Biomedical subjects
Y Conwell
Publications and source records attributed to Y Conwell.
Depression as a "cause" of late life suicide.
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Rational suicide and the right to die. Reality and myth.
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Suicide in later life: psychological autopsy findings.
The authors report preliminary data from a psychological autopsy study of completed suicide in late life. Sixteen of 18 victims had diagnosable psychopathology, most commonly major depression of late onset. Symptoms manifest prior to death are described and directions for future investigation discussed. The psychological autopsy is shown to be a viable method for studying suicide in the elderly.
Predicting severity of depression in the elderly at six-month follow-up: a neuropsychological study.
The authors conducted psychopathological and neuropsychological assessments on a pilot sample of 15 nondemented elderly depressed patients at the outset of inpatient treatment and again after 6 months. Pretreatment performance on a test of confrontation naming was predictive of severity of depressive symptoms at follow-up. These findings tentatively suggest that the naming ability of elderly depressed subjects may have prognostic significance.
The neuropsychology of depression in the elderly: a comparative study of normal aging and Alzheimer's disease.
The neuropsychological testing of 23 elderly depressed patients was compared to that of 23 healthy controls and 20 Alzheimer's disease (AD) patients. Depressed subjects were deficient relative to controls on most tasks, including naming and cued memory. There was a greater negative influence of age on the performance of depressed subjects (relative to controls) on some tasks. Despite their significant deficits, depressed patients were clearly distinguishable from AD patients. It is suggested that the combined effects of age and depression produce a pattern of deficits that is distinct from that of younger depressives, but less severe than that of Alzheimer's patients.
Completed suicide at age 50 and over.
The authors present data abstracted from medical examiners' investigative reports of 246 completed suicides of persons over the age of 50 years classified into four age groups. The sample population conformed to epidemiologic studies with regard to sex distribution. With increasing age, more suicide victims were widowed, and significantly fewer were single, separated, or divorced. Violent methods of suicide were more prevalent and alcohol use and psychiatric histories less common with aging. Physical illness and loss became the most common definable precipitants to suicide, whereas job, financial, and family relationship problems became less frequent with increasing age. The indications for future research and intervention in primary care settings are discussed.
Suicide and cancer in late life.
In a controlled psychological autopsy study of suicide in late life, eight cases in which the victim's belief that he had cancer played a major role in the decision to end his life were examined. All victims were men. The majority had diagnosable major affective disorders, but none had been seen in mental health care settings. Other common characteristics were an active relationship with a primary physician, numerous losses, prior experience with cancer or debilitating disease, and a rigid, self-sufficient personality style. The cases illustrate the complex determinants of suicidal behavior in the elderly and suggest preventive strategies for the primary care setting.
Elderly patients admitted to the psychiatric unit of a general hospital.
Elderly psychiatric patients who are cared for in general hospital psychiatric settings have not been clearly characterized in the literature in terms of demographics, primary diagnoses, hospital course, and outcome. The authors reviewed charts of 168 patients over the age of 60 years admitted to a general hospital inpatient psychiatry unit over a 5-year period in order to develop a demographic and clinical profile of this patient population. Results indicated that the large majority of patients had affective syndromes; dementia was the second most common diagnosis. Length of stay correlated with severity of depressive illness, while a diagnosis of dementia was associated with a shorter hospitalization. Outcome measures showed favorable response to treatment in three-fourths of this population of elderly psychiatric patients. These data suggest that the general hospital acute inpatient setting is well suited to care for the combined medical and mental illnesses of elderly psychiatric patients.
Age at onset in late-life delusional depression.
Mean age at onset was not significantly different in 39 delusional and 70 nondelusional unipolar depressed patients over 60 years of age. The finding was unchanged when sex, concurrent dementia, and medical illness were examined.
Lithium augmentation of combined neuroleptic-tricyclic treatment in delusional depression.
Recent clinical studies have reported rapid improvement following administration of lithium to depressed patients who are unresponsive to tricyclic antidepressants. The clinical value of lithium augmentation would be greatest in subtypes of depression refractory to tricyclic treatment, such as delusional depression. The authors describe the results of a preliminary study of lithium augmentation in six patients with delusional depression who were unresponsive to combined neuroleptic-tricyclic treatment. Of the six, three had a dramatic response, two had a more gradual response, and one was unresponsive. The authors discuss alternative mechanisms of lithium action in these patients.
Depression in late life: age of onset as marker of a subtype.
Late-onset depression may be pathogenetically and prognostically distinct from early-onset, recurrent affective disorder. The authors reviewed records of 94 consecutively admitted unipolar major depressives over the age of 60 years, divided subjects into groups based on their age of onset, and examined demographic and clinical features. Late-onset elderly depressives had a lower incidence of family history of affective illness, longer hospital stay, and more residual symptoms at discharge. However, there was no demonstrable relationship between age of onset and presence of psychosis, melancholia, medical illness, symptom severity at admission, or indicators of neuropathology. Although late-onset elderly depressives did less well than those with early-onset illness, the data do not support the notion of late-onset depression as a distinct pathological process.
After the drinking stops: completed suicide in individuals with remitted alcohol use disorders.
A substantial minority of suicide victims have remitted alcohol use disorders. The authors hypothesized that psychiatric disorders are likely to be present in this group to create the necessary conditions for suicide. They compared suicide victims with active alcohol use disorders and those with remitted alcohol use disorders. Using data on a community sample of suicide victims (N=141), it was determined that 39% (N=55) had a history of alcohol misuse. These subjects were categorized by alcohol use disorder status (remitted versus active) and by age (<50, > or =50), creating four cells: younger remitted (N=8), older remitted (N=9), younger active (N=22), and older active (N=16) alcohol misusers. Results comparing proportions of DSM-III-R Axis I disorders in the four groups indicated that suicide victims with remitted alcohol use disorders were predominantly younger victims with psychotic disorders or older victims with major depression. These findings have implications for identifying those at risk for suicide even after the cessation of alcohol misuse. Case examples of suicide victims with remitted alcohol use disorders-a younger woman victim with a psychotic disorder and an older man with major depression-are presented.