PHARMACOTHERAPY TREATMENT OF PTSD AND COMORBID DISORDERS

Comorbity is very high in posttraumatic stress disorder (PTSD) patients. PTSD is very often complicated with depressive disorder, substance abuse, other anxiety disorders, personality disorders, psychotic features, etc. There have been few pharmacotherapy studies in this complicated field. In the past few years the literature on pharmacotherapy treatment for PTSD and comorbidity has arisen. From empirical evidence (level A) exist three sertraline studies in PTSD comorbid with: 1) anxiety, 2) depression, and 3) anxiety and depression, and one risperidone study in PTSD comorbid with psychotic symptoms. From empirical evidence (level B) exist two disulfiram, naltrexone, and their combination studies in patients with PTSD comorbid with alcohol dependence and one paroxetine or bupropion versus cognitive behavioral therapy (CBT) versus community mental health referral study in PTSD women outpatients with major depressive disorder. The results from our label trials in the Croatian war veterans with chronic PTSD comorbid with psychotic features treated with novel antipsychotics (olanzapine, risperidone, or quetiapine) are promising. In the future more rigorously designed, comparative studies are needed to determine the usefulness, efficacy, tolerability, and safety of particular psychopharmaceutical drugs in the treatment of this therapeutically and functionally challenging disorder, especially the trials from level A

Pharmacotherapy of Treatment-resistant Combat-related Posttraumatic Stress Disorder with Psychotic Features

Aim: To assess retrospectively the clinical effects of typical (fluphenazine) or atypical (olanzapine, risperidone, quetiapine) antipsychotics in three open clinical trials in male Croatian war veterans with chronic combat-related posttraumatic stress disorder (PTSD) with psychotic features, resistant to previous antidepressant treatment. Methods: Inpatients with combat-related PTSD were treated for 6 weeks with fluphenazine (n=27), olanzapine (n=28), risperidone (n=26), or quetiapine (n=53), as a monotherapy. Treatment response was assessed by the reduction in total and subscales scores in the clinical scales measuring PTSD (PTSD interview and Clinician-Administered PTSD Scale) and psychotic symptoms (Positive and Negative Syndrome Scale). Results: After 6 weeks of treatment, monotherapy with fluphenazine, olanzapine, risperidone, or quetiapine significantly decreased the scores listed in trauma reexperiencing, avoidance, and hyperarousal subscales in the clinical scales measuring PTSD, and total and subscales scores listed in positive, negative, general psychopathology, and supplementary items of the Positive and negative syndrome scale subscales, respectively, in patients with PTSD (P<0.001). Conclusion: PTSD and psychotic symptoms were significantly reduced after monotherapy with typical or atypical antipsychotics. As psychotic symptoms commonly occur in combat-related PTSD, the use of antipsychotic medication seems to offer another approach to treat a psychotic subtype of combat-related PTSD resistant to previous antidepressant treatment

Važnost procjenjivanja kvalitete života u ovisnika o alkoholu

Alcohol dependence has a strong impact on quality of life (QoL) and OoL assessment is considered as a valid measure in evaluating the success of the treatment of patients with alcohol dependence. The goal of the study was to investigate QoL and some sociodemographic characteristics of patients with alcohol dependence in comparison with healthy individuals. Cross-sectional study (which is part of larger study) included 312 patients with alcohol dependence and 329 healthy individuals of both sexes. Structured interview for sociodemographic and alcohol related data, the Croatian version of the 5.00 Mini International Neuropsychiatric Interview (MINI), and the short version of the World Health Organization Quality of Life (WHOQoLBREF) were used. The results have shown that alcohol dependent patients were significantly more frequently uneducated (p=0.006) and primary education (p<0.001), while healthy individuals were significantly more likely to have secondary (p=0.003) and tertiary education (p=0.013). Patients with alcohol dependence were significantly more likely to be single (p=0.005), divorced (p<0.001), and living as married (p=0.008) compared to healthy people, while healthy populations were more often married (p<0.001) in comparison to alcohol addicts. Alcohol dependent persons were more often unemployed (p<0.001) and retired (p=0.005). Patients with alcohol dependence were more likely to have a perceived a sense of illness (p<0.001) than healthy subjects. There were significant differences in all domains of QoL: general, physical, psychological, social, and environment between patients with dependence and healthy individuals (p<0.001). To conclude, alcohol dependence has been shown to be negatively correlated with overall QoL and domains of QoL: physical, psychological, social, and environmental. Education of patients with alcohol dependence was lower than in healthy people, who were more likely to live in marriage and were employed.Sažetak - Ovisnost o alkoholu ima jaki utjecaj na kvalitetu života i procjena kvalitete života se smatra validnom mjerom u procjeni uspješnosti tretmana osoba ovisnih o alkoholu. Cilj istraživanja je bio istražiti kvalitetu života i neke sociodemografske karakteristike osoba ovisnih o alkoholu u odnosu na zdrave osobe. Krossekcijsko istraživanje (koje je dio većeg istraživanja) uključilo je 207 osoba ovisnih o alkoholu i 329 zdravih osoba oba spola. Korišten je strukturirani intervju za sociodemografske i alkohološke podatke, hrvatska verzija 5.00. Mini internacionalnog neuropsihijatrijskog intervjua (MINI) i kratka verzija Upitnika o kvaliteti života Svjetske zdravstvene organizacije (WHOQoL-BREF). Rezultati su pokazali da su osobe ovisne o alkoholu bile značajno češće neobrazovane (p=0,006) i primarnog obrazovanja (p<0,001), dok su zdrave osobe bile značajno češće sekundarnog (p=0,003) i tercijarnog obrazovanja (p=0,013). Alkoholičari su bili značajno češće samci (p=0,005), rastavljeni (p<0,001) i žive u izvanbračnoj zajednici (p=0,008) u odnosu na zdrave osobe, dok je zdrava populacija bila češće oženjena/udana (p<0,001) u odnosu na osobe ovisne o alkoholu. Osobe ovisne o alkoholu su bile češće nezaposlene (p<0,001) i umirovljene (p=0,005). Osobe ovisne o alkoholu češće su imale percepciju osjećaja bolesti (p<0,001) u odnosu na zdrave osobe. Postojale su značajne razlike u svim domenama kvalitete života: općoj, fizičkoj, psihološkoj, socijalnoj i okruženju između osoba ovisnih o alkoholu i zdravih osoba (p < 0,001). Zaključno, alkoholna ovisnost se pokazala negativno povezana s općom kvalitetom života i domenama kvalitete života: fizičkom, psihološkom, socijalnom i okruženjem. Obrazovanje osoba ovisnih o alkoholu je bilo niže u odnosu na zdrave osobe, koji su češće živjeli u braku i bili su zaposleni

Suicidality and Depression

Osobe s mentalnim poremećajima počine oko 90% svih suicida. Afektivne bolesti (velika depresija, bipolarni poremećaj i shizoafektivni poremećaj) najčešće su dijagnoze među počiniteljima i čine 60 do 70% udjela u suicidima. Doživotni rizik od suicida kod bolesnika s depresijom je 15%. Neki čimbenici suicidalnog rizika su: suicidalna ili homicidalna promišljanja, namjere ili planovi; pristup sredstvima za počinjenje suicida i njihova letalnost; prisutnost psihotičnih simptoma, imperativnih halucinacija ili teške anksioznosti; zlouporaba alkohola ili psihoaktivnih tvari; povijest i ozbiljnost prijašnjih pokušaja te obiteljska anamneza. U kliničkoj praksi je važno procijeniti rizik od suicidalnog ponašanja i njegov intenzitet. Kako suicid nije mentalni poremećaj ili psihijatrijska dijagnostička kategorija, glavnina tretmana odnosi se na depresivni poremećaj. Nema specifične farmakoterapije u liječenju suicidalnog ponašanja, ali se primjenjuju različite skupine lijekova. Velika je kontroverza mogu li određeni lijekovi povećati sklonost ekspresiji suicidalnog ponašanja ili preveniraju njegov početak kod osoba pod povećanim rizikom. Liječenjem simptoma djelujemo na ekspresiju suicidalnog ponašanja. Ipak, istraživanja pokazuju da je nedavni porast u propisivanju antidepresiva pridonio padu suicida. Specifični načini liječenja suicidalnog ponašanja su: 1. somatska terapija i 2. psihoterapija. Izbor psihofarmaka ovisi o težini bolesti, suicidalnom riziku, sigurnosti i učinkovitosti lijeka, nuspojavama ili interakcijama s drugim lijekovima, bolesnikovoj suradnji, socijalnoj potpori i tjelesnom komorbiditetu. Preventivni postupci obuhvaćaju adekvatno i pravovremeno prepoznavanje osnovne psihijatrijske bolesti, komorbiditeta te suicidalnog ponašanja bolesnika uz uvođenje odgovarajućih psihofarmaka, psihoterapijskih i psihosocijalnih postupaka.People with mental disorders commit about 90% of all suicides. Affective disorders (serious depression, bipolar disorder and schizoaffective disorder) are diagnosed in 60% to 70% of suicides. A lifetime risk of suicide in people suffering from depression is 15%. Some suicidal risk factors include: suicidal or homicidal thoughts, intentions and plans; access to the methods for committing suicide and their lethality; presence of psychotic symptoms, imperative hallucinations or serious anxiety; abuse of alcohol or psychoactive substances; history and seriousness of previous attempts, and positive family history. In clinical practice, it is important to evaluate the risk of suicide and its intensity. As suicide is neither a mental disorder nor a psychiatric diagnostic category, the treatment mainly focuses on a bipolar disorder. Although there is no specific pharmacotherapy, various drug classes are used. The question whether certain drugs can intensify or prevent suicidal behavior in people with increased risk is very controversial. By treating the symptoms, we influence the expression of suicidal behavior. However, the research shows that a recent increase in the prescription of antidepressants contributed to a drop in the suicide rate. Specific therapies for suicidal behavior include: 1) somatic therapy and 2) psychotherapy. The choice of psychopharmaceuticals depends on disease stage, suicidal risk, drug safety and efficacy, side effects or interactions with other medications, patient compliance, social support, and physical comorbidity. The preventive procedures comprise adequate and timely recognition of the underlying psychiatric disease, comorbidity (psychiatric or physical) and suicidal behavior in patients along with the introduction of appropriate psychopharmaceuticals and psychotherapeutic and psychosocial procedures

Somatization as a Defence from Narcissistic Injury

Somatizacijski poremećaj je poremećaj u kojem se psihički problemi i emocionalni konflikti izražavaju tjelesnim simptomima, a somatizacija je psihološki mehanizam u kojem se psihički problemi i emocionalni konflikti manifestiraju tjelesnim simptomima za koje se ne nalazi organska podloga. Može se javiti kao zasebni ili komorbidni poremećaj, osobito s poremećajima raspoloženja, anksioznim poremećajima, poremećajima ličnosti (najčešće histrionski poremećaj ličnosti i opsesivno-kompulzivni poremećaj ličnosti). Ovakve osobe primarno se javljaju u ambulante opće medicine ili tjelesne ambulante i tek kasnije i na psihijatrijska liječenja. Liječenje osoba s tzv. somatoformnim poremećajima je kompleksno, vrlo dugo i zahtjevno te je potrebna cijela lepeza psihijatrijskih vještina, često bez pozitivnih rezultata. U ovom radu prikazana je pacijentica kod koje je traumatska i konfliktna situacija na poslu doživljena kao narcistička povreda koja je dovela do razvoja dramatične kliničke slike u oblku somatizacija i somatizacijskog poremećaja kod osobe s histronskim poremećajem ličnosti. Nemogućnost suočavanja s povredom selfa kod histrionskog poremećaja ličnosti može dovesti do somatizacije kao načinom rješavanja problema. Prigodom liječenja je važno identificirati točan uzrok, tj. okidač (engl. trigger) koji je doveo do nastanka poremećaja te suočiti pacijenta s psihološkom i emocionalnom etiologijom tegoba, što uvelike doprinosi boljem terapijskom ishodu. Važnost pravovremenog prepoznavanja somatizacija je između ostaloga nužna i zbog izbjegavanja nepotrebnih tjelesnih dijagnostičkih postupaka, kao i zbog socijalne i radne disfunkcionalnosti takvih osoba.Somatization disorder is characterized by a tendency of a person to communicate psychological distress and emotional conflicts through physical symptoms, while somatization is a psychological mechanism manifesting psychological distress and emotional conflicts as physical symptoms that lack an organic basis. It can develop as a single disorder or a mental disorder comorbid with other disorders, especially co-occurring with mood disorders, anxiety disorders, and personality disorders (most commonly, histrionic and obsessive-compulsive personality disorders). In most cases, people suffering from such disorders seek help from general practitioners or at healthcare facilities specialized for physical disorders. It is only after this that they seek psychiatric assistance. The treatment of people suffering from so-called somatoform disorders is complex, time-consuming and demanding and it requires a broad spectrum of psychiatric skills. However, it rarely yields positive outcomes. This research paper focuses on a case study of a patient with histrionic behaviour who experienced a conflict situation at work as a narcissistic injury. The narcissistic injury triggered the development of a dramatic clinical picture in the form of somatization and, consequently, the development of the somatization disorder. The inability of a person with a histrionic personality disorder to confront an injury of self can trigger somatization as a defence mechanism. The treatment requires careful identification of the root cause, the so-called trigger that initiated the development of the disorder, and the confrontation of a patient with the psychological and emotional etiology of his/her symptoms. Such an approach has a profound impact on a more positive outcome of the therapy. However, timely detection of somatization is important, among other things, to avoid unnecessary physical diagnostic procedures and to enable the normal performance of social and occupational roles of a patient

Akutes post-traumatisches Streßsyndrom bei ehemaligen Kriegsgefangenen

The aim of the present study was to assess acute psychiatric disturbances in Croatian prisoners of war (POWs) released after 6-9 months of detention. Immediately (1-3 days) after exchange with the other side, 47 prisoners of war were examined at the Zagreb University Clinic for Infectious Diseases by a team of medical professionals to assess their physical and psychological health, and therapeutic needs. The team consisted of a general practitioner, surgeon, infectious diseases specialist, psychiatrist and clinical psychologist. All prisoners were active soldiers from Vukovar, and were of similar age, social background, combat activity and duration of detention. All were severely physically and psychically maltreated in the detention camp. Sixteen (34%) had symptoms of current post-traumatic stress syndrome as assessed by the Watsons PTSD questionnaire. In a structured clinical interview, all POWs reported at least 2 (average 8-9) symptoms of psychological disturbance. All POWs ranked the withdrawal of information on their families and the situation in Croatia as the most painful experience during detention. Minnesota Multiphasic Personality Inventory (MMPI-201 version) profiles of the prisoners of war showed a significant difference between the POWs with and without diagnosed PTSD on the paranoia scale. In conclusion, although only one third of the POWs released after 6-9 months of detention and torture had manifest PTSD, most had several symptoms of psychological disturbances with dominating anxiotic-depressive and psychosomatic reactions. Careful follow-up is needed to asses the extent and late consequences of polytrauma experienced by this high-risk group.Cilj ove studije bilo je utvrditi akutne psihičke poremećaje kod hrvatskih ratnih zatočenika puštenih nakon šest do devet mjeseci pritvora. Odmah nakon razmjene (jedan do tri dana) s drugom stranom, 47 ratnih zatočenika pregledala je na Zagrebačkoj sveučilišnoj klinici za zarazne bolesti skupina medicinskih stručnjaka kako bi utvrdila njihovo tjelesno i psihičko zdravlje te odredila liječenje. Skupinu je činio liječnik opće prakse, kirurg, stručnjak za zarazne bolesti, psihijatar i klinički psiholog. Svi su zatočenici bili pripadnici redovnih vojnih snaga iz Vukovara, bili su podjednake starosti, društvenog podrijetla, borilačke aktivnosti i trajanja pritvora. Svi su bili izloženi teškom tjelesnom i umnom zlostavljanju u zatočeničkom logoru. Šesnaest zatočenika (34 posto) pokazivalo je znakove akutnog sindroma posttraumatskog stresa utvrđenog Watsonovim PTSD upitnikom. U strukturiranom kliničkom upitniku svi su ratni zatočenici potvrdili bar dva (u prosijeku osam do devet) znakova pshihološkog poremećaja. Svi su zatočenici rangirali nedostatak obavijesti o svojim obiteljima i stanju u Hrvatskoj kao najbolnije iskustvo za trajanja pritvora. MMPI-201 (Minnesota Multiphasic Personality Inventory) profili ratnih zatočenika pokazali su značajnu razliku između zatočenika kojima jest i nije dijagnosticiran PTSD na ljestvici paranoje. U zaključku valja reći da je, iako je samo kod jedne trećine ratnih zatočenika puštenih nakon šest do devet mjeseci pritvora i mučenja utvrđeno postojanje PTSD, većina pokazivala nekoliko znakova psiholoških poremećaja s prevladavajućim anksiozno-depresivnim i psihosomatskim reakcijama. Potrebno je pažljivo pratiti ove rezultate kako bi se procijenili opseg i zakašnjele posljedice politraumatskih iskustava te visoko-rizične skupine.Ziel dieser Studie war, akute seelische Störungen bei kroatischen Kriegshäftlingen, die nach 6 bis 9 Monaten Internierung freigelassen wurden, zu ermitteln. Gleich nach dem Gefangenenaustausch (1-3 Tage später) untersuchte man in der Zagreber Universitätsklinik für Ansteckungskrankheiten 47 kroatische Kriegshäftlinge, um ihren körperlichen wie seelischen Zustand zu prüfen und erforderliche Behandlungsverfahren festzulegen. Das zuständige Ärzteteam bestand aus einem allgemeinen Arzt, einem Chirurgen, einem Facharzt für Ansteckungskrankheiten, einem Psychiater und einem klinischen Psychologen. Sämtliche ehemalige Kriegshäftlinge waren Mitglieder regulärer Militäreinheiten aus Vukovar, hatten annährend dasselbe Alter und denselben gesellschaftlichen Status, waren in den Kampfsportarten ausgebildet und verbrachten gleich lange in Kriegsgefangenschaft. Als Inhaftierte waren sie denselben körperlichen und seelischen Mißhandlungen ausgesetzt. 16 der ehemaligen Kriegshäftlinge (34%) wiesen Symptome eines akuten post-traumatischen Streßsyndroms auf, das anhand des Watson-Fragebogens ermittelt wurde. Nach diesem strukturierten, klinischen Fragebogen zeigten alle ehemaligen Kriegsgefangenen mindestens 2 (im Durchschnitt 8 bis 9) Symptome seelischer Störungen. Auch erklärten alle ohne Ausnahme, es sei die schmerzlichste Erfahrung während der Haft gewesen, daß sie nichts über ihre Angehörigen und über die Lage in Kroatien wußten. Gemäß dem MMPI-201 (Minnesota Multiphasic Personality Inventory) ergaben sich bedeutende Unterschiede zwischen den ehemaligen Kriegsgefangenen, denn gemessen an der Skala zur Ermittlung von Paranoia zeigten bestimmte Kriegsgefangene ganz klar das Bestehen von post-traumatischem Streßsyndrom, andere wiederum nicht. Abschließend muß gesagt werden, daß zwar nur ein Drittel der nach 6 bis 9 Monaten Kriegshaft und schweren Mißhandlungen freigelassenen kroatischen Soldaten Symptome eines post-traumatischen Streßsyndroms bekundete, daß aber bei den meisten von ihnen Anzeichen seelischer Störungen vorlagen, bei denen Angst- und Depressionszustände mit psychosomatischen Reaktionen überwogen. Diese Umfrageergebnisse müssen sorgfältig überwacht werden, um Umfang und verspätete Folgen mehrfacher traumatischer Erfahrungen dieser ausnehmend gefährdeten Risikogruppe beurteilen zu können

Dynamics of Shame in Psychotherapy of Alcoholics

Cilj ovog članka je naglasiti psihodinamsku ulogu srama u alkoholizmu te njegovu važnost u procesu psihoterapijskog liječenja osoba s dijagnosticiranim sindromom ovisnosti o alkoholu. Velika većina osoba ovisnih o alkoholu emocionalno je nezrela, a sram je snažno utjecao na izgradnju njihovih ličnosti. Sram je odredio razvoj njihovih identiteta te je potaknuo nastanak duboko ukorijenjenih emocija nepovjerenja, krivnje, inferiornosti i izolacije. Grupna psihoterapija prva je linija psihoterapijskog liječenja alkoholizma. No, njezin pozitivan ishod ograničen je činjenicom da se, upravo zbog sustava scenarija zasnovanog na sramu te često popratne anksioznosti i emocionalne labilnosti, osobe ovisne o alkoholu nerado pridružuju grupi, a ako joj se i pridruže, najčešće je to kratkoročno. U ovom članku razmatramo stilove grupnih psihoterapija koji bi mogli imati pozitivniji ishod u liječenju osoba ovisnih o alkoholu. Analiza objavljene literature ukazala je na nedostatak integrativnog psihoterapijskog pristupa liječenju.The aim of this article is to highlight the psychodynamic role of shame in alcoholism and its importance in the psychotherapeutic treatment of alcoholics. Alcoholics are often emotionally immature and have a shame-based personality. Shame has strongly influenced the development of their identity and led to deeply ingrained feelings of mistrust, guilt, inferiority, and isolation. Group psychotherapy is the first line of psychotherapeutic treatment of alcoholism, but its successfulness is limited by the fact that alcoholics find joining and staying in a group quite difficult due to a shame-based script system and accompanying anxiety and emotional lability. We discuss the styles of psychotherapeutic groups that may be more effective with alcoholics. A review of published literature indicated the lack of integrative psychotherapeutic treatment

Epidemiologische Selbstmord-Indikatoren in der Republik Kroatien

The aim of the study was to investigate possible shifts of the suicide rate during the last 15 years in the Republic of Croatia (1985-2000), the distribution of male and female suicides according to age and some other characteristics according to sex in the 1990-2000 period, and the distribution of male and female suicides during the war and post-war period. Data were collected from the Suicide Register of the Ministry of the Interior. According to the Register, 9987 suicides had been reported in 1990-2000. The suicide rates in the last 15 years did not change as well as during the war and post-war period. The suicide rate was 19.26. The highest suicide rate was in the 15-30 age group and in those older than 65 years. The women were on average five years older than men. Hanging was the most frequent method of suicide (50%). Men used firearms and explosives more often than women. Medical problems were more often present among women than men, as opposed to alcoholism, which was more present among men. Almost 80% of the victims had previously verbally announced suicide. Prevention efforts should be focused on alcoholism, drug abuse, family crisis, reduction of firearms and explosives possession, and improvement of economic status among men, and toward previous suicide attempts, mental disorders and unemployment among women. Among both sex groups prevention must be directed toward the youth and the elderly and verbal suicide announcement must be seriously estimated.Cilj studije bio je istražiti moguće pomake u stopi suicida tijekom posljednjih 15 godina u Republici Hrvatskoj (1985-2000.), distribuciju muških i ženskih suicida prema dobi i neke druge karakteristike prema spolu u razdoblju od 1990. do 2000., te distribuciju muških i ženskih suicida tijekom rata i u poslijeratnom razdoblju. Podaci su prikupljeni iz Registra suicida Ministarstva unutarnjih poslova i u tom razdoblju prijavljeno je 9 987 suicida. Stope suicida u posljednjih 15 godina nisu se mijenjale, uključujući ratno i poslijeratno razdoblje. Stopa suicida bila je 19,26. Najviša stopa suicida bila je u dobnoj skupini između 15 i 30 godina starosti i kod starijih od 65 godina. Žene su u prosjeku bile pet godina starije od muškaraca. Vješanje je bila najčešća metoda suicida (50 posto). Muškarci su rabili vatreno oružje i eksploziv češće nego žene. Zdravstveni razlozi su bili češći kod žena nego kod muškaraca, nasuprot alkoholizmu koji je bio češćim uzrokom suicida kod muškaraca. Gotovo 80 posto žrtava je prethodno najavilo samoubojstvo. Prevenciju bi trebalo usmjeriti protiv alkoholizma, zloupotrebe droga, obiteljskih kriza te na smanjenje posjedovanja vatrenog oružja i eksploziva i poboljšanje ekonomskog položaja kod muškaraca. A kod žena bi se valjalo usredotočiti na prethodne pokušaje suicida, mentalne poremećaje i nezaposlenost. Među objema spolnim skupinama prevenciju treba usmjeriti na mlade i starije i verbalnu najavu suicida valja ozbiljno procjenjivati.Das Ziel dieser Studie war zu ermitteln, ob es im Laufe der letzten 15 Jahre (1985–2000) zu Veränderungen in den Selbstmordraten in Kroatien gekommen ist. Des Weiteren wollte man die geschlechts- und altersgebundene Verteilung von Selbstmordfällen im Zeitraum 1990–2000 feststellen, im Besonderen während der Kriegsjahre (1991–95) sowie unmittelbar danach. Die Angaben wurden aufgrund des beim kroatischen Innenministerium geführten Registers von Selbstmordfällen gewonnen. In der Zeit von 1990–2000 wurden 9987 Selbstmordfälle verzeichnet. Die Selbstmordraten haben sich im Laufe der letzten 15 Jahre – die Kriegs- und Nachkriegsjahre mit einberechnet – nicht verändert. Laut amtlichen Angaben betrug die Selbstmordrate für den angegebenen Zeitraum 19,26. Die meisten Selbstmordfälle wurden in der Altersgruppe von 15 bis 30 sowie bei Menschen von über 65 Jahren verzeichnet. Täterinnen waren im Durchschnitt 5 Jahre älter als männliche Selbstmörder derselben Altersgruppe. Die am meisten praktizierte Selbstmordmethode war der Tod durch Erhängen (50%). Feuerwaffen und Sprengstoffe wurden von Männern häufiger verwendet als von Frauen. Bei Frauen überwogen gesundheitliche Gründe, während eine unheilbare Alkoholsucht öfter bei Männern vorlag. Fast 80% der Selbstmöder hatten ihr Vorhaben angekündigt. Vorbeugungsmaßnahmen sollten auf die Bekämpfung der Alkohol- und Drogensucht sowie die Linderung familiärer Krisen ausgerichtet sein; ebenso sollte der Besitz von Feuerwaffen und Sprengstoffen eingeschränkt und der wirtschaftliche Status von Männern aufgebessert werden. Bei Frauen sollten wiederholte Selbstmordversuche mehr beachtet werden, ebenso das Bestehen von geistigen Störungszuständen und Arbeitslosigkeit. In beiden Geschlechtsgruppen sollten Vorbeugungsmaßnahmen auf junge sowie auf ältere Menschen ausgerichtet sein. Ausdrücklich geäußerte Ankündigungen sollten ernst genommen werden