Dopamine is involved in the pathophysiology of schizophrenia. Disrupted salience processing by the salience network (SN) may be a central link between dysregulated dopamine function and psychotic symptoms. However, dopaminergic influence...
moreDopamine is involved in the pathophysiology of schizophrenia. Disrupted salience processing by the salience network (SN) may be a central link between dysregulated dopamine function and psychotic symptoms. However, dopaminergic influence on the SN and its presumed influence on psychotic and subpsychotic symptoms or psychotic-like experiences in healthy individuals remain unclear. Therefore, we investigated dopamine-induced changes in functional connectivity of the right anterior insula (rAI), a central SN hub, and their association with psychotic-like experiences. We enrolled 54 healthy, right-handed male subjects in a randomized, double-blind, cross-sectional placebo-controlled experiment. Psychotic-like experiences were assessed using the revised Exceptional Experiences Questionnaire (PAGE-R). They then received either placebo (n = 32) or 200 mg L-DOPA (n = 33), a dopamine precursor, orally and underwent resting-state functional magnetic resonance imaging. In a seed-to-voxel approach, we analyzed dopamine-induced changes in functional connectivity of the rAI and assessed the relationship between functional connectivity changes and PAGE-R score. L-DOPA reduced functional connectivity between the rAI and the left auditory cortex planum polare. In the placebo group, we found a strong negative correlation between PAGE-R score and rAI to planum polare functional connectivity; in the L-DOPA group, there was a strong positive correlation between PAGE-R score and functional connectivity between rAI and planum polare. The PAGE-R score explained about 30% of the functional connectivity variation between rAI and planum polare in the two groups. Our findings suggest that psychotic-like experiences are associated with dopamine-induced disruption of auditory input to the SN, which may lead to aberrant attribution of salience.
There is increasing evidence pointing toward a continuous distribution of psychotic symptoms and accompanying factors between subclinical and clinical populations. However, for the construction of continuum models, a more detailed...
moreThere is increasing evidence pointing toward a continuous distribution of psychotic symptoms and accompanying factors between subclinical and clinical populations. However, for the construction of continuum models, a more detailed knowledge of different types of psychotic-like experiences (PLE) and their associations with distress, functional impairment, and demographic variables is needed. We investigated PLE in a sample of healthy adults (N = 206) incorporating the recently developed revised Exceptional Experiences Questionnaire (PAGE-R). For the first time, the PAGE-R was cross validated with PLE, disorganized-, and negative-like symptoms [Schizotypal Personality Questionnaire (SPQ), Physical Anhedonia Scale (PAS)]. We subjected the PAGE-R to exploratory factor analyses and examined the resulting subtypes of EE for specific associations with contextual factors, valence ratings, socio-demographic variables, and general psychological burden (Revised Symptom-Checklist-90). Correlational cross-validation suggested that the PAGE-R measures facets of PLE. Importantly, we (1) identified three types of exceptional experiences (EE): Odd beliefs, dissociative anomalous perceptions, and hallucinatory anomalous perceptions. Further, the results suggested that even in healthy individuals (2) PLE and EE are indicative of reduced functioning, as reflected by increased psychological burden and lower educational achievement. Moreover, (3) similar sex-differences might exist as in psychotic patients with women reporting more positive-like symptoms and EE but less disorganized-like symptoms than men. Importantly, (4) EE might be differentially implicated in psychological functioning. We suggest that the PAGE-R holds the potential to complement the current assessment of sub-clinical psychosis. However, whereas our results might point toward a continuity of psychotic symptoms with EE and normal experiences, they require replication in larger samples as well as equivalence testing across the psychosis continuum. Future analyses incorporating the PAGE-R might shed more light onto mechanisms that are implicated in the progress or resilience toward clinical illness.
The interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate...
moreThe interplay between subclinical psychotic, negative, and affective symptoms has gained increased attention regarding the etiology of psychosis spectrum and other mental disorders. Importantly, research has tended to not differentiate between different subtypes of psychotic-like experiences (PLE) although they may not have the same significance for mental health. In order to gain information on the subclinical interplay between specific PLE and other symptoms as well as the significance of PLE for mental health, we investigated their specific associations in 206 healthy individuals (20–60 years, 73 females) using correlational and linear regression analyses. PLE were assessed with the Magical Ideation Questionnaire, the revised Exceptional Experiences Questionnaire, and subscales of the Schizotypal Personality Questionnaire (SPQ). The revised Symptom Checklist 90, the SPQ, and the Physical Anhedonia Scale were used to measure subclinical negative symptoms, affective symptoms, and other symptoms such as, emotional instability. As hypothesized, we found that (1) most affective symptoms and all other subclinical symptoms correlated positively with all PLE, whereas we found only partial associations between negative symptoms and PLE. Notably, (2) magical ideation and paranormal beliefs correlated negatively with physical anhedonia. In the regression analyses we found (3) similar patterns of specific positive associations between PLE and other subclinical symptoms: Suspiciousness was a specific predictor of negative-like symptoms, whereas ideas of reference, unusual perceptual experiences, and dissociative anomalous perceptions specifically predicted anxiety symptoms. Interestingly, (4) ideas of reference negatively predicted physical anhedonia. Similarly, paranormal beliefs were negatively associated with constricted affect. Moreover, odd beliefs were a negative predictor of depression, emotional instability, and unspecific symptoms. Our findings indicated that subtypes of PLE are differentially implicated in psychological functioning and should therefore not be categorized homogeneously. Moreover, paranormal beliefs, odd beliefs, and partly ideas of reference might also contribute to subjective well
Purpose of review South America and Brazil have undergone major reforms in their mental healthcare systems during the past few decades. The Caracas Declaration, formulated in Venezuela in 1990, states that mental healthcare should be...
morePurpose of review South America and Brazil have undergone major reforms in their mental healthcare systems during the past few decades. The Caracas Declaration, formulated in Venezuela in 1990, states that mental healthcare should be directed toward community treatment rather than hospital-based models. We review how mental health services were previously organized and how they are currently provided to persons with mental illnesses. Recent findings In many South American countries, the number of beds in psychiatric hospitals has been reduced (e.g., between 2001 and 2005, from 18.3 to 12.7 and from 38.7 to 25.6 per 100 000 persons in Chile and Brazil, respectively). Meanwhile, the number of psychiatric beds in general hospitals has increased slightly and more human resources are being devoted to mental health services. Nevertheless, the total number of beds is still insufficient and financing for mental health programs is far below the optimum. Summary More than 20 years after the Caracas Declaration, much has been done but many changes are still required. Some reforms have already been proposed but not put into practice. Future efforts should include fighting against stigma and improving budgeting for mental healthcare, a lack of which might be interpreted as structural stigma.
At the end of the 19(th) century, male suicide rates in Switzerland were as high as the respective rates in recent decades, whereas female suicide rates were distinctly lower. An age-period-cohort analysis was performed to provide more...
moreAt the end of the 19(th) century, male suicide rates in Switzerland were as high as the respective rates in recent decades, whereas female suicide rates were distinctly lower. An age-period-cohort analysis was performed to provide more information about the gender-specific changes over the last century. Suicide mortality has been reported in Switzerland since 1876 when the standardised registration of mortality data began. The analysed data cover the period 1881-2000. The statistical analyses were based on log-linear models and data aggregated by 10-year age-intervals and 10-year period intervals. The results indicate similar age and period effects in males and females. The estimates representing age-specific risk increase steadily with age, with intermediate plateaus in the 20s and the 50s. The period-specific estimates follow the economic cycles. The birth cohort effects are stronger in males and weaker in females. In the males' estimates, there is a peak in cohorts born around 1840 and a low in cohorts born some 60-100 years later. The estimates increased again in generations born after World War II. In females, the birth cohort estimates are low in cohorts born in the first half of the 19(th) century and increase until the first half of the 20(th) century. Birth cohort effects remain an intriguing topic in epidemiology of suicide. A better understanding of birth cohort effects might open new doors to suicide prevention.
To examine the relation between the day of death and the day of birth. To determine whether the...
moreTo examine the relation between the day of death and the day of birth. To determine whether the "death postponement" hypothesis or the "anniversary reaction" hypothesis is more appropriate. We analyzed data from the Swiss mortality statistics 1969-2008. Deaths below the age of 1 were excluded from the analysis. Time series of frequencies of deaths were based on differences between the day of death and the day of birth. We applied autoregressive integrated moving average modeling with intervention effects both in straight and reverse time series. The overall death excess on the day of birth was 13.8%, mainly because of cardiovascular and cerebrovascular diseases (more in women than in men) as well as suicides and accidents (in particular, falls in men). Unexpectedly, we also found an excess of deaths in cancers. An (negative) aftereffect was found in cancers, and (positive) anticipatory effects were found in falls in men. In general, birthdays do not evoke a postponement mechanism but appear to end up in a lethal way more frequently than expected ("anniversary reaction").
It is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex...
moreIt is generally accepted that modern mental health care gives community treatment priority over partial or full inpatient treatment. The requirements for community treatment of severely ill and chronic psychiatric patients are complex and, together with financing by the different social insurance providers, may lead to a rather problematic fragmentation of health service supply. Schizophrenia is considered the most expensive mental illness in Germany. It is estimated that indirect costs (expressed in financial terms) are five times higher than the direct costs of treatment and care. Innovative concepts of psychosocial intervention show that case management and assertive community treatment reduce the hospitalisation rate and duration of inpatient treatment, enhance social integration, and find the approval of most patients. However, there is no empirical evidence supporting this "psychiatry with no beds". Consideration should be given to psychosocial interventions as an al...
When young people at risk of psychosis experience early signs of the disorder or early intervention, they may label themselves as...
moreWhen young people at risk of psychosis experience early signs of the disorder or early intervention, they may label themselves as "mentally ill." However, empirical data related to the potentially harmful effects of self-labeling and stigma among young people at risk of psychosis are lacking. This study used a stress-coping model to examine mechanisms by which stigma may exert an impact on young people at risk of psychosis. The authors assessed self-reports of perceived public stigma, shame about having a mental illness, self-labeling, and the cognitive appraisal of stigma as a stressor (stigma stress) as predictors of well-being among 172 residents of Zürich, Switzerland, who were between 13 and 35 years old. All participants were at high risk or ultra-high risk of psychosis or at risk of bipolar disorder. Psychiatric symptoms were assessed by the Positive and Negative Syndrome Scale, and well-being was measured by instruments that assessed quality of life, self-esteem, and self-efficacy. Perceived public stigma, shame, and self-labeling were independently associated with increased stigma stress. More stigma stress, in turn, predicted reduced well-being, independent of age, gender, symptoms, and psychiatric comorbidity. Stigma stress partly mediated the effects of perceived public stigma, shame, and self-labeling on well-being. Perceived public stigma, shame, and self-labeling appear to be associated with stigma stress and reduced well-being among young people at risk of psychosis. With early intervention programs gaining traction worldwide, effective strategies to address the shame and stigma associated with at-risk states and early psychosis are needed.
The assessment of the therapeutic relationship has become increasingly important due to evidence suggesting that it has a direct therapeutic effect and may improve outcome indirectly. In Great Britain and Sweden the STAR (Scale To Assess...
moreThe assessment of the therapeutic relationship has become increasingly important due to evidence suggesting that it has a direct therapeutic effect and may improve outcome indirectly. In Great Britain and Sweden the STAR (Scale To Assess Therapeutic Relationship) was developed for pan-theoretical assessment of therapeutic relationships from both clinicians' and patients' points of view. We translated the English version of the instrument into German and made an analysis of its feasibility and reliability. The German translation (STAR-D) was generated in a consensus procedure. The STAR-D was then administered to 100 patients admitted to the Psychiatric University Hospital Zurich (STAR-P) and their clinicians in charge (STAR-C). The psychometric qualities of feasibility and reliability were assessed. The overall results for the scales in terms of feasibility and reliability were satisfactory. We did, however, find shortcomings concerning the subscales. They could not be extracted in the principal component analysis and showed high inter-correlation coefficients. STAR can serve as an important tool in research concerning the therapeutic relationship. We suggest conducting further analyses concerning the validity of the subscales in the German version.
The Health of the Nation Outcome Scales (HoNOS) were developed to assess the severity of a mental illness. They are used as outcome measures in different countries, and are meanwhile translated from the original English version into many...
moreThe Health of the Nation Outcome Scales (HoNOS) were developed to assess the severity of a mental illness. They are used as outcome measures in different countries, and are meanwhile translated from the original English version into many languages, among others into German (HoNOS-D). We conducted a study in order to estimate the concurrent validity and sensitivity to change using clinical parameters as ICD-10 diagnoses, as well as the Clinical Global Impression Scale (CGI), and the Association for Methodology and Documentation in Psychiatry (AMDP) psychopathology scale, a frequently used psychopathological rating system, in a representative clinical sample. Data on the three instruments (CGI, AMDP, HoNOS-D) were collected at admission and discharge of 100 psychiatric inpatients using a representative clinical sample. Experienced clinicians completed the CGI, AMDP and HoNOS-D. Descriptive and comparative data analyses were performed. We estimated the concurrent validity by calculating correlations between the HoNOS and other scales. Secondly, we examined the differences between HoNOS scores related to diagnoses and demographic parameters. Thirdly we calculated change criteria and outcome effect size for the HoNOS. Even in a small clinical sample (n = 100), the HoNOS-D items are highly correlated with the corresponding AMDP syndromes (p < 0.003). The HoNOS-D score is associated with the CGI score (p < 0.01). Correlations of HoNOS symptoms, behavior and impairment items with AMDP syndromes as well as differences in diagnoses were appropriate and comprehensible as regards clinical content, and change on the HoNOS total score is statistically significant (t = 6.57, d.f. = 89, p < 0.0001). This study is the first to investigate the concurrent validity of HoNOS-D concerning psychopathology using the AMDP rating system in a clinical sample of patients with mental disorders in an inpatient setting. HoNOS-D can be recommended for routinely screening outcomes in inpatient psychiatric settings. Our analysis showed that HoNOS-D covers psychopathology corresponding to the AMDP rating system. A limitation of the study is that the study sample comprised only an inpatient population; there may well be differences compared to an outpatient sample.
Mental health service use is helpful but rare among young people at risk of psychosis. The label and stigma associated with mental illness may affect attitudes towards help-seeking. We examined 67 individuals at risk of psychosis over the...
moreMental health service use is helpful but rare among young people at risk of psychosis. The label and stigma associated with mental illness may affect attitudes towards help-seeking. We examined 67 individuals at risk of psychosis over the course of 1 year. An increase of self-labelling as "mentally ill" predicted more positive attitudes towards psychiatric medication, while increased perceived stigma and the cognitive appraisal of stigma as a stressor predicted poorer attitudes towards psychotherapy after 1 year. Early intervention could improve non-stigmatizing awareness of at-risk mental state and reduce the public stigma associated with at-risk status to facilitate help-seeking.
According to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness...
moreAccording to stress-vulnerability models, social stressors contribute to the onset of schizophrenia. Stigma and discrimination associated with mental illness may be a stressor for young people at risk of psychosis even prior to illness onset, but quantitative longitudinal data on this issue are lacking. We examined the cognitive appraisal of stigma-related stress as predictor of transition to schizophrenia among young people at risk of psychosis. In Zürich, Switzerland, 172 participants between 13 and 35years old and with either high or ultra-high risk of psychosis or risk of bipolar disorder were included. With 71 dropouts, transition was assessed during 12months among 101 participants of whom 13 converted to schizophrenia. At baseline, the cognitive appraisal of stigma as a stressor was measured by self-report, based on the primary appraisal of stigma as harmful and the secondary appraisal of resources to cope with stigma. Positive and negative symptoms were examined using the Positive and Negative Syndrome Scale. Compared with participants who did not convert to schizophrenia, converters had significantly more positive (p<.001) and negative (p<.001) symptoms and reported higher levels of stigma-related harm (p=.003) and stress (p=.009) at baseline. More perceived harm due to stigma at baseline predicted transition to schizophrenia (odds ratio 2.34, 95%-CI 1.19-4.60) after adjusting for age, gender, symptoms and functioning. Stigma stress may increase the risk of transition to schizophrenia. Research is needed on interventions that reduce public negative attitudes towards young people at risk and that support individuals at risk to cope with stigma-related stress.
This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment...
moreThis paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room in a sheltered housing facility. We investigated the longest inpatient treatment period of all patients aged between 18 and 65 years on an acute ward of the Psychiatric University Hospital Zurich (n = 3,928) using the basic documentation of the years 2006 to 2010. 20 % of all patients on acute wards had a stay of more than 60 days. Socio-demographic and clinical characteristics are similar to those of "heavy users" of mental health services. Social work is involved more frequently, and placement in sheltered housing facilities is intended in one third of those patients. A substantial part of the patients who stay at least once longer than two months on an acute ward are discharged to sheltered housing. Besides severity of illness it is likely that lack of availability of an adequate housing option contributes to length of stay. Intensified cooperation of the psychiatric clinic with sheltered housing facilities as well as alternative options for those in need of assisted housing and mental health care might help to reduce their extensive usage of inpatient treatment capacities. Interventions and services have to be adapted to local conditions.
The task-positive network (TPN) is anticorrelated with activity in the default mode network (DMN), and pos-sibly reflects competition between the processing of external and internal information, while the salience network (SN) is pivotal...
moreThe task-positive network (TPN) is anticorrelated with activity in the default mode network (DMN), and pos-sibly reflects competition between the processing of external and internal information, while the salience network (SN) is pivotal in regulating TPN and DMN activity. Because abnormal functional connectivity in these networks has been related to schizophrenia, we tested whether alterations are also evident in subjects at risk for psychosis. Resting-state functional magnetic resonance imaging was tested in 28 subjects with basic symptoms reporting subjective cognitive-perceptive symptoms; 19 with attenuated or brief, limited psychotic symptoms; and 29 matched healthy controls. We char-acterized spatial differences in connectivity patterns, as well as internetwork connectivity. Right anterior insula (rAI) was selected as seed region for identifying the SN; medioprefrontal cortex (MPFC) for the DMN and TPN. The 3 groups differed in connectivity patterns between the MPFC and right dorsolateral prefrontal cortex (rDLPFC), and between the rAI and posterior cingu-late cortex (PCC). In particular, the typically observed antagonistic relationship in MPFC-rDLPFC, rAI-PCC, and internetwork connectivity of DMN-TPN was absent in both at-risk groups. Notably, those connectivity pat-terns were associated with symptoms related to reality distortions, whereas enhanced connectivity strengths of MPFC-rDLPFC and TPN-DMN were related to poor performance in cognitive functions. We propose that the loss of a TPN-DMN anticorrelation, accompanied by an aberrant spatial extent in the DMN, TPN, and SN in the psychosis risk state, reflects the confusion of internally and externally focused states and disturbance of cogni-tion, as seen in psychotic disorders.
There is growing evidence that reward processing is disturbed in schizophrenia. However, it is uncertain whether this dysfunction predates or is secondary to the onset of psychosis. Studying 21 unmedicated persons at risk for psychosis...
moreThere is growing evidence that reward processing is disturbed in schizophrenia. However, it is uncertain whether this dysfunction predates or is secondary to the onset of psychosis. Studying 21 unmedicated persons at risk for psychosis plus 24 healthy controls (HCs) we used a incentive delay paradigm with monetary rewards during functional magnetic resonance imaging. During processing of reward information, at-risk individuals performed similarly well to controls and recruited the same brain areas. However, while anticipating rewards, the high-risk sample exhibited additional activation in the posterior cingulate cortex, and the medio-and superior frontal gyrus, whereas no significant group differences were found after rewards were administered. Importantly, symptom dimensions were differentially associated with anticipation and outcome of the reward. Positive symptoms were correlated with the anticipation signal in the ventral striatum (VS) and the right anterior insula (rAI). Negative symptoms were inversely linked to outcome-related signal within the VS, and depressive symptoms to outcome-related signal within the medial orbitofrontal cortex (mOFC). Our findings provide evidence for a reward-associated dysregulation that can be compensated by recruitment of additional prefrontal areas. We propose that stronger activations within VS and rAI when anticipating a reward reflect abnormal processing of potential future rewards. Moreover, according to the aberrant salience theory of psychosis, this may predispose a person to positive symptoms. Additionally, we report evidence that negative and depressive symptoms are differentially associated with the receipt of a reward, which might demonstrate a broader vulnerability to motivational and affective symptoms in persons at-risk for psychosis.
All patients suffering from severe and persistent mental illness require rehabilitation. The goal of psychiatric rehabilitation is to help disabled individuals to develop the emotional, social and intellectual skills needed to live, learn...
moreAll patients suffering from severe and persistent mental illness require rehabilitation. The goal of psychiatric rehabilitation is to help disabled individuals to develop the emotional, social and intellectual skills needed to live, learn and work in the community with the least amount of professional support. The overall philosophy of psychiatric rehabilitation comprises two intervention strategies. The first strategy is individual-centered and aims at developing the patient's skills in interacting with a stressful environment. The second strategy is ecological and directed towards developing environmental resources to reduce potential stressors. Most disabled persons need a combination of both approaches. The refinement of psychiatric rehabilitation has achieved a point where it should be made readily available for every disabled person.
The spectrum of risk and concomitant factors in stuttering is generally thought to be wide and heterogeneous. However, only a few studies have examined these factors using information from large databases. We examined the data on 11,905...
moreThe spectrum of risk and concomitant factors in stuttering is generally thought to be wide and heterogeneous. However, only a few studies have examined these factors using information from large databases. We examined the data on 11,905 Swiss conscripts from 2003. All cases with high psychiatric screening scores indicating "caseness" for a psychiatric disorder were excluded, among them potential malingerers, so that 9,814 records remained. The analyses rely on self-reported information about stuttering in childhood, problems at birth, problems in school, mental disorders of parents and relatives, childhood adversity and socio-demographic information. Statistical modelling was done using logistic regression and path analysis models. Risk factors determined in the logistic regression include premature birth, probable attention deficit hyperactive disorder, alcohol abuse of the parents, obsessive-compulsive disorder in parents and relatives, having a disabled mother and having a parent from a foreign country. There is no overwhelmingly strong risk factor; all odds ratios are about 2 or below. In conclusion, large databases are helpful in revealing less obvious and less frequent risk factors for heterogeneous disorders such as stuttering. Obviously, not only secondary analyses, but also systematical large scale studies would be required to complete the complex epidemiological puzzle in stuttering. An extensive examination of young adults who were initially assessed in childhood might provide the most promising design.
Reducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex...
moreReducing the complexity of major depressive disorder by symptom-based subtypes constitutes the basis of more specific treatments. To date, few studies have empirically derived symptom subtypes separated by sex, although the impact of sex has been widely accepted in depression research. The community-based sample included 373 males and 443 females from the Zurich Program for Sustainable Development of Mental Health Services (ZInEP) manifesting depressive symptoms in the past 12 months. Latent Class Analysis (LCA) was performed separately by sex to extract sex-related depression subtypes. The subtypes were characterized by psychosocial characteristics. Three similar subtypes were found in both sexes: a severe typical subtype (males: 22.8%; females: 35.7%), a severe atypical subtype (males: 17.4%; females: 22.6%), and a moderate subtype (males: 25.2%; females: 41.8%). In males, two additional subgroups were identified: a severe irritable/angry-rejection sensitive (IARS) subtype (30%) comprising the largest group, and a small psychomotor retarded subtype (4%). Males belonging to the severe typical subtype exhibited the lowest masculine gender role orientation, while females of the typical subtype showed more anxiety disorders. The severe atypical subtype was associated with eating disorders in both sexes and with alcohol/drug abuse/dependence in females. In contrast, alcohol/drug abuse/dependence was associated with the severe IARS subtype in males. The study had a cross-sectional design, allowing for no causal inferences. This study contributes to a better understanding of sex-related depression subtypes, which can be well distinguished on the basis of symptom profiles. This provides the base for future research investigating the etiopathogenesis and effective treatment of the heterogeneous depression disorder.
Current research is yielding an increasingly heterogeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing...
moreCurrent research is yielding an increasingly heterogeneous picture of suicide seasonalities: They seem to depend on methods and, moreover, they seem to have smoothed in recent decades. This work examines the latter issue by comparing suicide seasonalities in the canton of Zurich, Switzerland, in the 16 th -18 th centuries, 1901-1920 and 1969-94. The results indicate shifts of peaks and lows on suicide seasonalities over the centuries, with a smoothing of seasonalities toward the 21 th century. The recent period does not show any suicide seasonality at all. The canton of Zurich seems to be ahead of the general trend found in other regions of Switzerland.
Background. Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and...
moreBackground. Seasonal as well as weekly cycles in suicide have been described, replicated and poorly understood for a long time. In Western countries, suicides are typically least frequent on weekends and most frequent on Mondays and Tuesdays. To improve understanding of this phenomenon a strategy is required which focuses on anomalous findings beyond the regular patterns. Here, we focused on instances where the weekly suicide patterns disappear or are interrupted. Methods. We used data from Swiss and Austrian mortality statistics for the periods 1969-2010 and 1970-2010, respectively. First, the data were cross-tabulated by days of the week and the available socio-demographic information (sex, age, religious affiliation and region). Second, time series of cumulated daily frequencies of suicide were analysed by seasonal Autoregressive Integrated Moving Average (ARIMA) models which included intervention effects accounting for Easter and Pentecost (Whit) holidays. Results. First, the cross tabulations showed that weekly cycles may be smoothed above all in young persons and smoothed in drowning, jumping and car gas exhaustion suicides. Second, the ARIMA analyses displayed occasional preventive effects for holidays Saturdays and Sundays, and more systematic effects for holiday Mondays. There were no after effects on Tuesdays following holiday Mondays. Conclusions. In general, the weekend dip and the Monday backlog effect in suicide show striking similarities to the Advent season effect and are interpretable within the same template. The turning points between low and high frequencies possibly provide promising frames for the timing of prevention activities.
The aim of this study was to determine the pattern of cancer comortality in deaths registered with schizophrenia and psychotic disorders. It focused on the question of whether the proportions of different types of cancer diverge when they...
moreThe aim of this study was to determine the pattern of cancer comortality in deaths registered with schizophrenia and psychotic disorders. It focused on the question of whether the proportions of different types of cancer diverge when they are co-registered with schizophrenia/psychotic disorders or with other causes of death in mortality statistics. We developed an analysis approach applicable to common mortality statistics data when no linkage with morbidity databases or other registers is possible. The analysis covered Swiss mortality data from a 39-year period (1969 - 2007) and was confined to the most frequent cancers. We applied a two-step case-control analysis with bootstrapping (1000 repetitions). The cases were defined by the cancer-schizophrenia registrations for each specific cancer, whereas the controls were matched from the remaining cases (matching criteria: sex, age, region, subperiod). Cancers with deviant standardized mortality ratios (SMRs) included stomach cancer (1.6; 2.2 after reweighting), lung cancer (0.8; 0.5 after reweighting) and breast cancer (1.6; 1.5 after reweighting). The comortality pattern of cancers in schizophrenia and psychotic disorders diverges from the pattern found in other co-registered causes of death. The relatively low frequency of lung cancers is particularly paradoxical in view of the smoking habits of schizophrenia patients.
