Antidepressants and suicide.
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Antidepressive Agents↗
Biomedical subjects
G Isacsson
Publications and source records attributed to G Isacsson.
Outcome of 6-week treatment with transcutaneous electric nerve stimulation compared with splint on symptomatic temporomandibular joint disk displacement without reduction.
The aim of the present study was to compare the effect of transcutaneous electric nerve stimulation (TENS) with the flat occlusal splint in the treatment of temporomandibular joint (TMJ) disk displacement without reduction. Thirty-one patients were included and randomly selected to be treated 6 weeks with either TENS (90 Hz, 30 min, three times/day) or with a flat occlusal splint (24 h/day. Those selected for the TENS group had one electrode placed over the painful TMJ and another electrode over the anterior temporal muscle. The splint group used a conventional flat occlusal splint with cuspid guidance. Both treatment groups visited the clinic once a week. Symptoms and signs were registered before and after treatment. The intensity of pain was recorded with a visual analogue scale (VAS) and with an electronic pocket-sized recorder (Pain-Track) carried 1 week before and also the last week of treatment for continuous registration of pain. Measured with the VAS, half of the patients treated with splints became pain-free or their TMJ pain improved at least 50% both at rest and with jaw function compared with only 6% in the TENS-treated group. With regard to strictly chewing pain, the VAS-registered pain improved in two-thirds of the splint group, compared with 50% of the TENS group. With the Pain-Track device it was found that in most individuals pain was aggrevated at mealtimes. The conclusion was that flat occlusal splints in several respects are better than TENS in the treatment of symptoms associated with TMJ disk displacement without reduction.
Adolescent↗
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↗
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↗
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↗
Antidepressants, depression and suicide: an analysis of the San Diego study.
Depression has been consistently reported in 40-50% of suicides. Previous toxicologic studies of suicides have not included diagnostic information, however. This report includes 247 (87%) of 283 suicides in whom it was possible to perform toxicological analyses for tricyclic antidepressants. We wanted to see if any relationships existed among the presence of antidepressants at autopsy, diagnosis of Depression, recent contact with physicians and prescription of antidepressant medication. Toxicology was positive in 19 (8%) subjects. Only 12% of the subjects with a DSM-III diagnosis of Major or Atypical Depression were positive. Lethal blood levels of antidepressants were found in only 4% of all subjects and most of those involved multiple drugs. Also, most of those subjects had co-morbid Depression and Substance Abuse. More than half of the Depressed subjects had seen a physician within 90 days from suicide but less than half of these were prescribed antidepressants and only one-third of the latter were positive for antidepressants in toxicology. These data suggest that more suicides might be averted by decisively treating Depressed patients with ADs, including strict monitoring of dosage and compliance, than by not treating them to avoid AD overdoses. Diagnostic caution should be observed to identify co-morbid Substance Abuse when treating patients with Depression and suicidal ideation.
Adult↗
Benign osteoblastoma associated with an aneurysmal bone cyst of the mandibular ramus and condyle.
This article reviews the clinical behavior, the histologic conditions, and the treatment of a benign osteoblastoma associated with an aneurysmal bone cyst of the mandibular condyle and ramus. A 14-year-old boy, otherwise healthy, was referred for pain and enlargement in his right temporomandibular joint-cheek region. The swelling was firm and tender, a slight facial asymmetry was present, and the mouth-opening capacity was reduced. During a 6-weeks period from the primary examination to surgery the lesion expanded extensively, anesthesia appeared in the right inferior alveolar nerve and a lateral open bite developed on the affected side. Computed tomography displayed a total destruction of the right mandibular condyle and ramus to the level of the mandibular foramen. The lesion was radiolucent without distinct borders to adjacent bone. Surgery revealed a bluish, well-vascularized predominantly cystic tumor. The lesion included the temporomandibular joint disk but without overgrowth to the temporal component. After resection of the lesion, the condyle and the mandibular ramus was reconstructed with the use of an autogenous costochondral graft. The postoperative healing was uncomplicated. At follow-up 2 years after surgery the boy was free of recurrence with normal motor and sensory nerve function.
Adolescent↗
Effect of maxillomandibular fixation on condylar growth in juvenile Macaca mulatta: a cephalometric and histologic study.
The effect of maxillomandibular fixation on the growth of the mandibular condyle was studied in eight control and eight experimental male juvenile monkeys. All animals had metallic implants placed throughout the craniofacial complex in order to facilitate cephalometric analysis of growth-related changes in the maxillomandibular complex during jaw immobilization. Every 3, 6, 12, and 24 wk after insertion of the appliance two experimental animals were killed for histologic analysis. Cephalometric analysis indicated no major deviation from normal maxillary or mandibular growth in the experimental animals. The condylar growth in the experimental animals was comparable with that of the controls. Histologic analysis indicated that the articular connective tissue in experimental joints remained the same thickness as in the controls. On the postero-superior aspect of the condyle, the thickness of the prechondroblastic-chondroblastic cell layer was reduced by 70-80% in the experimental animals. On the posterior aspect this cell layer was not visible after 12 wk of fixation, but was replaced by a periosteum-like, cell-rich tissue which appeared to be active in appositional formation of cancellous bone. These results indicate that long-term maxillomandibular fixation does not cause major alterations in the growth of condyle or the entire mandible despite a profound decrease of the prechondroblastic-chondroblastic cell layer in the postero-superior and posterior regions of the condyle. The growth is probably due to a compensatory appositional bone formation along the surface of the condyle. It is also concluded that jaw mobility is not a prerequisite for normal maxillary or mandibular growth.
Animals↗
[Can anabolic steroids cause personality changes?].
Anabolic and androgen steroids such as testosterone have receptors in the brain and may have manifest effects on behaviour. The sequela most consistently cited is aggressiveness, but acute affective and paranoid psychoses have also been reported, though in a strictly scientific sense causality has not been established. However, as the abuse of steroids spreads among the young, other risk factors such as abuse of alcohol and other drugs as well as psychological susceptibility may contribute to the risk of personality changes or of violent behaviour as a result of anabolic steroid abuse.
Adolescent↗
Low level of antidepressant prescription for people who later commit suicide: 15 years of experience from a population-based drug database in Sweden.
The use of antidepressants has been low in Jämtland County for many years, while the suicide rate has been among the highest in Sweden. A continuous outpatient prescription recording system has been in operation in Jämtland since 1970. Through this system we traced the prescription pattern of 80 individuals who committed suicide from 1970 to 1984. Suicide patients obtained 1.5 times more prescription drugs than 80 matched controls, mainly psychotropics and vitamins. During the 3 months prior to the suicide, half of the patients had received medical attention and 73% of the women and 40% of the men had obtained prescription drugs, in one-third from the psychiatric department. While 53% and 29%, respectively, obtained psychotropic drugs, only 13% and 9% respectively were prescribed antidepressants, often in low doses. People who will commit suicide often seek medical help. The low rate of antidepressant prescription in patients committing suicide probably reflects insufficient diagnosis and treatment of depressive disorders. It is urgent--for the individual as well as for society--that diagnostic and pharmacotherapeutic routines be improved.
Adolescent↗
Radiographic signs of temporomandibular disorders to predict outcome of treatment.
In 32 consecutive patients with temporomandibular disorders radiographic changes were correlated with the patients' assessment of treatment outcome. The patients had been referred for tomographic examination because the clinical signs and anamnestic data were inadequate for definite clinical diagnosis. Initially all patients were treated conservatively with a flat occlusal splint. Surgery was advised in appropriate cases. The subjective effect of treatment was assessed using a questionnaire, and the material was divided into responder and nonresponder groups. Seventy-eight percent (25) of the patients experienced a positive subjective response to the treatment. No radiographic sign was found to be statistically correlated to the outcome of treatment.
Adult↗
Frequency of bilateral temporomandibular joint disc displacement in patients with unilateral symptoms: a 5-year follow-up of the asymptomatic joint. A clinical and arthrotomographic study.
Bilateral arthrotomography was performed in 50 consecutive patients with unilateral symptoms of disc displacement to evaluate the frequency of temporomandibular joint disc displacement in asymptomatic joints. Using well-defined clinical criteria, there were no false-positive findings of either reducing or non-reducing discs. On the other hand, a risk of false-negative diagnosis of non-reducing disc was apparent. Sixty per cent of the patients had a non-reducing displaced disc in the asymptomatic joint. Most of these patients could recall a previous spell of discomfort from this joint. Severe or moderate deformation had taken place in non-reducing discs, while reducing discs were normal in shape or had, at most, a thickening of the posterior band. The duration of symptoms was significantly correlated with the degree of deformation in the symptomatic joints (P less than 0.01). Perforation was statistically, significantly correlated with disc deformation and, in symptomatic joints, hard tissue changes. Fifty-seven per cent of the asymptomatic joints with displaced discs developed pain following the onset of symptoms from the contralateral side, most within 2 years. Less than half of them were free of pain at the end of the 5 year follow-up period. In view of this tendency for an asymptomatic joint with a displaced disc to subsequently develop pain refractory to treatment, such a joint must be considered a weakened link in the craniomandibular system, vulnerable to changes in mandibular function such as, for instance, displacement of the disc on the contralateral side.
Adolescent↗
Coronoid process elongation in rhesus monkeys (Macaca mulatta) after experimentally induced mandibular hypomobility. A cephalometric and histologic study.
The present study provided an experimental model that allowed a cephalometric and histologic analysis of craniofacial growth in monkeys with induced translatory impairment of the mandibular condyle. Cauterization was performed anterior to the joint in nine experimental rhesus monkeys, while eight animals served as control subjects. The experimental procedure produced mandibular hypomobility in six animals, in three by means of temporomandibular joint ankylosis and in three by means of dense scar tissue formation anterior to the joint. In the remaining three experimental animals no restriction of mandibular mobility was created. Mandibular hypomobility was found to induce elongation of the coronoid process and was also associated with bone deposition in the gonial region. In contrast, normal remodeling of the gonial region was found in the experimental animals with normal range of movements and in the control animals.
Animals↗
A radiographic and histologic study of the topographic relations in the temporomandibular joint region: implications for a nerve entrapment mechanism.
A radiographic and histologic investigation was performed in 18 temporomandibular joint (TMJ) autopsy specimens. Disc position was determined arthrotomographically. The pathway of the nerve branches in the vicinity of the joint was reconstructed from serial sagittal or frontal histologic sections. The relationship between the joint components and the different nerves running in the vicinity of the joint was studied. The results revealed the existence of topographical prerequisites for mechanical influence upon the nerve branches passing in the TMJ region. In two joints, both with a displaced disc, the auriculotemporal nerve trunk was almost in contact with the medial aspect of the condyle instead of having its normal sheltered course at the level of the condylar neck, thus exposing the nerve to the risk of mechanical irritation during condylar movements in an anteromedial direction. Two joints with normal disc position had an extension of the medial fossa wall in a caudal direction. In these joints the auriculotemporal nerve had its course between the condyle and the elongated fossa wall, exposing it to the risk of mechanical irritation during medial disc displacement. Compression of the masseteric nerve anterior to the TMJ was found in one joint with excessive condylar translation. The deep posterior temporal nerves may pass close to the anterior insertion of the joint capsule on the temporal bone, exposing them to the risk of mechanical irritation when there is condylar hypermobility. It was also found that the inferior alveolar and the lingual nerves may pass close to the medial part of the condyle. In joints with this nerve topography, a medially displaced disc could interfere mechanically with these nerves. These findings could offer an explanation for the sharp, shooting pain felt locally in the joint with jaw movements and the pain and other sensations projecting to the terminal area of distribution of the nerve branches in the vicinity of the TMJ such as the ear, temple, cheek, tongue, and teeth.
Aged↗
Clinical signs in patients with disk displacement versus patients with myogenic craniomandibular disorders.
Patients with disorders of the masticatory system were clinically examined with reference to tender TMJs and sore muscles of the head and neck, jaw movement range, occlusal interferences, and aberrations of the bite. The 158 patients were divided into three groups according to diagnosis: 46 with reducing disk displacement, 57 with nonreducing disk displacement, and 55 with myogenic CMD. Unilateral symptoms were found in 83% of the two TMJ groups and 47% of the myogenic CMD group. At intraoral palpation, significantly more patients with nonreducing disk displacement displayed tender sites on the symptomatic side. Tender TMJ, crepitation, and restricted condylar translation on the symptom side were significantly more common in the group with nonreducing disk displacement. Mean maximal mouth opening was 31 mm in the nonreducing disk displacement, 42 mm in the reducing disk displacement, and 47 mm in the myogenic CMD group. Total laterotrusion was significantly less in the nonreducing disk displacement group. Myogenic CMD patients had more interferences in retruded position on the symptomatic side and more tender neck and shoulder muscles. Patients with nonreducing disk displacement displayed more signs from the masticatory system than those with myogenic CMD.
Adolescent↗
Mobility of the upper esophageal sphincter in relation to the cervical spine: a morphologic study.
If the posterior part of the upper esophageal sphincter (UES) were to lag behind due to the presence of dense tissue strands between the sphincter and the prevertebral ligament, as suggested in the literature, it would be impossible to use the larynx as a radiographic indicator of the location of the UES at intraluminal pressure measurements. The goal of this investigation was to study UES behavior during induced movements in autopsy specimens and to search for dense fibrous strands between the UES and the prevertebral fascia. Histologic studies of frozen sections and paraffin sections showed a loose fatty tissue in the prevertebral space. There were no dense connective tissue strands. Autopsy specimens were used in experiments mimicking the laryngeal/UES elevation during swallowing. The results of this study indicate that the larynx and the UES move as one entity. When one is attempting to register the UES movement during swallowing, the laryngeal skeleton can therefore serve as a radiographic indicator of the UES movements.
Adult↗
Subjective symptoms in patients with temporomandibular joint disk displacement versus patients with myogenic craniomandibular disorders.
Signs and symptoms in the masticatory system can be caused by several specified diseases leading to diagnostic problems. This investigation compared patients with temporomandibular joint disk displacement and patients with complaint of myogenic craniomandibular disorders. In association with the onset of the patient's problem, a physical event was found in half the number of patients with permanent disk displacement, compared with only 27% in the myogenic craniomandibular disorders group. Patients with permanent disk displacement reported more pain in the temporomandibular joint ear and jaw region in association with jaw function whereas patients with myogenic craniomandibular disorders reported more bruxism and dental discomfort.
Adolescent↗