Unexpected Death of Psychiatric Patients: Suicide, Misadventure, Accident or Unsolved Mystery?

1997 ◽  
Vol 37 (3) ◽  
pp. 210-214 ◽  
Author(s):  
Emad Salib ◽  
Ann Joseph ◽  
Sheila Cawley
Keyword(s):  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Psychiatric History ◽  
Unexpected Death ◽  
Related Condition ◽  
Condition Method ◽  
Duration Of Illness ◽  
History Of ◽  
Main Factors

We examined the association between the psychiatric history of patients who were the subjects of a coroner's inquest and the recorded verdict, in a seven-year retrospective review. A suicide verdict was less frequently returned on patients who had inpatient psychiatric treatment compared to other unexpected deaths. History and diagnosis of an alcohol-related condition, method of death and intimation of intent were the main factors that appeared to be associated with the coroner's verdict. Age, sex, duration of illness, time and number of admissions, previous suicide attempts and treatment received did not appear to be significantly associated with the recorded verdict.

Utilization of Emergency Departments for Psychiatric Treatment

1978 ◽  
Vol 23 (3) ◽  
pp. 143-148 ◽  
Author(s):  
G.D. Watson
Keyword(s):  
Emergency Department ◽  
Emergency Services ◽  
Suicide Attempts ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
Relevant Literature ◽  
Emergency Department Utilization ◽  
Annual Number ◽  
Personal Distress ◽  
Clinical Records

A survey of four Edmonton hospital emergency department records for a one month period was carried out to determine the frequency of utilization by patients suffering from psychiatric disorders. Male attenders outnumbered females and the majority of patients fell into the 21 — 50 year age range. Alcohol-related illness was almost three times more frequent in males than females, whereas females were more frequently categorized as suffering “personal distress” or presented as suicide attempts. Overall, seventy-three percent of the patients were discharged; of those admitted, females outnumbered males. The changing pattern of emergency department utilization was compared by examining data from one hospital for the years 1972, 1974 and 1976. During this four-year period the annual number of visits by psychiatric patients increased by almost eighty percent, largely due to dramatic increases in alcohol related problems in males and those described as “personal distress” in females. The establishment of intoxication recovery centres in 1973 paralleled a drop in the proportion of patients admitted to inpatient wards for alcohol-related, street drugs and overdose problems. The results of the present survey are compared to those reported in the relevant literature, and the methodological problems encountered in carrying out a retrospective study of emergency services from clinical records are described.

Italian Bipolar II vs I patients have better individual functioning, in spite of overall similar illness severity

CNS Spectrums ◽  
2016 ◽  
Vol 22 (4) ◽  
pp. 325-332 ◽  
Author(s):  
Bernardo Dell’Osso ◽  
Cristina Dobrea ◽  
Laura Cremaschi ◽  
Massimiliano Buoli ◽  
Shefali Miller ◽  
...  
Keyword(s):  
Stressful Life Events ◽  
Suicide Attempts ◽  
Age At Onset ◽  
Bipolar Disorders ◽  
Severe Illness ◽  
Text Revision ◽  
Duration Of Illness ◽  
Lifetime Number ◽  
History Of ◽  
Antidepressant Use

IntroductionBipolar disorders (BDs) comprise different variants of chronic, comorbid, and disabling conditions, with relevant suicide and suicide attempt rates. The hypothesis that BD types I (BDI) and II (BDII) represent more and less severe forms of illness, respectively, has been increasingly questioned over recent years, justifying additional investigation to better characterize related sociodemographic and clinical profiles.MethodsA sample of 217 outpatients with Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR)–described BD (141 BDI, 76 BDII), without a current syndromal mood episode, was recruited, and sociodemographic and clinical characteristics of BDI and II patients were compared.ResultsBDII patients had significantly more favorable sociodemographics, in relation to occupational stability, cohabitation, and marital status. However, BDII compared with BDI patients had significantly longer duration of untreated illness, more frequent lifetime anxiety disorders comorbidity, longer most recent episode duration, higher rate of depressive first/most recent episode, and more current antidepressant use. In contrast, BDI compared with BDII patients had significantly more severe illness in terms of earlier age at onset; higher rate of elevated first/most recent episode, lifetime hospitalizations, and involuntary commitments; lower Global Assessment of Functioning score; and more current antipsychotic use. BDI and II patients had similar duration of illness, psychiatric family history, lifetime number of suicide attempts, current subthreshold symptoms, history of stressful life events, and overall psychiatric/medical comorbidity.ConclusionBDII compared with BDI patients had more favorable sociodemographic features, but a mixture of specific unfavorable illness characteristics, confirming that BDII is not just a milder form of BD and requires further investigation in the field.

Which Neurotic Patients Do Psychiatrists Treat?

1988 ◽  
Vol 152 (2) ◽  
pp. 222-228 ◽  
Author(s):  
John M. Eagles ◽  
David A. Alexander
Keyword(s):  
Alcohol Abuse ◽  
Short Duration ◽  
Psychiatric Treatment ◽  
Deliberate Self Harm ◽  
Factors Associated ◽  
Main Hospital ◽  
Duration Of Illness ◽  
History Of ◽  
Self Harm

Of 336 newly referred neurotic patients, 80 were not offered continuing psychiatric treatment. The factors associated with patients' not being offered continuing treatment were: short duration of illness; history of alcohol abuse and/or deliberate self-harm; age over 50 years; being widowed; and living more than 20 miles from the main hospital complex. The implications of these findings are discussed.

scholarly journals Suicidal behaviour: an epidemiological and genetic study

1998 ◽  
Vol 28 (4) ◽  
pp. 839-855 ◽  
Author(s):  
D. J. STATHAM ◽  
A. C. HEATH ◽  
P. A. F. MADDEN ◽  
K. K. BUCHOLZ ◽  
L. BIERUT ◽  
...  
Keyword(s):  
Suicidal Behaviour ◽  
Suicide Attempts ◽  
Religious Affiliation ◽  
Physical Assault ◽  
Psychiatric History ◽  
Birth Cohorts ◽  
Suicidal Thoughts ◽  
Logistic Regression Models ◽  
Childhood Conduct Problems ◽  
History Of

Background. Psychiatric history, familial history of suicide attempts, and certain traumatic life events are important predictors of suicidal thoughts and behaviour. We examined the epidemiology and genetics of suicidality (i.e. reporting persistent suicidal thoughts or a plan or suicide attempt) in a large community-based sample of MZ and DZ twin pairs.Method. Diagnostic telephone interviews were conducted in 1992–3 with twins from an Australian twin panel first surveyed in 1980–82 (N=5995 respondents). Data were analysed using logistic regression models, taking into account twin pair zygosity and the history of suicidality in the respondent's co-twin.Results. Lifetime prevalence of suicidal thoughts and attempts was remarkably constant across birth cohorts 1930–1964, and across gender. Major psychiatric correlates were history of major depression, panic disorder, social phobia in women, alcohol dependence and childhood conduct problems. Traumatic events involving assault (childhood sexual abuse, rape or physical assault) or status-loss (job loss, loss of property or home, divorce), and the personality trait neuroticism, were also significantly associated with suicide measures. Prevalence of serious suicide attempts varied as a function of religious affiliation. After controlling for these variables, however, history of suicide attempts or persistent thoughts in the respondent's co-twin remained a powerful predictor in MZ pairs (odds ratio=3·9), but was not consistently predictive in DZ pairs. Overall, genetic factors accounted for approximately 45% of the variance in suicidal thoughts and behaviour (95% confidence interval 33–51%).Conclusions. Risk of persistent suicidal thoughts and suicide attempts is determined by a complex interplay of psychiatric history, neuroticism, traumatic life experiences, genetic vulnerability specific for suicidal behaviour and sociocultural risk or protective factors.

Thinking about prognosis

Psychiatry ◽  
2019 ◽  
Author(s):  
Rebecca McKnight ◽  
Jonathan Price ◽  
John Geddes
Keyword(s):  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Warning Signs ◽  
Lifetime Risk ◽  
Daily Consumption ◽  
Risk Of Recurrence ◽  
Prognostic Assessment ◽  
Supportive Family ◽  
History Of ◽  
The Individual

The prognostic assessment of a patient aims to pre­dict the future, using the range of evidence available. This evidence relates to: … ● the individual patient (e.g. their own history of illness, and their compliance with medication); ● groups of patients like the individual patient, that is, diagnostic and subdiagnostic groups (e.g. in depressive disorder, the risk of recurrence; and in anorexia nervosa, the risk of suicide or of death by starvation); ● psychiatric patients in general (e.g. the importance of good relationships with healthcare professionals, supportive family and friends, and insight into illness). … Prognostic assessment results in an understanding of the following: … ● What outcomes are likely to happen? Relevant outcomes can be related to the illness (relapse and recurrence, for example— see ‘Terminology’ for definitions), to treatments (such as side effects or complications), to risks (to self, to others— see Chapter 7), or to important social outcomes (such as return to work, marital break- up, or permission to drive a car, bus, or lorry). ● How likely are they to happen, and when/ over what time period? An estimate of both likelihood and timeline is helpful. So, for example, in a patient with recurrent depressive episodes, who is now well, we may view that their lifetime risk of suicide is significantly higher than the population risk, that they are not currently at increased risk, and that suicide attempts are likely to occur in the context of depressive recurrence. ● What can change the nature or likelihood of the outcomes? For example, in the case just mentioned, we may view that the lifetime risk of recurrence can be reduced by training the patient and family to spot the early warning signs of illness, by reducing daily consumption of alcohol, and by finding regular, stable employment. In addition, we can reduce suicidal risk by ensuring that the patient is prescribed medicines that are relatively safe in overdose (e.g. SSRI antidepressants rather than tricyclics), and by making family members aware of the risk of their own medication being used in an overdose.

scholarly journals Prescription patterns in psychiatric compulsory care: polypharmacy and high-dose antipsychotics

BJPsych Open ◽  
2021 ◽  
Vol 7 (5) ◽  
Author(s):  
Katerina Kaikoushi ◽  
Maria Karanikola ◽  
Nicos Middleton ◽  
Evanthia Bella ◽  
Andreas Chatzittofis
Keyword(s):  
Psychiatric Treatment ◽  
Male Gender ◽  
Psychotic Symptoms ◽  
High Dose ◽  
Psychiatric History ◽  
Cross Sectional ◽  
Prescription Patterns ◽  
Syndrome Scale ◽  
History Of ◽  
Compulsory Care

Background Antipsychotic polypharmacy and prescription of high-dose antipsychotics are often used for the treatment of psychotic symptoms, especially in compulsory psychiatric care although there is lack of evidence to support this practice and related risks for patients. Aims We aimed to investigate prescription patterns in patients with psychosis under compulsory psychiatric treatment in Cyprus and to identify predictors for pharmaceutic treatment patterns. Method This was a nationwide, descriptive correlational study with cross-sectional comparisons, including 482 patients with compulsory admission to hospital. Sociodemographic and clinical data were collected. Psychotic symptoms were assessed with the Positive and Negative Syndrome Scale (PANSS). Prescribed medication patterns, including use of medication pro re nata (PRN, when required), were recorded. Results Antipsychotic polypharmacy with a PRN schema was reported in 33.2% (n = 160) of the participants. Polypharmacy without a PRN schema was reported in 5.6% (n = 27) of the participants. We found that 27.2% (n = 131) of the participants were prescribed high-dose antipsychotics without PRN included; and 39.2% (n = 189) prescribed high-dose antipsychotics with PRN included. In the logistic regression analyses, predictors for prescription of high-dose antipsychotics were male gender, positive psychiatric history, receiving state benefits and a negative history of substance use. Male gender was the only predictor for polypharmacy without a PRN schema whereas male gender, negative family psychiatric history, receiving state benefits and the total score on the positive symptoms PANSS subscale were predictors for polypharmacy with a PRN schema included. Conclusions A high frequency of polypharmacy and use of medication PRN beyond clinical guidelines has been reported for the first time in psychiatric compulsory care in Cyprus; revision in antipsychotic prescription is needed.

In-Patient and Post-Discharge Suicides in Tyrol 2004–2011

2017 ◽  
Vol 41 (S1) ◽  
pp. S292-S292
Author(s):  
E.A. Deisenhammer ◽  
E.M. Behrndt ◽  
G. Kemmler ◽  
C. Haring ◽  
C. Miller
Keyword(s):  
Risk Factors ◽  
Hospital Stay ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
High Risk Population ◽  
Post Discharge ◽  
Patient Status ◽  
History Of ◽  
Competing Interest ◽  
Commit Suicide

IntroductionPsychiatric patients constitute a high-risk population for suicide. In-patient status and the period after discharge are of particular interest concerning risk assessment.ObjectiveTo assess risk factors for in-patient and post-discharge suicides.MethodsThe Tyrol suicide register was linked with the registers of three psychiatric departments/hospitals of the region. Suicides were categorized according to whether the suicide was committed during a hospital stay or within 12 weeks after discharge or whether the suicide subject had not recently been hospitalized. Groups were compared with regard to demographic and clinical variables. Further, case-control comparisons were performed for the in-patient and post-discharge groups.ResultsDuring the study period (2004–2011) 30 in-patients, 89 post-discharge and 592 not recently hospitalized suicides were identified. Groups differed in terms of gender distribution, history of suicide attempts, warning signals and suicide methods. Compared with controls matched for a number of variables, in-patient suicides were significantly more suicidal and depressed at admission, reported more often a recent life event and showed less often aggressive behavior and plans for the future. Post-discharge suicides had more often a history of attempted suicide, depressive and thought disorder symptomatology, a ward change and an unplanned discharge and less often a scheduled appointment with a non-psychiatric physician.ConclusionsSuicide victims differ with regard to whether they die during, shortly after or not associated with a hospitalization. Compared to controls there are specific risk factors for those who commit suicide during a hospital stay and within 12 weeks after discharge.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Elderly patients with no previous psychiatric history: suicidality and other factors relating to psychiatric acute admissions

BJPsych Open ◽  
2020 ◽  
Vol 6 (4) ◽  
Author(s):  
Hallvard Lund-Heimark ◽  
Eirik Kjelby ◽  
Lars Mehlum ◽  
Rolf Gjestad ◽  
Geir Selbæk ◽  
...  
Keyword(s):  
Psychotic Disorders ◽  
Suicide Attempts ◽  
Psychiatric Patients ◽  
Psychiatric History ◽  
Cross Sectional ◽  
Somatic Comorbidity ◽  
Somatic Disorders ◽  
The Common ◽  
Cognitive Problems ◽  
Acute Admissions

Background The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence. Aims To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH). Method Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014. Results Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission. Conclusions Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.

Variables Affecting the Decision Making of a Review Panel

1985 ◽  
Vol 30 (8) ◽  
pp. 577-581 ◽  
Author(s):  
J. Higenbottam ◽  
B. Ledwidge ◽  
J. Paredes ◽  
M. Hansen ◽  
C. Kogan ◽  
...  
Keyword(s):  
Decision Making ◽  
Mental Hospital ◽  
Suicide Attempts ◽  
Group Membership ◽  
Discharge Planning ◽  
The Other ◽  
Psychiatric History ◽  
Review Panel ◽  
Case Summary ◽  
History Of

This study was designed to identify the variables that influence a review panel's decision to discharge or detain an involuntary patient. A group of fifty patients consecutively discharged by the review panel of a provincial mental hospital were compared according to thirty-five variables, with a group of forty-five patients consecutively detained by the panel. The variable set included information on the patient's psychiatric history, current hospitalization and treatment as well as ratings of dangerousness, insight and psychopathology, as reflected in the attending physician's case summary prepared for the review panel. The released and detained groups were found to be remarkably similar. They differed on ten of the thirty-five variables measured, but they did not differ on some variables that one would expect to form the basis of the panel's decision, including diagnosis and a history of suicide attempts. On the other hand, when the predictive value of the variable set as a whole was examined using discriminant analysis, the results indicated that there was a substantial amount of predictability to the review panel process. The group membership of 77.5% of the patients can be predicted from only nine variables that contribute to the discriminant function. The results will be of interest to clinicians who deal with review panels on a regular basis and the findings have implications for other practical issues including discharge planning and readiness for community living.

Violent Death and Mental Illness

1990 ◽  
Vol 156 (5) ◽  
pp. 714-720 ◽  
Author(s):  
Elizabeth King ◽  
Brian Barraclough
Keyword(s):  
Relative Risk ◽  
Psychiatric Treatment ◽  
Psychiatric Patients ◽  
District General Hospital ◽  
Violent Death ◽  
Accidental Death ◽  
Hospital Unit ◽  
Catchment Population ◽  
Lifetime History ◽  
History Of

The names of 412 residents of the catchment population of a district general hospital unit who died potentially self-inflicted deaths in the eight years 1974–81 were identified. They were classified as suicide (245), accidental death (126), and undetermined (41). In each group, over half had a lifetime history of psychiatric treatment and over a third were psychiatric patients at the time of their death. The relative risk of a violent death for those who died within a year of their last psychiatric contact was 27 times greater than that of residents with no recent psychiatric contact. The relative risk was highest for those aged 35–44 and lowest for those of 75 years and over.

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