Rüdiger Vogel

Ethyl glucuronide discloses recent covert alcohol use not detected by standard testing in forensic psychiatric inpatients

BACKGROUND Considerable lives and money could be saved if one could detect early stages of lapsing/relapsing behavior in addicted persons (e.g., in safety-sensitive workplaces) and could disclose harmful drinking in social drinkers. Due to the serious public health problem of alcohol use and abuse worldwide, markers of alcohol use have been sought. Both ethyl glucuronide (EtG) and phosphatidyl ethanol (PEth) appear to have high sensitivity and specificity and a time frame of detection that may elucidate alcohol use not detected by standard testing. Our aim was to assess their potential for detecting recent covert alcohol use under controlled conditions. METHODS Thirty-five forensic psychiatric inpatients in a closed ward who had committed a substance-related offense ( section sign 64 StGB), were followed for 12 months. The complete time spectrum of possible alcohol consumption was covered by the complementary use of breath and urinary ethanol (hours), urinary EtG (days), %carbohydrate-deficient transferrin (CDT)/PEth (weeks), and gamma-glutamyltranspeptidase (GGT)/mean corpuscular volume (MCV) (weeks-months). RESULTS Fourteen of the 146 urine samples examined were positive for EtG. In all EtG-positive cases, patients reported alcohol consumption of between 40 and 200 g of ethanol 12-60 hr prior to testing. Urinary and breath ethanol were positive in only one case. In the blood samples, PEth was not positive in any case and %CDT did not exceed the reference value. Isoelectric focusing showed no abnormal Tf subtypes. CONCLUSIONS The findings emphasize the diagnostic and therapeutic usefulness, specificity, and sensitivity of EtG as a marker of recent alcohol use. Such a test is needed in numerous settings, including alcohol and drug treatment (to detect lapse/relapse), in safety-sensitive work settings where use is dangerous or in other settings where use may be inappropriate (e.g., such as driving, workplace, pregnancy, or monitoring physicians or other professionals who are in recovery and working), or for testing other groups (such as children or those with medical problems) where alcohol use would be unhealthy or unsafe. The health, social and socioeconomic benefits arising from the future use of these markers is hard to overestimate.

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.

Suicide and Mental Illness in the Elderly

This report deals with the relation of suicide to mental illness in the elderly. Our investigation of this relation proceeds from the following two points of view: First, we asked whether the fact that the elderly are most at risk of committing suicide is confounded with their increased psychiatric morbidity. Second, we asked to what extent suicides of older mentally ill persons are definitely created by their mental illness. The sample includes 310 suicides of psychiatric in-patients. There were explored in the course of a multicentre study of 6 psychiatric state hospitals in the south of the Federal Republic of Germany. The method of analysis involved the motives of the suicidal acts. Results demonstrate that the age is an autonomous risk factor and not to be confounded with the psychiatric morbidity. Psychiatric morbidity of older suicides is not sufficient to explain the suicidal act. Moreover, we found that if mental illness played a part, motives reflecting aspects of chronicity predominated motives reflecting psychopathology (i.e. feeling of being persecuted, loosing mind) of the suicidal patients. Results are discussed with special reference to preventing and managing suicides in the elderly.

Suizid im psychiatrischen Krankenhaus

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.ZusammenfassungSuizidprävention ist eine zentrale psychiatrisch-psychotherapeutische Aufgabe. Umbruchszeiten gehen auch unter den beschützenden Rahmenbedingungen einer Klinik mit vermehrt auffälligem Verhalten einher, hier mit erhöhten Suizidraten, wie sie in den 1970er und 1980er Jahren in der deutschsprachigen klinischen Psychiatrie beobachtet wurden. Dass es sich dabei um eine reale Zunahme handelte, die dann ab den 1990er Jahren durch eine deutliche Abnahme auf die aktuell niedrigsten Suizidraten um 50 auf 100.000 Aufnahmen pro Jahr zurückging, ist belegt. Man kann in der Psychiatrie auch sterben, eine absolute Suizidprävention gibt es nicht, auch nicht unter optimalen Bedingungen von Therapie und Pflege, Kommunikation und Sicherung. Die Suizidraten, bezogen auf Aufnahmen, haben in den letzten beiden Jahrzehnten deutlich abgenommen. Vor allem die als neue klinische Suizidrisikogruppe definierte Gruppe junger schizophrener Männer hat unter den Suizidenten abgenommen, während der Anteil depressiv Kranker prozentual gestiegen ist. Die Abnahme mag mit der umfänglichen Verbesserung der Aus-, Weiter- und Fortbildung zum Thema Suizidalität und Suizidprävention, mit einer Versachlichung des Umganges damit, mit der Entwicklung diagnostischer und therapeutischer Strategien, mit einer Verbesserung von Therapie und Beziehungsangeboten und mit einer allgemeinen Abnahme der Suizidzahlen in Deutschland zusammenhängen.AbstractSuicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.

[Suicide in psychiatric hospitals : Results, risk factors and therapeutic measures].

Suicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.ZusammenfassungSuizidprävention ist eine zentrale psychiatrisch-psychotherapeutische Aufgabe. Umbruchszeiten gehen auch unter den beschützenden Rahmenbedingungen einer Klinik mit vermehrt auffälligem Verhalten einher, hier mit erhöhten Suizidraten, wie sie in den 1970er und 1980er Jahren in der deutschsprachigen klinischen Psychiatrie beobachtet wurden. Dass es sich dabei um eine reale Zunahme handelte, die dann ab den 1990er Jahren durch eine deutliche Abnahme auf die aktuell niedrigsten Suizidraten um 50 auf 100.000 Aufnahmen pro Jahr zurückging, ist belegt. Man kann in der Psychiatrie auch sterben, eine absolute Suizidprävention gibt es nicht, auch nicht unter optimalen Bedingungen von Therapie und Pflege, Kommunikation und Sicherung. Die Suizidraten, bezogen auf Aufnahmen, haben in den letzten beiden Jahrzehnten deutlich abgenommen. Vor allem die als neue klinische Suizidrisikogruppe definierte Gruppe junger schizophrener Männer hat unter den Suizidenten abgenommen, während der Anteil depressiv Kranker prozentual gestiegen ist. Die Abnahme mag mit der umfänglichen Verbesserung der Aus-, Weiter- und Fortbildung zum Thema Suizidalität und Suizidprävention, mit einer Versachlichung des Umganges damit, mit der Entwicklung diagnostischer und therapeutischer Strategien, mit einer Verbesserung von Therapie und Beziehungsangeboten und mit einer allgemeinen Abnahme der Suizidzahlen in Deutschland zusammenhängen.AbstractSuicide prevention is a core responsibility of psychiatry and psychotherapy. Periods of change in psychiatric inpatient treatment concepts are usually also accompanied by an increase in psychopathological behavior and with increased suicide rates in psychiatric hospitals, as seen in the 1970s and 1980s in Germany. That this represented a real increase of inpatient suicides during those years was confirmed and subsequently the number and rate of inpatient suicides has decreased from approximately 280 out of 100,000 admissions of patients in 1980 to approximately 50 in 2014. Death can also occur in psychiatric hospitals and an absolute prevention is not possible even under optimal conditions of therapy and nursing, communication and security. The suicide rate has clearly decreased over the last two decades in relation to admissions. The group of young male schizophrenic patients newly identified as having a high clinical suicide risk has decreased among the suicide victims whereas the percentage of severely depressed patients with delusions has increased. This reduction could be associated with the comprehensive improvements in educational and training programs in the field of suicide and suicide prevention, objectification of coping methods, development of diagnostic and therapeutic strategies, improvements in therapy and relationship possibilities and a general reduction in the number of suicides in Germany.