Elie Lepkifker

Anger, Impulsivity and Suicide Risk

BACKGROUND To examine the relationship between anger, impulsivity and suicidality. METHODS Thirty psychiatric inpatients admitted for suicidal behavior were compared with 30 nonsuicidal psychiatric inpatients and 32 healthy controls on measures of anger, impulsivity and suicide risk. RESULTS The three groups were similar on demographic variables, but the suicidal group scored higher on the suicide risk scale, impulsivity scale and anger scale. Anger and impulsivity correlated significantly with suicide risk. High anger and impulsivity contributed synergistically to the suicide risk. Whereas anger was specific to both psychiatric groups, suicidals and nonsuicidals, only impulsivity was specific to the suicidal group. CONCLUSIONS These findings may have important implications for therapists and primary prevention workers, and may pave the way for the recognition of risk factors and for effective intervention in patients with a high suicide risk.

Coping styles and suicide risk.

A total of 30 psychiatric in‐patients admitted because of suicidal behaviour were compared with 30 non‐suicidal psychiatric in‐patients and 32 healthy controls on measures of suicide risk and coping styles. The three groups were similar with regard to demographic variables, but the suicidal group scored higher on the suicide risk scale. Suicidal patients were significantly less likely to use the coping styles of minimization and mapping. They were unable to de‐emphasize the importance of a perceived problem or source of stress. They also lacked the ability to obtain new information required to resolve stressful life events. Four coping styles correlated negatively with the suicide risk (minimization, replacement, mapping and reversal), while another three (suppression, blame and substitution) correlated positively. These findings may have important implications for therapists and primary prevention workers, and might pave the way towards recognition of the role played by coping styles in predicting suicide and its use for cognitive intervention in these high‐risk patients.

Nightmares related to fluoxetine treatment.

Sleep disturbances are found in most depressive patients. Serotonin reuptake inhibitors, such as fluoxetine hydrochloride, seem to improve sleep by changing the depressive affect and the underlying biological mechanisms. Insomnia is an occasional adverse effect of the medication, but it was shown that only 2-3% of the patients with fluoxetine-induced insomnia discontinued the drug for this reason. We could not find any report of nightmares or night terrors under fluoxetine treatment. We report on four patients who experienced nightmares on fluoxetine monotherapy.

Gas chromatographic measurement of myo-inositol in human blood, cerebrospinal fluid and seminal fluid

Abstract The concentration of myo -inositol in samples of human blood serum and plasma, cerebrospinal fluid, and seminal fluid, were determined by gas chromatography of the trimethylsilyl derivative. The average inositol level in blood serum was 6.9 μg/ml. Higher values were found in pools of serum obtained from a mixed patient population from a general hospital. High inositol values were found in pooled plasma from uremic patients. Patients with depression did not demonstrate significant differences from normal controls, whether or not they were treated with lithium carbonate. A survey of cerebrospinal fluids from a patient population revealed inositol values from 4–163 μg/ml, with the majority of samples falling between 6 and 35 μg/ml. In a few samples extremely high values were found. Clinical findings and discussion of these cases are included.

Alexithymia, Affect Intensity and Emotional Range in Suicidal Patients

Background: Although negative affect in general has been widely associated with suicide, the role of specific emotions and affect features in depression and suicidality is unclear. This study examined the potential of three major components of the affect structure as predictors of suicidal behavior. Methods: Twenty suicidal depressed (SD) inpatients were compared with 20 nonsuicidal depressed (NSD) inpatients and 20 healthy controls for alexithymia, emotional range (ER; i.e. variety of emotions experienced by the subjects) and affect intensity (AI; i.e. the intensity of their emotional responsiveness). Results: Both the SD and the NSD patients had a narrower range of emotions, a stronger AI and a higher degree of alexithymia than did the healthy controls. No differences were found between the scores of the two inpatients groups. Conclusions: The three affect components examined (alexithymia, AI and ER) did not prove to represent sensitive predictors of suicidal behavior. Hopelessness and depression severity were found to be more reliable in the prediction of suicidal risk. We discuss the implications of this study, particularly the possibility of early detection and intervention in patients at risk.

The treatment of kleptomania with serotonin reuptake inhibitors.

Kleptomania is characterized by an irresistible impulse to steal objects not needed for personal use or for their monetary value. Several recent case reports have shown that Serotonin Specific Reuptake Inhibitors (SSRIs) could be effective in the treatment of kleptomania just as it is in other obsessive-compulsive spectrum disorders. We report five cases of kleptomania patients who were successfully treated with fluoxetine or paroxetine in combination with a psychotherapeutic intervention. In one case, the discontinuation of the medication repeatedly led to the resurgence of the kleptomanic behavior. Our case series illustrates the effectiveness of SSRIs in kleptomania. It thus supports the assumption that this syndrome involves a dysfunctional serotoninergic mechanism.

A follow-up study of patients with DSM-IV schizophreniform disorder.

Background: Schizo phreni form dis or der (SFD) has an un clear di ag nos tic and prog nos tic status within the psy chotic spec trum. Method: We stud ied 36 in pa tients ad mit ted to our ward be tween 1983 and 1993 due to SFD. The pa tients were con tacted an av er age of 12 years af ter in dex hos pi tali za tion, and we noted the course of their ill ness, as well as their pres ent di ag no sis. Results: Of the sam ple, 84% had ad di tional, mostly psy chotic, epi sodes dur ing the follow-up, and 70% had di ag no ses in the schizo phrenic spec trum (that is, schizo phre nia and schizoaf fec tive dis or der). A sur vival analy sis re vealed that con fu sion and the pres ence of at least 2 good prog nos tic fac tors (GPF) at in dex hos pi tali za tion pre dicted bet ter out come. Conclusions: SFD seems to be an early mani fes ta tion of schizo phre nia. Only a few of those sam pled did not ex pe ri ence ad di tional re lapses—a pes si mis tic find ing at 12-year follow- up. The find ings of this study ac cord with DSM- IV cri te ria and the lit era ture regard ing the long- term prog no sis of SFD and the im por tance of the GPF.

Life satisfaction and adjustment in lithium-treated affective patients in remission

The aim of this study was to assess life satisfaction and adjustment of lithium‐treated affective patients in remission. Scores of life satisfaction and adjustment in four areas were obtained for two experimental groups of 50 unipolars and 50 bipolars and for two control groups of 50 healthy individuals and 50 patients with personality disorders. Subjects’ self‐assessments and psychiatrists’ evaluations were rated using a modification of Cantrils ladder device. No significant differences were found between affective patients and healthy controls regarding life satisfaction and adjustment, whereas psychiatric controls scored significantly less on most indices. Moreover, the treating psychiatrists rated affective patients significantly higher than psychiatric controls and perceived them as actualizing their potential to a greater degree. Thus, it is concluded that neither the affective illness nor lithium as a prophylactic agent interfered with the patients’ feelings of satisfaction or with manifest functioning while in remission.

Valproic acid in ultra-rapid cycling: a case report.

Valproic acid has been proven to be efficient in the treatment of bipolar affective disorders as an adjunctive agent to lithium and carbamazepine. Recently, its efficacy in rapid cycling states has attracted interest. We present the case of a male patient with bipolar affective disorder who developed an extreme state of ultra-rapid cycling (48-h cycles). Only the addition of valproic acid therapy to prior lithium treatment succeeded in curtailing the ultra-rapid cycling. Several issues regarding ultra-rapid cycling and valproates efficacy in bipolar disorder are discussed.

Famotidine : a supplemental drug for the treatment of schizophrenia

Summary In an open-label study, famotidine was added to the regular neuroleptic regimen of 11 schizophrenic patients for 4 weeks. Each patient was scored weekly with SAPS, SANS, CGI and HAM-D-17 scales. The results suggest that famotidine is indeed effective as an adjunctive drug to neuroleptics in the treatment of schizophrenia.