Simple and sensitive analysis of nereistoxin and its metabolites in human serum using headspace solid-phase microextraction and gas chromatography-mass spectrometry.
A simple method for the analysis of nereistoxin and its metabolites in human serum using headspace solid-phase microextraction (SPME) and gas chromatography-mass spectrometry (GC-MS) is developed. A vial containing a serum sample, 5M sodium hydroxide, and benzylacetone (internal standard) is heated to 70 degrees C, and an SPME fiber is exposed for 30 min in the headspace of the vial. The compounds extracted by the fiber are desorbed by exposing the fiber in the injection port of the GC-MS. The calibration curves show linearity in the range of 0.05-5.0 micrograms/mL for nereistoxin and N-methyl-N-(2-methylthio-1-methylthiomethyl)ethylamine, 0.01-5.0 micrograms/mL for S,S'-dimethyl dihydronereistoxin, and 0.5-10 micrograms/mL for 2-methylthio-1-methylthiomethylethylamine in serum. No interferences are found, and the analysis time is 50 min for one sample. In addition, this proposed method is applied to a patient who attempted suicide by ingesting Padan 4R, a herbicide. Padan 4R contains 4% cartap hydrochloride, which is an analogue of nereistoxin. Nereistoxin and its metabolites are detected in the serum samples collected from the patient during hospitalization. The concentration ranges of nereistoxin in the serum are 0.09-2.69 micrograms/mL. (+info
Characteristics and prognosis of alcoholic doctors.
Five medically qualified women and 36 men who were being treated for alcoholism at a London postgraduate hospital were studied. Most were middle-aged and at an advanced stage of alcoholism. They had usually started drinking heavily in the wake of well-established drug dependence or other psychiatric disorder; as students or housemen; and in the armed forces. Thirty-six doctors were followed up for a mean of 63 months. Five doctors either killed themselves or died of cirrhosis, and nine persisted in almost continuous dependent drinking, while seven completely overcame their alcohol problem and 10 had only occasional relapses. Their prealcoholic careers had ranged from repeated failure to spectacular success, but of 29 doctors alive at follow-up only eight were practising satisfactorily. (+info
Use of the critical incident technique in primary care in the audit of deaths by suicide.
OBJECTIVE: To explore the usefulness of the critical incident technique in primary care to improve policy and practice to prevent cases of suicide. DESIGN: Inviting all primary care teams in County Durham with a patient who committed suicide between 1 June 1993 and 31 May 1994 to take part in a critical incident audit with an external facilitator. RESULTS: 49 cases of suicide were available for study, registered with 31 practices. 19 (61%) practices accounting for 27 (55%) cases agreed to take part. Case discussions showed areas where practice could be improved, but no substantive preventive measures were identified within primary care, which would reduce the number of people committing suicide. The wider social and economic context was thought to be more important. CONCLUSIONS: The use of the critical incident technique in primary care may have only a limited role in improving the management of people at risk from suicide. However, one of the potential strengths of this approach is to encourage reflection on practice in a difficult emotional area. (+info
Psychosocial correlates of health compromising behaviors among adolescents.
The objective of the present study was to examine psychosocial correlates of diverse health-compromising behaviors among adolescents of different ages. The study population included 123,132 adolescents in sixth, ninth and 12th grades. Psychosocial correlates of substance abuse, delinquency, suicide risk, sexual activity and unhealthy weight loss behaviors were examined. Risk-taking disposition was significantly associated with nearly every behavior across age and gender groups. Other consistent correlates included sexual abuse and family connectedness. Correlates of health-compromising behaviors tended to be consistent across age groups. However, stronger associations were noted between sexual abuse and substance use for younger adolescents, and risk-taking disposition and school achievement were stronger correlates for older youth. The results suggest the presence of both common and unique etiological factors for different health-compromising behaviors among youth. The results emphasize the importance of focusing on positive 'risk-taking' experiences for youth in prevention programs; being sensitive to possible sexual abuse experiences among both female and male adolescents in health-care consultations; integrating strategies for improved family connectedness into health promotion efforts; and making school relevant for all adolescents. (+info
Evaluation and treatment of patients with suicidal ideation.
Suicidal ideation is more common than completed suicide. Most persons who commit suicide have a psychiatric disorder at the time of death. Because many patients with psychiatric disorders are seen by family physicians and other primary care practitioners rather than by psychiatrists, it is important that these practitioners recognize the signs and symptoms of the psychiatric disorders (particularly alcohol abuse and major depression) that are associated with suicide. Although most patients with suicidal ideation do not ultimately commit suicide, the extent of suicidal ideation must be determined, including the presence of a suicide plan and the patient's means to commit suicide. (+info
Potential for suicide prevention in primary care? An analysis of factors associated with suicide.
BACKGROUND: General practitioners (GPs) need to be aware of the risk factors for suicide. GP records may provide clues to identifying the relative importance of such risk factors. AIMS: To identify, in suicide cases and matched controls, the patterns of consultation, diagnosis, and treatment of mental illness, and recording of risk factors for suicide. To examine the usefulness of data routinely collected by GPs in computerized databases to investigate treatment of patients in general practice prior to suicide. METHOD: Case control study using GP records from the General Practice Research Database (GPRD). Three controls selected for each case, matched for age, sex, and duration of registration with practice. Information extracted of the prevalence of major disease; diagnosis of, and treatment, or referral for, mental illness; frequency of recording of recent life events; and consultations with the GP in the 12 months prior to death. RESULT: Of the 339 suicide cases recorded, 80% were male, which is similar to the national percentage for this age group. Females were more likely than males to have a history of mental illness and to have been diagnosed and treated for mental illness in the 12 months before death (59% versus 35%), and women were more likely to have previously attempted suicide (47% versus 27%). There was no significant difference between males and females in period of time since last contact with GP practice, but females consulted more frequently. Twenty-nine per cent of cases had not consulted their GP in the six months prior to death. In multivariate analysis, the following were identified as independent risk factors: history of attempted suicide; untreated serious mental illness (odds ratio > 20); recent (past 12 months) marital life event; alcohol abuse; frequent consultations with GP; and previous mental illness. Recording of life events by GPs was poor. CONCLUSIONS: Females at risk of suicide are more likely than males to have been diagnosed and treated for mental illness. It is likely that GPs are under-diagnosed and under-treating males at risk. Data from the GPRD give comparable results to those from other studies. The GPRD is a potentially useful tool for research into relatively uncommon events in general practice. (+info
A worldwide assessment of the frequency of suicide, suicide attempts, or psychiatric hospitalization after predictive testing for Huntington disease.
Prior to the implementation of predictive-testing programs for Huntington disease (HD), significant concern was raised concerning the likelihood of catastrophic events (CEs), particularly in those persons receiving an increased-risk result. We have investigated the frequency of CEs-that is, suicide, suicide attempt, and psychiatric hospitalization-after an HD predictive-testing result, through questionnaires sent to predictive-testing centers worldwide. A total of 44 persons (0.97%) in a cohort of 4,527 test participants had a CE: 5 successful suicides, 21 suicide attempts, and 18 hospitalizations for psychiatric reasons. All persons committing suicide had signs of HD, whereas 11 (52.4%) of 21 persons attempting suicide and 8 (44.4%) of 18 who had a psychiatric hospitalization were symptomatic. A total of 11 (84.6%) of 13 asymptomatic persons who experienced a CE during the first year after HD predictive testing received an increased-risk result. Factors associated with an increased risk of a CE included (a) a psychiatric history +info)
Suicide within 12 months of contact with mental health services: national clinical survey.
OBJECTIVE: To describe the clinical circumstances in which psychiatric patients commit suicide. DESIGN: National clinical survey. SETTING: England and Wales. SUBJECTS: A two year sample of people who had committed suicide, in particular those who had been in contact with mental health services in the 12 months before death. MAIN OUTCOME MEASURES: Proportion of suicides in people who had had recent contact with mental health services; proportion of suicides in inpatients; proportion of people committing suicide and timing of suicide within three months of hospital discharge; proportion receiving high priority under the care programme approach; proportion who were recently non-compliant and not attending. RESULTS: 10 040 suicides were notified to the study between April 1996 and March 1998, of whom 2370 (24%; 95% confidence interval 23% to 24%) had had contact with mental health services in the year before death. Data were obtained on 2177, a response rate of 92%. In general these subjects had broad social and clinical needs. Alcohol and drug misuse were common. 358 (16%; 15% to 18%) were psychiatric inpatients at the time of death, 21% (17% to 25%) of whom were under special observation. Difficulties in observing patients because of ward design and nursing shortages were both reported in around a quarter of inpatient suicides. 519 (24%; 22% to 26%) suicides occurred within three months of hospital discharge, the highest number occurring in the first week after discharge. 914 (43%; 40% to 44%) were in the highest priority category for community care. 488 (26% excluding people whose compliance was unknown; 24% to 28%) were non-compliant with drug treatment while 486 (28%; 26% to 30%) community patients had lost contact with services. Most people who committed suicide were thought to have been at no or low immediate risk at the final service contact. Mental health teams believed suicide could have been prevented in 423 (22%; 20% to 24%) cases. CONCLUSIONS: Several suicide prevention measures in mental health services are implied by these findings, including measures to improve compliance and prevent loss of contact with services. Inpatient facilities should remove structural difficulties in observing patients and fixtures that can be used in hanging. Prevention of suicide after discharge may require earlier follow up in the community. Better suicide prevention in psychiatric patients is likely to need measures to improve the safety of mental health services as a whole, rather than specific measures for people known to be at high risk. (+info