G. Hole

Are hospital suicides on the increase? A survey of reports on hospital suicides in the psychiatric literature of the 19th and 20th century.

SummaryThe first part of our paper provides an overview of literature on clinic suicides in regard to suicide numbers and rates. The main focus of attention is on articles from the last 30 years. The second part examines the hypothesis that there exists a linear increase in both the number of admission and the absolute number of suicides, and thus a connection between increases in admissions and discharges and in suicides. Using selected examples, we found less where there was a direct connection between patient turnover and the number of suicides (with the suicide rate remaining constant), and others in which suicide rates also increased, seeming to indicate the influence of other factors. A list of selected studies from the psychiatric literature of the 19th century suggests that clinic suicide is one of the oldest problems known to psychiatry and that suicide rates calculated from 19th century data are by and large comparable to those of today. Clinic suicide would thus appear to be a problem of psychiatry in general and not only one of modern psychiatry or of modern methods of treatment.

Delusional depression and suicide

ABSTRACT: After a short survey of the relevant literature, the authors discuss the significance of delusional depression symptoms for suicidality, whereby they do not regard such symptoms alone as a sufficient condition for classifying a delusional patient as suicidal. In a comparison of delusional depressed patients with a non‐delusional control group (matched pairs), the former were adjudged to be significantly less suicidal than the control group and did not differ from the control group in regard to suicide frequency.

Suicidal behaviour and electrodermal activity in depressive inpatients

Within the context of a habituation experiment, the electrodermal activity (EDA) of suicidal depressed patients was measured. Twenty‐four patients had a suicide attempt in their most recent history; these attempts were divided into attempts with violent or nonviolent methods. All the patients who had used a violent method habituated quickly, as was the case for 4 of 5 patients who committed suicide in the year following the experiment. Just as many patients who used nonviolent methods habituated quickly or slowly. There was no indication that age, sex or medication had any influence. For 18 of these 24 patients, comparable groups, in terms of age and sex distribution, were formed containing either nonsuicidal depressed patients or patients with suicidal thoughts. No differences between groups concerning any of the EDA variables could be found. In accordance with these results, EDA cannot be considered to be a valid predictor for suicide‐proneness. The relations between violent suicide attempts and nonreactivity should, however, be further examined and the group of non‐reactive patients in EDA should be treated as a risk group for clinical reasons.

Depressive Patienten in stationärer Behandlung

Between the end of 1976 and the beginning of 1980 more than 700 patients were admitted to the Weissenau Depression Ward. The most important data were obtained by way of special questionnaires, and par

Psychopathologie und Therapie der wahnhaften Depression

Die Angaben zur Haufigkeit wahnhaften Erlebens bei affektiven Erkrankungen liegen zwischen 20 – 45 Prozent bei endogen Depressiven und 10 – 15 Prozent bei nosologisch unausgelesenen stationaren Gruppen Depressiver (Winokur, Scharfetter & Angst, 1985; Tolle & Wefelmeyer, 1987, Wolfersdorf, Steiner & Keller, 1987). Im Gegensatz zur Schizophrenie ist die wahnhafte Melancholie jedoch selten Thema spezifischer therapeutischer Uberlegungen geworden. Der schizophrene Wahn als eine besondere Art des In-der-Welt-Seins hat Psychiater und Psychoanalytiker immer fasziniert (s. Benedetti und Mitarbeiter, 1983), die Betrachtung wahnhafter Symptomatik beim depressiv Kranken, insbesondere unter psychotherapeutischen Aspekten wurde gerne gemieden. Der Faszination von der Buntheit und Symbolhaftigkeit wahnhaft schizophrenen Erlebens, der Auseinandersetzung des Schizophrenen mit der Welt steht eine „scheinbare“ Monotonie der depressiven „Schuld-Welt“ gegenuber, welche eher zum Zuruckweichen und zum Erschrecken veranlast. Der Autismus des wahnhaft Depressiven scheint nicht nur eine eingeschrankte Reaktivitat auf soziale Kommunikation abzubilden, sondern auch eine aktive Abwendung der Umwelt zu bewirken (Mitterauer, 1981).