Are sedatives and hypnotics associated with increased suicide risk of suicide in the elderly?

<p>Abstract</p> <p>Background</p> <p>While antidepressant-induced suicidality is a concern in younger age groups, there is mounting evidence that these drugs may reduce suicidality in the elderly. Regarding a possible association between other types of psychoactive drugs and suicide, results are inconclusive. Sedatives and hypnotics are widely prescribed to elderly persons with symptoms of depression, anxiety, and sleep disturbance. The aim of this case-control study was to determine whether specific types of psychoactive drugs were associated with suicide risk in late life, after controlling for appropriate indications.</p> <p>Methods</p> <p>The study area included the city of Gothenburg and two adjacent counties (total 65+ population 210 703 at the start of the study). A case controlled study of elderly (65+) suicides was performed and close informants for 85 suicide cases (46 men, 39 women mean age 75 years) were interviewed by a psychiatrist. A population based comparison group (n = 153) was created and interviewed face-to-face. Primary care and psychiatric records were reviewed for both suicide cases and comparison subjects. All available information was used to determine past-month mental disorders in accordance with DSM-IV.</p> <p>Results</p> <p>Antidepressants, antipsychotics, sedatives and hypnotics were associated with increased suicide risk in the crude analysis. After adjustment for affective and anxiety disorders neither antidepressants in general nor SSRIs showed an association with suicide. Antipsychotics had no association with suicide after adjustment for psychotic disorders. Sedative treatment was associated with an almost fourteen-fold increase of suicide risk in the crude analyses and remained an independent risk factor for suicide even after adjustment for any DSM-IV disorder. Having a current prescription for a hypnotic was associated with a four-fold increase in suicide risk in the adjusted model.</p> <p>Conclusion</p> <p>Sedatives and hypnotics were both associated with increased risk for suicide after adjustment for appropriate indications. Given the extremely high prescription rates, a careful evaluation of the suicide risk should always precede prescribing a sedative or hypnotic to an elderly individual.</p

Snapshot Provisioning of Cloud Application Stacks to Face Traffic Surges

Traffic surges, like the Slashdot effect, occur when a web application is overloaded by a huge number of requests, potentially leading to unavailability. Unfortunately, such traffic variations are generally totally unplanned, of great amplitude, within a very short period, and a variable delay to return to a normal regime. In this report, we introduce PeakForecast as an elastic middleware solution to detect and absorb a traffic surge. In particular, PeakForecast can, from a trace of queries received in the last seconds, minutes or hours, to detect if the underlying system is facing a traffic surge or not, and then estimate the future traffic using a forecast model with an acceptable precision, thereby calculating the number of resources required to absorb the remaining traffic to come. We validate our solution by experimental results demonstrating that it can provide instantaneous elasticity of resources for traffic surges observed on the Japanese version of Wikipedia during the Fukushima Daiichi nuclear disaster in March 2011.Les pics de trafic, tels que l'effet Slashdot, apparaissent lorsqu'une application web doit faire face un nombre important de requêtes qui peut potentiellement entraîner une mise hors service de l'application. Malheureusement, de telles variations de traffic sont en général totalement imprévues et d'une grande amplitude, arrivent pendant une très courte période de temps et le retour à un régime normal prend un délai variable. Dans ce rapport, nous présentons PeakForecast qui est une solution intergicielle élastique pour détecter et absorber les pics de trafic. En particulier, PeakForecast peut, à partir des traces de requêtes reçues dans les dernières secondes, minutes ou heures, détecter si le système sous-jacent fait face ou non à un pic de trafic, estimer le trafic futur en utilisant un modèle de prédiction suffisamment précis, et calculer le nombre de ressources nécessaires à l'absorption du trafic restant à venir. Nous validons notre solution avec des résultats expérimentaux qui démontrent qu'elle fournit une élasticité instantanée des ressources pour des pics de trafic qui ont été observés sur la version japonaise de Wikipedia lors de l'accident nucléaire de Fukushima Daiichi en mars 2011

Risk factors for suicide in Hungary: a case-control study

<p>Abstract</p> <p>Background</p> <p>Hungary previously had one of the highest suicide rates in the world, but experienced major social and economic changes from 1990 onwards. We aimed to investigate the antecedents of suicide in Hungary. We hypothesised that suicide in Hungary would be associated with both risk factors for suicide as identified in Western studies, and experiences related to social and economic restructuring.</p> <p>Methods</p> <p>We carried out a controlled psychological autopsy study. Informants for 194 cases (suicide deaths in Budapest and Pest County 2002–2004) and 194 controls were interviewed by clinicians using a detailed schedule.</p> <p>Results</p> <p>Many of the demographic and clinical risk factors associated with suicide in other settings were also associated with suicide in Hungary; for example, being unmarried or having no current relationship, lack of other social contacts, low educational attainment, history of self-harm, current diagnosis of affective disorder (including bipolar disorder) or personality disorder, and experiencing a recent major adverse life event. A number of variables reflecting experiences since economic restructuring were also associated with suicide; for example, unemployment, concern over work propects, changes in living standards, practising religion. Just 20% of cases with evidence of depression at the time of death had received antidepressants.</p> <p>Conclusion</p> <p>Suicide rates in Hungary are falling. Our study identified a number of risk factors related to individual-level demographic and clinical characteristics, and possibly recent societal change. Improved management of psychiatric disorder and self-harm may result in further reductions in suicide rates.</p

Mental health literacy and attitudes in a Swedish community sample – Investigating the role of personal experience of mental health care

<p>Abstract</p> <p>Background</p> <p>Mental ill health is a common condition in the general population, yet only about half of those with a mental disorder have treatment contact. Personal experience may affect attitudes, which in turn influence the help-seeking process. This study investigated differences in mental health literacy and attitudes among mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact.</p> <p>Method</p> <p>A postal screening questionnaire was sent to a random sample of the general population aged 20–64 in the county of Skaraborg, Sweden in order to ascertain mental health status and history of treatment contact; 3538 responded (49%). Face-to-face interviews were carried out in random sub samples of mentally healthy persons (n = 128) and in mentally ill persons with (n = 125) and without (n = 105) mental health care contact. Mental health literacy and attitudes to treatment were assessed using questions based on a vignette depicting a person with depression. Past month mental disorder was diagnosed according to the Schedule for Clinical Assessment in Neuropsychiatry (SCAN).</p> <p>Results</p> <p>Two thirds failed to recognize depression in a vignette; recognition was equally poor in mentally healthy persons and in persons with symptoms of mental illness with and without treatment contact. In response to an open-ended question concerning appropriate interventions, one third suggested counselling and only one percent proposed antidepressant treatment. Again, proportions were similar in all groups. Persons with a history of mental health contact more often suggested that a GP would provide the best form of help. When presented with a list of possible interventions, those with a history of mental health contact were more positive to medical interventions such as antidepressants, hypnotics, and inpatient psychiatric treatment. When asked about the prognosis for the condition described in the vignette, persons with treatment contact were less likely to believe in full recovery without intervention; mentally ill without treatment contact were more optimistic.</p> <p>Conclusion</p> <p>Mental health literacy, specially concerning attitudes towards interventions is associated with personal history of mental health care.</p