessive-compulsive disorder (OCD), were followed up. Besides an assessment of the cross-sectional symptomatology of OCD and depression, the long-term course of OCD and its relationship to depression were investigated. Five courses of OCD could be differentiated: continuous and unchanging (27.4%); continuous with deterioration (9.7%); continuous with improvement (24.4%); episodic with partial remission (24.2%), and episodic with full remission (11.3%). There was no difference between primary or secondary depression on the prognosis of OCD, and there was also no difference between the continuous or episodic course with regard to primary or secondary depression. Our results may be biased by the fact that we selected a sample of OCD and not primarily major depressive patients.

Obsessive-compulsive disorder: course and interaction with depression. A review of the literature

Long-term follow-up studies suggest that obsessive-compulsive disorder (OCD) is commonly associated with co-morbid conditions such as depression anxieties and phobias. In the review of the literature the weaknesses in the current methodology are discussed. The instruments for measurement of severity are lacking reliability and sensitivity to change. Serious questions are asked about whether the measured changes reflect alterations in depression in general, or obsessional phenomena specifically. No instruments exist for the documentation of long-term course of OCD and documentation of psychotherapy and pharmacotherapy. In a preliminary report we want to introduce our own study. Approximately 40 OCD inpatients of the psychiatric clinic, University of Vienna, with and without primary or secondary depression diagnosed simultaneously by DSM-III-R and ICD-9 criteria will be included in the study. In general, the major goal of the preliminary reported study will be the elaboration of predictors for course, outcome and therapy response.