Self-perceived Difficulties With Suicidal Patients in A Sample of Italian General Practitioners

BACKGROUND: Suicidal behaviours are relatively common among primary care patients, but suicide ideation seems to be poorly detected by GPs. The purpose of the present study is to investigate the frequency of issues related to suicidal behaviour in GPs' setting and to inquire the level of difficulties perceived by physicians when dealing with suicidal patients. METHODS: A survey on 88 GPs in Rovigo (Italy) has been conducted through the use of a self-administered questionnaire inquiring about suicidal behaviour in patients, personal history and outside professional lives. RESULTS: Four out of 5 doctors have encountered at least a case of suicide in their professional career, and 3 out of 4 recorded at least a case of suicide attempt in a working year. The frequency of personal history of suicidal ideation/behaviour was 2.3%. One third of GPs have come into contact with suicides or suicide attempts outside the professional setting. Sixty one per cent of doctors admitted difficulties in exploring suicidal ideation, but tended to ascribe it to a reluctant attitude of patients. CONCLUSIONS: The study underscores GPs' need of being helped in the difficult task of recognising suicidal patient

Parasuicide in Rovigo (North of Italy) during the period 2000-2005

Introduction. The greatest predictor of eventual suicide is parasuicide, which includes both suicide attempts and deliberate self-harm with no intent to die. The rate of parasuicide is reckoned to be at least ten times the suicide rate. Methods. An observational study of the population of Rovigo Public Health Unit has been carried out to investigate parasuicide cases that presented to a general hospital in the six-year period from 1st January 2000 to 31st December 2005. Results. An incidence of 36.39 parasuicides/100,000/year referred to a general hospital has been estimated, with a majority of female and young subjects. The principal method used was drug poisoning (59.1%); the more frequent diagnoses are mood and personality disorders. Method of attempt distribution is different for age and gender (p inf. 0.001), while diagnosis distribution is different only for age (p inf. 0.001). Comparison between method of attempt and diagnosis distribution indicates a significant difference (p inf. 0.01). In 36.4% of cases there was no contact with the Mental Health Service after parasuicide. Discussion. The present study confirms that parasuicide is more common in females and younger people and that the more probable diagnoses are mood and personality disorders. The finding of a high number of subjects without any previous contact with the Mental Health Service and, especially, after parasuicide, claims attention on primary and secondary prevention of suicidal behaviour. Conclusions. The results appear to be in line with those from literature on parasuicide in Western populations

Mood, cognition and EEG changes during interferon alpha (alpha-IFN) treatment for chronic hepatitis C.

Abstract: Background: This study is aim to investigate concurrent long-term psychiatric. cognitive and neurophysiological measure's of alpha-IFN neurotoxicity in the treatment of chronic viral hepatitis. Methods: Twenty patients with HCV hepatitis were enrolled while treated with alpha-IFN (3-6 MU for 6-12 months). Neurotoxicity was evaluated by psychiatric [Hamilton Depression Rating Scale (HAM-D), Hamilton Scale for Anxiety (HAM-A), Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI-Y)], complete cognitive and neurophysiological assessments (EEG : spectral analysis, P300). Patients were assessed at baseline (t(0)), 2 (t(1)) and 6 months (t(2)) since the beginning of therapy. Results: Depression scores significantly increased (HAM-D: t(0)=4.4+/-2.6; t(1)=8.9+/-3.9, p<0.00; and t(2)=1.7+/-3.8, p<0.001). A concurrent increase was shown also for anxiety (HAM-A: t(0)=6.0+/-3.2; t(1)=9.6+/-4.5, p<0.005; and t(2)=9.1+/-4.5, p<0.005). Significant neurophysiological effects were also detected: increase of alpha power (p<0.05) in frontal derivations, reduction of the mean dominant frequency (p<0.005) and increase of theta power (p<0.05) in parietal derivations. In contrast, no significant cognitive changes occurred. Limitations: The study was performed on a relative small sample of patients mainly with observational intentions. Biological data (e.g. blood cytokines samples) are not available: they could have given useful information about biological mechanisms related to the alterations observed

Inhalation of 7.5% carbon dioxide increases threat processing in humans

Inhalation of 7.5% CO2 increases anxiety and autonomic arousal in humans, and elicits fear behavior in animals. However, it is not known whether CO2 challenge in humans induces dysfunction in neurocognitive processes that characterize generalized anxiety, notably selective attention to environmental threat. Healthy volunteers completed an emotional antisaccade task in which they looked toward or away from (inhibited) negative and neutral stimuli during inhalation of 7.5% CO2 and air. CO2 inhalation increased anxiety, autonomic arousal, and erroneous eye movements toward threat on antisaccade trials. Autonomic response to CO2 correlated with hypervigilance to threat (speed to initiate prosaccades) and reduced threat inhibition (increased orienting toward and slower orienting away from threat on antisaccade trials) independent of change in mood. Findings extend evidence that CO2 triggers fear behavior in animals via direct innervation of a distributed fear network that mobilizes the detection of and allocation of processing resources toward environmental threat in human

Inhalation of 7.5% carbon dioxide increases alerting and orienting attention network function

Rationale: The development of experimental models that readily translate between animals and humans is required to better integrate and clarify the biological, behavioural and cognitive mechanisms that underlie normal fear and pathological anxiety. Inhalation of low concentrations of carbon dioxide (CO2) increases anxiety and autonomic arousal in humans, triggers related behaviours in small animals, and increases selective attention to threat in healthy humans. However the effects on broader cognitive (non-emotional) processes that characterize anxiety are not known. Objectives: To examine the effect of 7.5% CO2 inhalation (vs. air) on the efficiency of discrete attention networks implicated in anxiety: alerting (maintaining an alert state), orienting (the selection of information from sensory input) and executive control (resolving cognitive conflict).Methods: 23 healthy human participants completed a computerized Attention Network Test (ANT) during inhalation of 7.5% CO2 enriched and normal/medical air. Gas was administered blind to participants with inhalation order counterbalanced across participants. Measures of heart rate, blood pressure and subjective mood/anxiety were obtained at baseline and following each inhalation period.Results: CO2 inhalation increased anxiety, autonomic arousal and the efficiency of alerting and orienting attention network function. Autonomic response to CO2 correlated with increased orienting; and CO2–induced anxiety, autonomic arousal and orienting network function increased with chronic (trait) anxiety.Conclusions: Evidence that CO2 modulates attention mechanisms involved in the temporal detection and spatial location of salient stimuli converges with evidence that CO2 triggers fear behaviour in animals via direct innervation of a distributed neural network that facilitates environmental hypervigilance. <br/