Ayhan Kalyoncu

Heroin-dependent patients attempting and not attempting suicide: a comparison

Objective: Heroin dependence is a serious illness associated with an increased risk of suicidal behaviour. There are many risk factors associated with heroin dependence. The current study examined the sociodemographic and clinical characteristics of a number of young adult heroin-dependent patients who had attempted suicide. Methods: We studied a group of 108 young adult heroin-dependent patients in our in-patient clinics. All diagnoses were made according to DSM-IV diagnostic criteria using the Structured Clinical Interview for DSM-IV Axis I-II Disorders (SCID-I, II). The age range of patients was 18–24 years. Their substance abuse histories were assessed by semistructured interview. The Addiction Severity Index (ASI) was administered to all the patients. Serum total cholesterol and high-density lipoprotein cholesterol (HDL-C) levels were routinely measured. In the statistical analyses, Student’s t test, and chi-squared tests were applied. Results: Of the 108 heroin-dependent patients, 40 (37.0%) had histories of attempted suicide. There was a statistically significant difference in the age at which heroin use had commenced between female attempters [mean = 16.82, standard deviation (SD) = 3.06] and nonattempters (mean = 18.32, SD = 2.68, t= 2.25, P < 0.05). Both the male (mean = 33.35, SD = 4.05) and the female (mean = 28.00, SD = 5.36) attempters had significantly higher ASI scores than did the male (mean = 20.16, SD = 3.80) and the female (mean = 18.88, SD = 4.14) nonattempters (t= 14.34, P < 0.001; t= 5.25, P < 0.001, respectively). A significant difference in total cholesterol (mean = 131.8, SD = 19.3; mean = 172.2, SD = 21.3, t= 3.9, P < 0.05) and HDL-C (mean = 30.9, SD = 1.0 and mean = 54.8, SD = 13.7; t= 5.1, P < 0.05) levels between the group of violent and nonviolent suicide attempters was revealed. Conclusions: These results suggest that suicide attempts in young adult heroin-dependent patients are associated with more profound biopsychosocial pathology and decreased serum cholesterol levels. In particular, low levels of total cholesterol and HDL-C might indeed be associated with violent suicide attempts in young heroin-dependent patients.

Neurosyphilis presenting as psychiatric symptoms: an unusual case report.

Objective: Neurosyphilis remains a differential diagnosis for a wide variety of psychiatric syndromes, including dementia, mood disorders and psychosis. However, the incidence of neurosyphilis presenting initially with psychiatric symptomalogy is unclear. In this article, a clinical case is reported so as to illustrate some of the issues involved. Case presentation: A 33-year-old married man was admitted because of a depressive episode associated with somatic preoccupations and a gradual loss of ability to function a year prior to his admission. The symptoms described above raised the question of an organic brain syndrome associated with the psychotic depression. Some laboratory and additional examinations were performed. Serological tests for syphilis were positive for both the hemagglutination test, Treponema pallidum hemaglutination (TPHA), and the immunofluorescent antibody test, fluorescent treponemal antibody-absorption (FTA-ABS). Based on these findings, the diagnosis of neurosyphilis was made. The patient was treated with benzathine penicillin (2 400 000 units i.m. once a week) for 3 weeks and venlafaxine (150 mg daily) and olanzapine (5 mg daily). His depression disappeared gradually, and he was discharged in partial remission. Conclusion: High-risk groups such as patients with neuropsychiatric diseases should be screened with serological tests so as to prevent morbidity and help eliminate syphilis.