Biomedical subjects
K Hawton
Publications and source records attributed to K Hawton.
Psychiatric disorder in medical in-patients.
Four hundred and fifty-three general medical in-patients were screened for mood disorder (anxiety and depression), organic mental states and alcohol problems. Using the Present State Examination, affective disorder was identified in 14.6 per cent, being especially common in younger women. Organic psychiatric disorder was very common in the elderly, occurring in 31 per cent of those over 70 years, and 18 per cent of men and 4 per cent of women admitted to a drink problem. Mood disorder was not related to the type or severity of physical illness, but was significantly associated with previous psychiatric history and social problems. Two-thirds of those with mood disorder on admission who were still alive four months after discharge were improved. House officers and family doctors identified approximately half the cases of depression and anxiety, but house officers were no more likely to recognise the more severe cases than the milder ones. Organic psychiatric disorder was often missed, alcohol problems less so.
Sex therapy: current perspectives.
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Increased sexual function in benzodiazepine withdrawal.
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Prognostic factors in sex therapy.
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Long-term outcome of sex therapy.
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Psychiatric disorder in the general hospital.
There have been many reports of psychiatric disorder in medical populations, but few have used standard methods on representative patient groups. Even so, there is consistent evidence for considerable psychiatric morbidity in in-patient, out-patient and casualty department populations, much of which is unrecognised by hospital doctors. We require a better classification of psychiatric disorder in the general hospital, improved research measures, and more evidence about the nature and course of the many different types of problem so that we can provide precise advice for their management of routine clinical practice.
Repetition of self-poisoning and subsequent death in adolescents who take overdoses.
Hospital Activity Analysis data and record linkage were used to investigate repetition of self-poisoning, and deaths, among 2,492 people, aged 12 to 20 years, who took overdoses between 1974 and 1978. Repetition occurred most frequently during the first few months after an initial admission; 9.5% of patients repeated within the study period (mean follow-up of 2.8 years). Ten of the 2,492 subjects died during the study period, and the average annual death rate in the cohort was approximately four times higher than the national average annual death rate in this age-group as a whole. Six of the deaths were probably suicides. Repetition and suicide rates were highest among males aged 16 to 20 years.
Overdoses: explanations and attitudes in self-poisoners and significant others.
Marked differences were found between the reasons chosen to explain overdoses by the closest relatives or friends (the 'significant others') of 34 self-poisoners and those reasons chosen by the self-poisoners themselves. Whilst 41% of the latter claimed suicidal intent, in only one case was the significant other in agreement. The significant others were more likely to attribute manipulative reasons, commonly viewing the overdoses as directed at themselves, but the two groups agreed that the overdoses were often a means of alleviating distress. As well as evoking sympathy, the overdoses often caused the significant others to feel considerable guilt and anger. Discrepancies in the way self-poisoners and significant others interpret overdoses, and the strong feelings that overdoses evoke in the latter, should be considered during assessment and treatment of overdose patients.
The risk of child abuse among mothers who attempt suicide.
The association between parental attempted suicide and child abuse was investigated in 114 mothers with children aged five years and under, referred to a general hospital following suicide attempts. The risk was greatly increased in the attempted suicide mothers, compared with both similar mothers at risk for depression and general population control mothers; well-documented risk of child abuse was identified in 29.8% of those who attempted suicide. No major differences were found between the attempted suicide mothers whose children were at risk and those whose children were not at risk. During the general hospital assessment of mothers with young children who attempt suicide, careful enquiry concerning the relationship with the children is essential.
Sexual dysfunction.
Drug treatment of sexual dysfunction has often been unwise and lacked a sound physiological basis. However, medication has a small but important role in treatment, the most usual being the reversal of hypogonadism. Recent advances in the drug treatment of erectile dysfunction are also very promising.
Sexual adjustment of men who have had strokes.
Fifty men who had suffered moderate to severe strokes were interviewed approximately six months later and asked about their sexual adjustment. Interest in sex had returned in most cases, although the level of interest was reduced in some. Nearly all the men had regained their erectile capacity, usually after a delay of approximately seven weeks following the stroke. Of those sexually active with their partner before their strokes, over half had resumed sexual intercourse by the time of the interview. Most of these men had encountered difficulties because of the physical consequences of their strokes, but two-thirds had tried new sexual positions to compensate for this. Whether or not a couple resumed sexual activity after the man's stroke was largely predictable on the basis of the frequency of their previous sexual activity, rather than the man's age or the severity of physical disability. For patients who are sexually active before suffering strokes, subsequent rehabilitation should include brief counselling on sexual readjustment for both the patients and their partners.
Why people take overdoses: a study of psychiatrists' judgements.
There was considerable agreement between 50 psychiatrists in their choices of reasons to explain patients' overdoses after reading transcripts of interviews with self-poisoning patients. The reasons attributed in each case were similar to those chosen by three psychiatrists in an earlier study. Most psychiatrists chose more than one reason for each case. Multidimensional scaling analysis of the psychiatrists' choices across the cases suggested four groups of reasons: (a) directed at some significant person; (b) help-seeking; (c) self-referring; (d) suicidal intent. Future research could include the use of shorter lists of reasons, and should be directed particularly towards assessing the intended and actual effects of self-poisioning behaviour on significant others.
Behavioural approaches to the management of sexual deviations.
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Attempted suicide in children and adolescents.
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Symposium on sexual dysfunction. The behavioural treatment of sexual dysfunction.
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Adolescents who take overdoses: their characteristics, problems and contacts with helping agencies.
In a consecutive sample of 50 adolescents aged 13-18 admitted to hospital after taking overdoses, 90 per cent were girls. There were other clear differences between this sample and adolescents in general. Twenty-four per cent had visited their general practitioners in the previous week, and 50 per cent during the previous month. The most common difficulties preceding the overdoses were problems with parents, boys or girlfriends, and with school or work, including unemployment. A substantial proportion of the subjects had recent recurrent physical ill health. In the majority of cases the problems appeared to be transient so that one month later two-thirds of the adolescents had shown considerable general improvement. However, 14 per cent were referred to hospital for further self-poisoning or self-injury in the following year. The recent increase in the incidence of self-poisoning among adolescents suggests that more attention must be paid to this group in terms of both primary and secondary prevention.
Hospital admissions for adverse effects of medicinal agents (mainly self-poisoning) among adolescents in the Oxford Region.
Hospital statistics for episodes coded as adverse effects of medicinal agents' were used to study deliberate self-poisoning among people aged 12-20 years in the Oxford Region. Admission rates rose sharply from the age of 12 years, more so for females than males, up to the age of 16 years in females and 18 years in males. Analgesics, antipyretics and psychotropic drugs were the agents most commonly used by both sexes and accounted for three-quarters of all admissions. Admission rates varied from year to year, but increased overall between 1974 and 1979, notably among people under 16 years of age. Admissions for 'adverse effects of medicinal agents' accounted for 4.7 per cent of all general admissions among people aged 12-20 years.