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Biomedical subjects

D Wasserman

Publications and source records attributed to D Wasserman.

At least 73 records · Page 4Linked to original sources
PubMed1996

Living conditions of female suicide attempters: a case-control study.

A total of 51 hospitalized female suicide attempters (17-64 years old) were interviewed according to a questionnaire used by Statistics Sweden, SCB (ULF 88:1) for investigation of living conditions. Control subjects from similar geographical areas included in the ULF investigation in 1988, and matched for age and nationality, were identified through the SCB (n = 153). Odds ratios (OR) and 95% confidence limits were estimated. Correlation coefficients were used to study the relative importance of specific factors. Not less than 26 items reached the level of statistical significance, but only four of them (mental disorder, use of anxiolytics, unemployment at some time during the last 5 years, and no professional work during the past year) showed a considerable excess risk (lower 95% CI limit for OR > 3). Physical illness was relevant as an independent factor. Although of secondary importance, hospitalization during the previous 3 months was also a characteristic of suicide attempters.

Adolescent↗
PubMed1996

Attempted suicide in Europe: rates, trends and sociodemographic characteristics of suicide attempters during the period 1989-1992. Results of the WHO/EURO Multicentre Study on Parasuicide.

The World Health Organization/EURO Multicentre Project on Parasuicide is part of the action to implement target 12 of the WHO programme, "Health for All by the Year 2000', for the European region. Sixteen centres in 13 European countries are participating in the monitoring aspect of the project, in which trends in the epidemiology of suicide attempts are assessed. The highest average male age-standardized rate of suicide attempts was found for Helsinki, Finland (314/100,000), and the lowest rate (45/100,000) was for Guipuzcoa, Spain, representing a sevenfold difference. The highest average female age-standardized rate was found for Cergy-Pontoise, France (462/100,000), and the lowest (69/100,000) again for Guipuzcoa, Spain. With only one exception (Helsinki), the person-based suicide attempt rates were higher among women than among men. In the majority of centres, the highest person-based rates were found in the younger age groups. The rates among people aged 55 years or over were generally the lowest. For the majority of the centres, the rates for individuals aged 15 years or over decreased between 1989 and 1992. The methods used were primarily "soft' (poisoning) or cutting. More than 50% of the suicide attempters made more than one attempt, and nearly 20% of the second attempts were made within 12 months after the first attempt. Compared with the general population, suicide attempters more often belong to the social categories associated with social destabilization and poverty.

Adolescent↗
PubMed1996

The use of antidepressants and therapeutic drug monitoring by general practitioners and psychiatrists: findings from a questionnaire survey in two Swedish areas.

We wished to assess general practitioners' and psychiatrists' sensitivity and specificity in the diagnosis of depression, rationale for drug of choice, average and range of prescribed daily doses of antidepressants, and use of therapeutic drug monitoring (TDM). A questionnaire survey was given to 264 psychiatrists and general practitioners (GPs) in one urban area of Stockholm and the rural county of Jamtland, Sweden. The response rate was 86% (n = 228). The survey was validated against independent studies of actual prescription rates. One of eight physicians presented with a hypothetical case history of major depression appeared unwilling to use antidepressants. Two-thirds of the GPs and one-fourth of the psychiatrists usually prescribed doses that were too low. Many doctors never prescribed doses higher than 150 mg/day of common tricyclic antidepressants, although many patients clearly need higher doses. The choice of drug was based mostly on the therapeutic tradition and seldom on considerations of scientific evidence. The few physicians who utilized TDM (plasma concentrations) for dosing prescribed a more flexible dosage schedule and higher average doses as well as higher maximal doses. Interestingly, there were no significant differences in dosing between GPs and psychiatrists in this group, while striking differences were found in the whole study group, with GPs prescribing much smaller doses. Regular use of TDM as a means for individualizing the dose regimen of antidepressants should be encouraged, as well as continuous education of general practitioners in the diagnosis and treatment of depression.

Antidepressive Agents↗
PubMed1995

Self-poisonings with antidepressants and other psychotropics in an urban area of Sweden.

As part of a WHO project on parasuicide, the medications used for self-poisoning in the Stockholm area were studied. The prescribing rates of the medications were estimated from an independent survey of prescriptions. Anxiolytics, hypnotics, and analgesics were the drugs most commonly used for parasuicide. Related to prescribing rates, antipsychotics and anxiolytics represented an increased risk for parasuicide compared to the average for psychotropics. Analgesics, on the other hand, showed a lower risk for parasuicide. The low number of self-poisonings with antidepressants may reflect that suicidal individuals are seldom prescribed antidepressants and/or that antidepressants actually prevent suicidal acts. As we have shown earlier for completed suicides, underprescribing and therapeutic failure seem to be greater problems with antidepressants than their use for self-poisoning.

Adolescent↗
PubMed1995

Capnocytophaga ochracea chronic blepharoconjunctivitis.

A 70-year-old woman presented with a 10-month history of chronic blepharoconjunctivitis that had been unresponsive to multiple methods of treatment. The patient was not immunocompromised and had no history of corneal disease, ocular trauma, or lacrimal duct obstruction. Gram and Giemsa staining of conjunctival smears resulted in visualization of slender, fusiform bacilli. Culture of conjunctival scrapings led to the recovery of a fastidious isolate identified as Capnocytophaga ochracea. The same microorganism was also recovered from cultures of the patient's gingiva. The blepharoconjunctivitis responded well to treatment with fortified cefazolin eye drops. Awareness of this easily overlooked bacterial species should prompt the use of smear and cultural techniques.

Aged↗
PubMed1994

Choice of antidepressants: questionnaire survey of psychiatrists and general practitioners in two areas of Sweden.

OBJECTIVE: To identify factors that affect physicians' choice of specific antidepressant drugs in order to evaluate the validity of epidemiological studies of the risks (particularly suicide) and benefits of different compounds. DESIGN: Questionnaire survey of 264 psychiatrists and general practitioners in an urban area and a rural area of Sweden with validation of data by independent prescription surveys. SETTING: Urban area of greater Stockholm and rural county of Jämtland, Sweden. SUBJECTS: 228 physicians (86%) who answered the questionnaire. MAIN OUTCOME MEASURES: The drugs used as first line drugs of choice, as drugs of choice in particularly severe depression, and as drugs of choice for disorders other than depression. RESULTS: Amitriptyline was the most common first line drug of choice among both psychiatrists and general practitioners. The patterns of choice of antidepressants in the two areas accorded with prescribing patterns in two independent prescription surveys. Amitriptyline was chosen even more frequently for severe depression and depression with severe insomnia. Clomipramine was chosen comparatively more often for depression with severe anxiety. Low toxicity compounds (mainly lofepramine, mianserin, and moclobemide) were more often the drug of choice in depression associated with overt risk of suicide. Amitriptyline and clomipramine were used extensively for disorders other than depression (40% and 54% of prescriptions, compared with 13-19% for some other major antidepressants). CONCLUSION: Patient groups treated with different antidepressant compounds may not be comparable with respect to diagnoses and severity of disease. In particular, lofepramine, mianserin, and moclobemide, and possibly amitriptyline, seem to be chosen more often for patients prone to suicide.

Antidepressive Agents↗
PubMed1994

Use of antidepressants among people committing suicide in Sweden.

OBJECTIVE: To analyse the outcome of depression in the Swedish population as reflected by the detection of antidepressants in a national forensic toxicological screening programme of unnatural deaths. DESIGN: Antidepressants detected by the National Laboratory of Forensic Chemistry were related to data on use expressed in person years of exposure. SUBJECTS: All 7000 cases of unnatural death with results from forensic toxicological screening in 1990-1; this included 3400 (85%) of the 4000 cases of suicide in Sweden. MAIN OUTCOME MEASURES: Number of findings of antidepressants in the screening programme and number of findings of different antidepressants in relation to their use. RESULTS: Antidepressants were found in 585 screening tests, corresponding to 542 subjects or less than 16% of the 3400 cases of suicide. Newer, less toxic antidepressants were found more often than the older compounds. Toxic concentrations of antidepressants were found in only 190 cases (5.6%). CONCLUSION: A consistent finding in surveys of suicide is that about half of the patients who commit suicide are depressed. The current data suggest that most depressed patients who commit suicide are not taking antidepressants immediately before death. Therapeutic failure may be a greater problem with antidepressants than toxicity as the results did not indicate any advantage of the newer, less toxic antidepressants. All causes of death should be included in risk analyses, thereby providing an estimate of effectiveness as well as toxicity of antidepressants.

Antidepressive Agents↗
PubMed1994

Aggravation of herpetic stromal keratitis after murine epidermal grown factor topical application.

We evaluated the epithelializing-promoting effect of a concentration of 0.005 mg/ml murine epidermal growth factor (mEGF), topically administered four times daily, on the herpes simplex virus 1 (HSV-1) corneal ulcers of the rabbit eye. The severity of the herpetic lesions was evaluated clinically, after the time course of the severity of epithelial keratitis, conjunctivitis, iritis, and stromal disease, for 14 days. A histological assessment was performed in the middle and at the end of the follow-up. The stromal keratitis of the mEGF-treated group was significantly more severe than the keratitis exhibited by the placebo-treated rabbits (Y = X3 X2*X4; p = 0.0001). There were no significant differences in the degree of conjunctivitis, epithelial keratitis, iritis, and virus shedding between these groups. No evidence of a toxic effect of mEGF or placebo was found in the mock infected rabbit eyes. More studies, using different herpes virus strains and a broad range of murine and human EGF concentrations, are mandatory to ascertain the general significance of these results. Meanwhile, caution is recommended when using mEGF in the presence of an occult or manifest herpetic eye disease.

Administration, Topical↗
PubMed1994

Aquagenic urticaria in a child.

A healthy 3-year-old boy developed acute urticaria five minutes after exposure to tap water in different areas of Jerusalem. Physical examination and baseline laboratory evaluation were within normal limits. The clinical picture and possible mechanisms of aquagenic urticaria are reviewed. This is the youngest patient to be reported.

Child, Preschool↗
PubMed1994

Male suicides and alcohol consumption in the former USSR.

A significant decline (34.5%) in the suicide rate occurred in 1984-1988 throughout the USSR. The decline was observed shortly after the introduction of strict restrictions on the sale of alcohol. We tested the hypothesis that the restrictive alcohol policy in the first years of perestroika (June 1985) caused the fall in suicide rates in the former USSR. Data on alcohol consumption, violent death caused by external injury and poisoning (n = 916,315), death due to accidental alcohol poisoning (n = 77,837), suicide (n = 192,305) and death undetermined whether accidentally or purposely (n = 54,253) were analyzed for all former Soviet republics for 1984, 1986, 1988 and 1990. Men were chosen for the analysis, since men are more prone to abuse alcohol than women. Regression analysis with alcohol consumption as the independent variable and suicide rates and violent death rates as dependent variables shows that suicide and alcohol consumption were positively correlated as were violet death and alcohol consumption. In the republics with high alcohol consumption (Slavic and Baltic), suicide rates were also high. In the Caucasian republics, low alcohol consumption was associated with low suicide rates. For most republics, alcohol seems to explain more than 50% of suicides. Alcohol also has considerable explanatory value for violent death. Thus, a restrictive alcohol policy might be a way to reduce suicide and violent death.

Alcohol Drinking↗
PubMed1994

Management of suicide attempters: what are the routines and the costs?

The services offered to a consecutive series of 97 suicide attempters (36 men and 61 women) at a general hospital were registered by a participating observer. All but one case were subjected to psychiatric consultation for suicide risk assessment, but only 34% were evaluated by a psychiatric specialist. Fifty-seven percent were admitted to psychiatric inpatient care. The length of inpatient care varied, the average duration was 5 days for men and 14 days for women. Repeaters were admitted more often than nonrepeaters. The short-term compliance was satisfactory. The direct cost for management was evaluated based on the detailed quantification of care provided for each subject. The care at the hospital equalled 6.4% of the total budget for psychiatric inpatient care.

Adolescent↗
PubMed1994

Suicides in the Baltic countries, 1968-90.

Trends of male and female suicides in the Baltic countries--Estonia, Latvia and Lithuania--in the years 1968-90 were studied. As throughout the former USSR, suicide rates declined sharply from 1986, the year marking the onset of turbulent social change. During the "period of stagnation" from 1968 to 1984, the mean value of male suicide rates per 100,000 males were 55.7 in Estonia, 52.5 in Latvia and 51.7 in Lithuania. The figures for female suicide rates were 14.3, 14.3 and 10.4, respectively. Suicide rates remained consistently high in Estonia and Latvia, while in Lithuania the male suicide rate rose gradually from 33.0 to 61.3 and the female rate from 8.0 to 13.1 during the stagnation period. In conjunction with perestroika in the former USSR (including a restrictive alcohol policy and the first tentative steps towards democracy), annual male suicide rates per 100,000 in the years 1986-90 fell considerably below those in the stagnation period. Mean values of male suicide rates decreased by 26.6% in Estonia, 26.6% in Latvia and 14.4% in Lithuania in the period 1986-90 compared with the mean values for the period 1968-84. Female suicide rates were relatively stable and the male-female ratio was accordingly lower in 1986-90 (Estonia and Latvia 3.1, Lithuania 4.2) than in 1968-84 (Estonia 3.9, Latvia 3.7 and Lithuania 5.0).

Estonia↗