Self-poisoning and the general hospital.
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Acetaminophen↗
Biomedical subjects
K Hawton
Publications and source records attributed to K Hawton.
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↗
Paracetamol self-poisoning. Characteristics, prevention and harm reduction.
BACKGROUND: Paracetamol is now the most common drug used for self-poisoning in the UK and is associated with potentially fatal liver damage. Patients admitted to hospital because of paracetamol overdoses were studied in order to determine their characteristics and factors which might have deterred them from taking paracetamol or reduced the dangers of the overdose. METHOD: Eighty patients were studied in hospital using a structured interview schedule, measures of depression and suicidal intent, information collected through the Oxford Monitoring System for Attempted Suicide, and the results of liver function tests. RESULTS: Acute liver dysfunction (25 patients) was associated with consumption of more than 25 tablets (odds ration 4.46, 95% CI 1.31 to 17.41, P = 0.014). The proportionate use of tablets from blister packs (60%) and loose preparations (46%; 5 patients using both types) reflected their general availability. More of those who took tablets from a loose preparation consumed 25 or more tablets (69%) than those who used a blister-pack preparation (40%; odds ratio = 3.0, 95% CI 1.12 to 9.95, P = 0.028). Only 20 patients thought that any type of warning label would have deterred them from taking a paracetamol overdose. CONCLUSIONS: Establishing a maximum number of tablets (e.g. 25) that can be available in individual preparations is likely to reduce the dangers of paracetamol self-poisoning. The potential effects of other measures are uncertain.
Acetaminophen↗
Deliberate self-poisoning and self-injury in children and adolescents under 16 years of age in Oxford, 1976-1993.
BACKGROUND: Deliberate self-harm (DSH) is common in adolescents in the United Kingdom and suicide has greatly increased in frequency in older male adolescents. There is, however, very little information about DSH in older children and young adolescents. METHOD: Analysis of data collected by the Oxford Monitoring System for Attempted Suicide between 1976 and 1993 for all cases of DSH in under 16-year-olds referred to the general hospital in Oxford. RESULTS: Seven hundred and fifty-five individuals were involved in 854 episodes of DSH. There were very few cases under 12 years of age but after that the behaviour increased greatly in frequency with each year of age, especially in girls. Eighty-five per cent were girls, the sex ratio being 5.7 girls to each boy. Most cases involved self-poisoning. During the final six years of the study period paracetamol was involved in 54.7% of overdoses, compared with 19.5% in 1976-1981. A minority of individuals had had previous psychiatric treatment. The most frequent problems were relationship difficulties with parents, followed by difficulties with friends, school and social isolation. Among those who reported previous episodes of DSH, in the majority of cases these had not come to medical attention. Repetition of self-harm occurred in 9.4% of cases within a year of an episode and 19.3% during the overall study period. There was some indication that repetition was most common in youngsters discharged from the Accident and Emergency Department without a psychiatric assessment. CONCLUSIONS: DSH in under 16-year-olds is not uncommon and there is evidence that it occurs far more frequently in the community than is reflected in general hospital figures. The problem of paracetamol self-poisoning in this age group needs to be addressed. A psychiatric assessment should be performed in all cases coming to the general hospital.
Adolescent↗
Why patients choose paracetamol for self poisoning and their knowledge of its dangers.
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Acetaminophen↗
Chronic fatigue syndrome: a cognitive approach.
Observations concerning the characteristics of patients who presented to a medical clinic with a principal complaint of chronic medically unexplained fatigue (Chronic Fatigue Syndrome or CFS) are described, including the cognitions (thoughts and assumptions) elicited from a sample of these patients who were treated using cognitive behavioural therapy. On the basis of these observations a cognitive theory of the aetiology of CFS is proposed. These observations have implications for the treatment of patients with CFS.
Adaptation, Psychological↗
Attempted suicide in Oxford University students, 1976-1990.
During the 14 years between the beginning of academic year 1976-7 and the end of academic year 1989-90, 216 Oxford University students (119 females and 97 males) were referred to the general hospital in Oxford because of suicide attempts (254 in all). The rate of attempted suicide during university term-time (106/100,000) was lower than in other young people of similar age in Oxford City (164/100,000). The difference was particularly marked in females (178/100,000 v. 269/100,000). The lower rate in the students may in part reflect their generally higher socio-economic status. Very few of the attempts by the students appeared to be failed suicides. The most frequent problems faced by the students at the time of their attempts were interpersonal, especially difficulties regarding partners, followed by academic problems. The latter were usually problems with ongoing course work rather than with the Finals examinations. Approximately a quarter of the students had psychiatric problems, with personality disorders and depression being most common. At least 30% had a history of previous attempts. Suggestions are made concerning measures for improving the management and prevention of attempted suicide by students.
Adolescent↗
Media influences on suicidal behavior in young people.
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Adolescent↗
Suicide in Oxford University students, 1976-1990.
BACKGROUND: The aim was to determine the extent, characteristics and timing of suicide in Oxford University students. METHOD: Students who died from suicide or undetermined cause between October 1976 and September 1990 were identified through University records and individual colleges. Information about each student was sought from coroners, college staff, general practitioners and hospital case notes. RESULTS: There were 21 suicides (16 men and 5 women) and one open verdict (female). The observed number of suicides (O) was greater than the number expected (E = 11.09) on the basis of mortality statistics for England and Wales (O/E = 1.89; 95% CI 1.17 to 2.90). When deaths due to undetermined cause were included, however, the difference between O and E (17.03) was much reduced (O/E = 1.29; 95% CI 0.81 to 1.95). There was no evidence of an association with the Finals examination but two-thirds of the students had been worried about academic achievement or their courses. Nearly half appeared to have had a psychiatric disorder (mostly depression). CONCLUSIONS: The much publicised apparent excess of Oxford University student suicides may be partly artefactual. Measures for preventing student suicides include careful induction upon arrival at university, means of alleviating academic stress and worries, and readily available and closely associated student counselling and psychiatric services.
Cause of Death↗
Psychological and sexual symptoms associated with the menopause and the effects of hormone replacement therapy.
BACKGROUND: There is considerable inconsistency in the results of studies of the psychological and sexual sequelae of the menopause and their treatment. METHOD: A search of the literature on Medline was made of studies of psychological symptoms in women who were either naturally or surgically menopausal or who were receiving hormone replacement therapy for menopausal symptoms. RESULTS: There is evidence of a small increase in psychological morbidity (not usually amounting to psychiatric disorder) preceding the natural menopause and following the surgical menopause. Psychosocial as well as hormonal factors are relevant. While the response of psychosocial symptoms to hormone replacement therapy with oestrogens is variable and most marked in the surgical menopause, in some studies the effect is little greater than that for placebo. Where sexual symptoms are present, there is more consistent evidence that hormone replacement therapy is effective. CONCLUSIONS: In the light of the available evidence, the current use of hormone replacement therapy to treat psychological symptoms detected at the time of (but not necessarily therefore due to) the natural menopause must be questioned. It does appear that oestrogen therapy ameliorates psychological symptoms after surgical menopause.
Adaptation, Psychological↗
Treatment of sexual dysfunctions by sex therapy and other approaches.
BACKGROUND: The treatment of sexual dysfunctions underwent a great change when sex therapy was developed more than 25 years ago. Since then the treatment programme has been modified in various ways, the response to treatment evaluated and other treatment approaches introduced. METHOD: A review of the literature concerning the application and outcome of sex therapy and other treatments for sexual dysfunction was conducted. RESULTS: The format of effective conjoint sex therapy is now fairly clear and there is good understanding of the sexual dysfunctions that respond best to this treatment and the couples most likely to benefit. Less is known about the effects of treatment of individuals without partners, bibliotherapy and combining sex therapy with marital therapy and with physical methods of treatment. CONCLUSIONS: Sex therapy is now a well-established form of treatment. It should be more widely available for patients seen in psychiatry departments.
Female↗
Media influence on parasuicide. A study of the effects of a television drama portrayal of paracetamol self-poisoning.
BACKGROUND: Paracetamol self-poisoning, which carries a significant risk of fatal liver damage, is increasing in the UK, especially among adolescents. There is concern that media portrayal of suicidal behaviour may influence its occurrence. We have investigated the effects of two broadcasts of a television drama showing a teenage girl's overdose of paracetamol. METHOD: Data from the Oxford Monitoring System for Attempted Suicide were used to examine changes in the number of overdoses and the use of paracetamol in the three week period before and after both broadcasts. An analysis of log-linear models was carried out, using additional data from two previous years, in order to control for the effects of gender, age group, time period, season, year and drug. A questionnaire was used to ascertain whether the programme had influenced patients' decisions to take an overdose or their choice of drug. RESULTS: An increase in paracetamol overdoses occurred following the first broadcast, but when data from the two previous years were examined and the log-linear analysis was used there was no evidence of significant effects attributable to the broadcasts. The questionnaire study revealed that very few people had seen either episode, and only two claimed that it had influenced them (one in terms of getting help). CONCLUSIONS: It is important to use sound methodology to avoid interpreting chance fluctuations as a media effect. The potential positive benefits of such programmes should also be investigated.
Acetaminophen↗
General hospital services for attempted suicide patients: a survey in one region.
A survey of the general hospital services for attempted suicide patients in one Region indicated that most hospitals fell short of many of the standards contained in the Department of Health 1984 guidelines and the recently established Royal College of Psychiatrists guidelines, particularly with regard to active planning and monitoring of the service, involvement of non-medical clinical staff, availability of the service and the training of staff.
England↗
Sexual function in a community sample of middle-aged women with partners: effects of age, marital, socioeconomic, psychiatric, gynecological, and menopausal factors.
A randomly selected community sample of 436 women with partners was studied with regard to frequency of sexual intercourse and orgasm with their partners and to attitudes to their sexual relationships. Associations were examined between these factors and demographic, psychiatric, marital, gynecological, and menopausal status. Frequency of sexual intercourse, orgasm, and enjoyment of sexual activity with the partner were most closely associated with younger age and better general marital adjustment, with the partners' ages also appearing to influence frequency of sexual intercourse and the duration of the relationships to affect enjoyment of sexual activity. Women's satisfaction with their sexual relationships was most closely associated with marital adjustment and bore no relation to age. Weak positive associations were found between higher socioeconomic status and frequency of orgasm and enjoyment of sexual activity. Psychiatric factors (psychiatric disorder and neuroticism) made little contribution to differences in frequency of sexual activity although they were associated with attitudes towards it. Sexual behavior was largely unrelated to gynecological symptoms. Little difference was found between age-matched subgroups of pre- and postmenopausal women in frequency of sexual behavior and attitudes towards their sexual relationships.
Adaptation, Psychological↗
Suicide prevention.
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Antidepressive Agents↗
Depressive disorders in long-term survivors of stroke. Associations with demographic and social factors, functional status, and brain lesion volume.
Sixty surviving patients from a community-based stroke register who had computerised tomography (CT) scan evidence of a single brain lesion were interviewed three to five years after their first ever stroke. Depression (DSM-III-R major depression, partially resolved major depression, and dysthymia) was present in 11 (18%) of the patients and was associated with impaired physical and cognitive functioning, greater age, residence in an institution, absence of a close personal relationship, and larger original brain lesion. Of these variables, only functional dependence (odds ratio 16.4; confidence interval 1.6-170), larger lesion volume (6.6; 1-50), and female sex (8; 1.1-56) remained significantly associated with depression after controlling for all other variables. We conclude that depression in long-term survivors of stroke has many of the same associations as depression in non-stroke elderly populations. Depression in long-term stroke survivors may also be associated with larger original brain lesions, although this requires confirmation in a prospective study.
Age Factors↗
Attempted suicide in Oxford and Utrecht.
BACKGROUND: Attempted suicide rates are much higher in the UK than in the Netherlands. We have compared the characteristics of suicide attempters referred to general hospitals in Oxford and Utrecht. METHOD: We compared the characteristics of referrals for attempted suicide to a general hospital in Oxford and one in Utrecht, for the years 1988 and 1989. RESULTS: Most of the attempters in Oxford were young whereas attempters in Utrecht were older; this age difference was particularly marked in females. Utrecht attempters appeared more often to have socio-economic problems and to suffer from psychiatric and personality disorders (except substance abuse), even when account was taken of the age differences of the two populations. CONCLUSIONS: There is some evidence for different thresholds for attempted suicide in the UK and the Netherlands, although other social explanations for the difference in attempted suicide rates are feasible and require further study.
Adolescent↗
Seasonal and weather factors in parasuicide.
BACKGROUND: Seasonal variation in suicide and parasuicide has previously been reported. Few investigations have examined whether meteorological factors could influence suicidal behaviour, and the inconclusive results produced may be due to a variety of methodological problems. The present study overcomes some previous difficulties and tested whether parasuicide admission rate is related to weather variables. METHOD: Over 12,000 admissions for parasuicide were analysed by month, season, and in relation to meteorological data, which were measured close to the admitting hospital. RESULTS: Marked seasonal (P < 0.001) and monthly (P < 0.001) variations in mean daily parasuicide numbers were seen in women but not men. Small but highly significant correlations were demonstrated between parasuicide rate and weather parameters (P < 0.01), which were more marked in women (P < 0.01). These effects were additional to the monthly variation (P < 0.05). CONCLUSIONS: Weather has a small influence on parasuicide. Gender differences in body temperature regulation might account for the sex difference seen.
Cross-Sectional Studies↗