Cardiovascular mortality in Northern Ireland during the 2008-2014 financial crisis years: who got the worst hit?

Background: Internationally, cardiovascular mortality and economic recessions showed an established relationship. Northern Ireland was badly affected by the global financial crisis in 2008-2014 but little is known in terms of how cardiovascular mortality was affected. Objective: The aim of the present study was to investigate the potential impact of the 2008 economic crisis on the annual cerebrovascular accidents CVA and ischaemic heart disease IHD related mortality in Northern Ireland. Method: Mortality data were extracted from Northern Ireland Statistics and Research Agency database. We utilized generalized linear regression Poisson modelling to estimate the impact of economic crisis on the IHD and CVA mortality. Results: We found a significant increase of IHD-deaths during the financial crisis years in males over the age of 65 (β = 49.466, p value = 0.003) and females over the age of 65 (β = 57.721, p value = 0.001). However, CVA-mortality in the post crisis years rose significantly for females who were 65 years or older (β = 56.010, p value = 0.005) but not for males. The rest of the age groups were not significantly affected in terms of either CVA or IHD mortality. Conclusion: For the total population the only age category with significant increase in both IHD and CVA mortality in the post-2008 era was the over 65 (p values < 0.001 and = 0.012, respectively) Declaration of interest: None. Keywords: IHD, CVA, Northern Ireland, economic recession, working-age, socio-economic change

Effect of the Irish Civil War 1922-1923 on suicide rates in Ireland: a retrospective investigation of the archives of the registrar-general for Saorstát Éireann

Introduction: Emile Durkheim differentiated between two types of wars: National and Civil Wars in terms of effect on suicide mortality. This study investigates Durkheim’s assertion by examining the effect of Irish Civil War on the 1882-1928 suicide rates trend. Method: We used Auto-Regressive Integrated Moving Average with Explanatory variables (ARIMAX) design adopting Bayesian approach. Results: The odds for death by suicide for the total Irish population during the civil war period were calculated as 0.932 (95% CI: 0.753 to 1.125). This translates to a reduction in the suicide rates by 6.7% (95% CI: 24.7% to -12.5%). The odds for death by suicide for the total Irish population during the First World War period were calculated as 0.872 (95% CI: 0.754 to 0.997). This indicates to a reduction in the suicide rates by 12.8% (95% CI: 24.6% to 0.3%). Conclusion: Evidence from this study support a significant drop in terms of the intensity of suicidal behaviour in the Irish population during World War I more so than during the Irish Civil War. Conflict of interest: non

Augmentation of clozapine with ECT: a retrospective case analysis

Objective:We sought to assess the effectiveness of clozapine augmentation with ECT (C+ECT) in patients with clozapine-resistant schizophrenia. Methods:We conducted a retrospective review of electronic health records to identify patients treated with C+ECT. We determined the response to C+ECT and the rate of rehospitalisation over the year following treatment with C+ECT. Results:Forty-two patients were treated with C+ECT over a ten year period. The mean age of the patients at initiation of ECT was 46.3 (SD=8.2) years (range 27-62 years). The mean number of ECTs given was 10.6(SD = 5.3)(Range 3-25) with the majority receiving twice weekly ECT. Seventy six percent of patients (n=32) showed a Clinical Global Impression improvement score (CGI-I) of≤3 (at least minimally improved) following C+ECT. The mean number of ECT treatments was 10.6 (SD = 5.3) (range 3-25) with the majority receiving twice weekly ECT. Sixty four percent of patients experienced no adverse events. Response to C+ECT was not associated with gender, age, duration of illness, or duration of clozapine treatment.Seventy five percent of responders remained out of hospital over the course of one-year follow up, while 70% of those with no response to C+ECT were not admitted to hospital. Three patients received maintenance ECT, one of whom was rehospitalised. Conclusion:This study lends support to emerging evidence for the effectiveness of C+ECT in clozapine resistant schizophrenia. These results are consistent with the results of a meta-analysis and the only randomised controlled trial (RCT) of this intervention. Further RCTs are required before this treatment can be confidently recommended

Effect of the 2008 economic crisis on the cardiovascular mortality of the Irish population: an ecological 12-year study of a heart-broken Celtic Tiger.

Ireland has endured a substantial financial crisis in 2008 and we sought to explore the effect of economic recession on Irish cardiovascular mortality. We found an increase by 17.2% in CVA-deaths during the financial crisis years (95% CI 11.1% to 23.6%). In males, we found a notable rise in the annual IHD rate by 7.56% (95% CI 4.73% to 10.46%), in annual MI rate by 2.96% (95% CI 0.16% to 5.84%), and in annual CVA death rate by 20.07% (95% CI 16.13% to 24.14%). In females our findings indicated an increased rate of CVA-related deaths during the economic crisis by 15.54% (95% CI 6.67% to 25.16%). Irish CVA-related deaths increased during the economic crisis for males and females alike. Male IHD-related deaths have also risen indicating a potential differential effect for financial hardships on male gender mortality

Tramadol-Induced Mood Elevation in a Patient with No Previous Psychiatric History

Tramadol is a powerful analgesic medication with antidepressant effects like venlafaxine. Hypomanic features were reported in patients with psychiatric history of mood disturbance when tramadol was prescribed for them. However, it is extremely rare to notice such mood-elevating effect in patients who have no previous psychiatric history. We report on the observation of a distressing mood-elevating effect for tramadol in a patient with no previous psychiatric history. We present the case of a 26-year-old female patient who developed accelerated flow of speech, overactivity, and difficulty in sleeping following intake of tramadol 50 mg dose. These symptoms resolved four hours later and recurred as she retook tramadol. The patient has no history of mood disorder or any other psychiatric comorbidity. Clinicians should exercise caution when prescribing tramadol

Effect of the First World War on suicide rates in Ireland: an investigation of the 1864-1921 suicide trends

Since the proposition of the social integration theory by Émile Durkheim, macro-sociological changes have been speculated to affect suicide rates. This study investigates the effect of the First World War on Irish suicide rates. We applied an interrupted time series design of 1864–1921 annual Irish suicide rates. The 1864–1913 suicide rates exhibited a slow-rising trend with a sharp decline from the year 1914 onwards. The odds for death by suicide for males during the 1914–1918 period was 0.811 (95% CI 0.768–0.963). Irish rates of suicide were significantly reduced during the First World War, most notably for males

“Suicide shall cease to be a crime”: suicide and undetermined death trends 1970–2000 before and after the decriminalization of suicide in Ireland 1993

Introduction: Suicide is criminalized in more than 100 countries around the world. A dearth of research exists into the effect of suicide legislation on suicide rates and available statistics are mixed. Materials and methods: This study investigates 10,353 suicide deaths in Ireland that took place between 1970 and 2000. Irish 1970–2000 annual suicide data were obtained from the Central Statistics Office and modelled via a negative binomial regression approach. We examined the effect of suicide legislation on different age groups and on both sexes. We used Bonferroni correction for multiple modelling. Statistical analysis was performed using the R statistical package version 3.1.2. The coefficient for the effect of suicide act on overall suicide deaths was −9.094 (95 % confidence interval (CI) −34.086 to 15.899), statistically non-significant (p = 0.476). The coefficient for the effect suicide act on undetermined deaths was statistically significant (p < 0.001) and was estimated to be −644.4 (95 % CI −818.6 to −469.9). Conclusion: The results of our study indicate that legalization of suicide is not associated with a significant increase in subsequent suicide deaths. However, undetermined death verdict rates have significantly dropped following legalization of suicide

Trifluoperazine-Induced Angioedema

Angioedema is a serious adverse drug reaction that can rarely be associated with trifluoperazine treatment. We present the case of a 44-year-old male with an established diagnosis of schizoaffective disorder, for which trifluoperazine therapy was considered. He presented to the emergency department with bilateral lower limb oedematous painful erythematous swelling that eased off completely when trifluoperazine was stopped. The possibility of allergic reaction, such as angioedema, should always be kept in mind by psychiatrists and mental health professionals when prescribing trifluoperazine antipsychotic

Effect of the Irish Civil War 1922-1923 on suicide rates in Ireland: a retrospective investigation of the archives of the registrar general for Saorstát Éireann

Introduction: Emile Durkheim differentiated between two types of wars: National and Civil Wars in terms of effect on suicide mortality. This study investigates Durkheim’s assertion by examining the effect of Irish Civil War on the 1882-1928 suicide rates trend. Method: The study is based on vital statistics data sourced from Central Statistics Office of Ireland. We used AutoRegressive Integrated Moving Average with Explanatory variables (ARIMAX) design adopting Bayesian approach. Results: The Standardized Mortality Rate SMR for death by suicide for the total Irish population during the civil war period were reduced by 0.041417 (95% Credible Interval CI: -0.2421749 to 0.15934012). The SMR for death by suicide for the total Irish population during the First World War period were reduced by 0.206202 (95% CI: -0.3776463 to -0.03475746). Conclusion: Evidence from this study support a significant drop in terms of the intensity of suicidal behaviour in the Irish population during World War I more so than during the Irish Civil War

False Positive Tramadol Urine Testing in Patients Taking Fexofenadine: A Tale of Two Consecutive Cases

Urine drug screen immunoassays have been widely used as point-of-care testing for detection of various drug classes in substance use disorders. However, these immunoassays frequently result in false positive results. We report two patients that used 180 mg daily dose of fexofenadine hydrochloride for treatment of skin allergy and, falsely, tested positive for use of tramadol during urine drug screening. We recommend caution when interpreting positive tramadol urine screening among patients on fexofenadine treatment