Alcohol Consumption or Excessive Use of Psychotropic Medication Prior to Suicidal Self-injury in Patients with Adjustment Disorder, Depression, and Schizophrenia: A Cross-sectional Study

The use of alcohol or drug(s) prior to self-injury is a possible inducing factor for suicidal self-injuries among patients with adjustment disorder. We analyzed the cases of 175 individuals who were admitted to the intensive care unit (ICU) of Tokyo Medical and Dental University Medical Hospital for suicidal self-injury to determine whether alcohol consumption or an excessive use of prescribed psychotropic medications prior to self-injury is more common in patients with adjustment disorder. During a 7-year period (July 2006 to June 2013) following their deliberate self-injuries, 971 patients were admitted to the ICU. Our study sample (n=175) was restricted to patients with adjustment disorder (n=48), major depressive disorder (n=90), or schizophrenia (n=37). The outcome variable was alcohol consumption or excessive use of medications prior to suicidal self-injury. A logistic regression analysis revealed that the patients with adjustment disorder more commonly showed alcohol consumption or excessive medication use prior to their suicidal self-injury compared to those with schizophrenia (odds ratio: 8.10; 95%CI: 2.97-24.60). To inhibit suicidal self-injury among patients with adjustment disorder, it is important to continue efforts to provide psychoeducation about alcohol use and to instruct the patients to take their prescribed medication(s) only as directed by their physician

The degree of social difficulties experienced by cancer patients and their spouses

Abstract Background Although recent studies have increasingly reported physical and psychological problems associated with cancer and its treatment, social problems of cancer patients and their families have not been sufficiently elucidated. The present study aimed to identify cancer-associated social problems from the perspectives of both patients and their spouses and to compare and analyze differences in their problems. Methods This was a cross-sectional internet-based study. Subjects were 259 patients who developed cancer within the previous five years and 259 patients’ spouses; the data were derived from two surveys in 2010 (patients) and 2016 (spouses) whose participants were not part of the same dyad but matched by propensity scores, estimated for age, sex, and the presence or absence of recurrence. We investigated the social difficulties of cancer patients and patients’ spouses. Regarding social difficulties experienced by cancer patients and spouses, the 60 patient survey items were categorized into 14 labels by the Jiro Kawakita (KJ) method, which is a qualitative synthesis method developed by Kawakita to classify categorical data. Results Although patients had higher scores on most subcategories, young spouses aged 39 or younger and female spouses had difficulty scores as high as the corresponding patients on many subcategories. Conclusion Health care providers should show sufficient concern for both patients and their spouses, particularly young and female spouses

Characteristics of the study participants.

<p>Characteristics of the study participants.</p

Associations of Adverse Clinical Course and Ingested Substances among Patients with Deliberate Drug Poisoning: A Cohort Study from an Intensive Care Unit in Japan

<div><p>Objectives</p><p>Some patients with deliberate drug poisoning subsequently have an adverse clinical course. The present study aimed to examine whether the type of drugs ingested and psychiatric diagnoses were related to an adverse clinical course.</p><p>Methods</p><p>We conducted a cohort study of patients with deliberate drug poisoning admitted to the intensive care unit of a university hospital located in Tokyo, Japan, between September 2006 and June 2013. Intensive care unit (ICU) stay of ≥4 days was used as a primary outcome measure, while the incidence of aspiration pneumonitis was used as a secondary outcome measure. Ingested substances and psychiatric diagnoses were used as explanatory variables.</p><p>Results</p><p>Of the 676 patients with deliberate drug poisoning, 88% had a history of psychiatric treatment and 82% had ingested psychotropic drugs. Chlorpromazine-promethazine-phenobarbital combination drug (Vegetamin^®) ranked fifth among the most frequently ingested substances in cases of deliberate drug poisoning and had the highest incidence of prolonged ICU stay (20%) and aspiration pneumonitis (29%). The top three major classes consisted of benzodiazepines (79%), new-generation antidepressants (25%), and barbiturates/non-barbiturates (23%). Barbiturate overdose was independently associated with increased odds of both prolonged ICU stay (8% vs. 17%; odds ratio [OR], 2.97; 95% confidence interval [CI], 1.60–5.55) and aspiration pneumonitis (8% vs. 24%; OR, 3.83; 95% CI, 2.18–6.79) relative to those associated with overdose of only other sedative-hypnotics (i.e., benzodiazepines).</p><p>Conclusion</p><p>These results suggest that judicious prescribing of barbiturates by psychiatrists could reduce the risk of an adverse clinical course when a patient attempts an overdose.</p></div

Flow diagram for inclusion in the study.

<p>Flow diagram for inclusion in the study.</p

Major classes of overdose.

<p>Major classes of overdose.</p

Psychiatric diagnoses.

<p>Psychiatric diagnoses.</p

Conducta de evitación asociada a síntomas depresivos en pacientes con desfibriladores cardioversores implantables

Antecedentes/Objetivo. Muchos pacientes con desfibriladores cardioversores implantables experimentan síntomas depresivos. Además, la conducta de evitación es un problema común entre estos pacientes. El objetivo fue examinar la asociación entre las conductas de evitación y síntomas depresivos en pacientes con desfibriladores cardioversores implantables. Método: Se llevó a cabo un estudio transversal en un único centro entre mayo de 2010 y marzo de 2011. Mediante autoinformes se midieron conductas de evitación (evitación a lugares, evitación a objetos y evitación a situaciones) y síntomas depresivos (mediante el Inventario de Depresión de Beck, Versión II) en 119 participantes. El instrumento de evitación se desarrolló para este estudio, con adecuada fiabilidad de consistencia interna. Resultados: Noventa y dos pacientes (77,3%) tenían más de 50 años y 86 pacientes (72,3%) eran hombres. Cincuenta y un pacientes (42,9%) informaron de “evitación a lugares”, 34 pacientes (28,6%) informaron de “evitación a objetos” y 63 pacientes (52,9%) informaron “evitación a actividad”. La conducta de evitación se asoció con un aumento en la probabilidad de síntomas depresivos (OR 1,31; IC del 95%, 1,06- 1,62). Conclusiones: Este es el primer estudio para identificar la relación entre la conducta de evitación y síntomas depresivos en pacientes portadores de desfibriladores cardioversores implantables, aunque existen algunas limitaciones metodológicas. © 2017 Asociación Española de Psicología Conductual. Published by Elsevier España, S.L.U. This is an open access article under the CC BY−NC−ND license (http://creativecommons. org/licenses/by−nc−nd/4.0/)