Descriptive epidemiology and underlying psychiatric disorders among hospitalizations with self-directed violence.

BACKGROUND: Suicide claims over one million lives worldwide each year. In the United States, 1 per 10,000 persons dies from suicide every year, and these rates have remained relatively constant over the last 20 years. There are nearly 25 suicide attempts for each suicide, and previous self-directed violence is a strong predictor of death from suicide. While many studies have focused on suicides, the epidemiology of non-fatal self-directed violence is not well-defined. OBJECTIVE: We used a nationally representative survey to examine demographics and underlying psychiatric disorders in United States (US) hospitalizations with non-fatal self-directed violence (SDV). METHOD: International Classification of Disease, 9(th) Revision (ICD-9) discharge diagnosis data from the National Hospital Discharge Survey (NHDS) were examined from 1997 to 2006 using frequency measures and adjusted logistic regression. RESULTS: The rate of discharges with SDV remained relatively stable over the study time period with 4.5 to 5.7 hospitalizations per 10,000 persons per year. Excess SDV was documented for females, adolescents, whites, and those from the Midwest or West. While females had a higher likelihood of self-poisoning, both genders had comparable proportions of hospitalizations with SDV resulting in injury. Over 86% of the records listing SDV also included psychiatric disorders, with the most frequent being affective (57.8%) and substance abuse (37.1%) disorders. The association between psychiatric disorders and self-injury was strongest for personality disorders for both males (OR = 2.1; 95% CI = 1.3-3.4) and females (OR = 3.8; 95% CI = 2.7-5.3). CONCLUSION: The NHDS provides new insights into the demographics and psychiatric morbidity of those hospitalized with SDV. Classification of SDV as self-injury or self-poisoning provides an additional parameter useful to epidemiologic studies

Demographic characteristics of hospital discharges with non-fatal self-directed violence (SDV) resulting in injury or poisoning.

<p>Demographic characteristics of hospital discharges with non-fatal self-directed violence (SDV) resulting in injury or poisoning.</p

Relationship between psychiatric disorders and non-fatal self-directed violence in hospital discharges.

<p>The first two columns of each set represent the proportion of discharges with psychiatric disorders that occur among all hospitalizations or among all SDV discharges, respectively. The third column relates to the method of SDV if a discharge record has the given comorbid psychiatric disorder. The column presents the percentage of SDV discharges with self-injury as opposed to self-poisoning. Error bars are shown if the 95% CI for the weighted sample exceeds 2%.</p

Counts and rates of self-directed injury and self-directed poisoning 1997–2006.

<p>SDV; self-directed violence.</p

Association between antibodies to multiple infectious and food antigens and new onset schizophrenia among US military personnel

Introduction: Multiple studies have documented immune activation in many individuals with schizophrenia suggesting that antigens capable of generating a prolonged immune response may be important environmental factors inmany cases of this disorder.While existing studies have found single-agent associations of antibodies to food and neurotropic infectious agents with schizophrenia, a simultaneous examination of multiple agents may shed light on agent interactions or possible etiopathogenic pathways. Methods: We used traditional regression and novel statistical techniques to examine associations of single and combined infectious and food antigens with schizophrenia. We tested 6106 serum samples from 855 cases and 1165 matched controls. Results: Higher antibody levels to casein were borderline significant in the prediction of schizophrenia (HR=1.08, p=0.06). Study participantswith higher cytomegalovirus (CMV) IgG antibody levels had a reduced risk of developing schizophrenia (HR=0.90; p=0.02). While IgG antibodies to gliadin, Toxoplasma gondii, vaccinia, measles, and human herpesvirus-6 (HHV-6) showed no significant independent associations with schizophrenia, the increase in antibody levels to several combinations of agents, to include casein, measles, CMV, T. gondii and vaccinia, was predictive of an 18–34% increase in the risk of developing schizophrenia. Conclusion: Certain patterns of antibodies, involving some agents, were predictive of developing schizophrenia, with the magnitude of association rising when the level of antibodies increased to two or more agents. A heightened antibody response to a combination of several infectious/food antigens might be an indicator of an altered immune response to antigenic stimuli

Cardiovascular complications after transplantation: treatment options in solid organ recipients

Premature cardiovascular disease is the commonest cause of death in solid organ transplant recipients, with coronary artery disease, sudden cardiac death and heart failure being highly prevalent. There are unique factors leading to CV disease in organ transplant recipients that include underlying comorbidities, and metabolic effects of immunosuppression. As a consequence management strategies developed in the general population may have limited benefit. In this review, we will focus on renal transplantation, where most research has been carried out and, despite incomplete understanding of the disease process, the incidence of cardiovascular disease appears to be falling