Ninety-four Canadian-born psychiatric patients who committed suicide were compared with 23 foreign-born patients committing suicide in Canada. East Europeans were over-represented, and significant differences were found in the age distribution, stress, level of education, social isolation, and methods of suicide. Most foreign-born patients had come to Canada for family or economic reasons but were unemployed, with poor social integration. Employment, housing, education, social integration and a support network seem to be important in preventing these deaths. Cultural evaluation of the patient and early intervention is recommended.
Impairment of psychornotor performance is a common adverse effect of many antidepressants, particularly tricyclics. Desipramine is thought to be an exception, with possible performance enhancing effects on psychomotor function. This multicentre study examined the relative effects on psychomotor function of sertraline versus desipramine versus placebo in mild to moderate depression.Fifty-eight patients who satisfied DSM-III-R criteria for major depression and had a minimum HAM-D score of 15 ( I 7 items) completed eight weeks of treatment. They underwent a standardized assessment which included depression and anxiety rating scales (HAM-D, HAM-A, MADRS) and a battery of psychomotor performance tests (The Simple and Choice Reaction Time, The Digit Symbol Substitution and The Trail Making Test), before, during, and after eight weeks of treatment with sertraline, desipramine, or placebo.At baseline, there was a trend for both the sertraline and placebo groups to exhibit better psychomotor performance than desipramine. No significant differences were found between groups after treatment nor between groups for the change from baseline to week 8. However, at week 3, the sertraline group performed significantly better i n the trail making test than the placebo patrents (p<0.05). Within each treatment group, there was a trend towards improvement in performance for all four parameters from baseline to the end of the study, with these improvements being most obvious in the desipramine group. Sertraline, however, was found to be associated with significantly fewer other adverse effects than the desipramine group, i.e. sweating, dry mouth, anorexia.These results suggest that desipramine and sertraline do not adversely affect psychomotor performance and may even enhance it in mild to moderately depressed patients.
The length of time a group of 70 psychiatric patients could be maintained in the community following discharge from a provincial hospital was found to be significantly related to post-discharge compliance with medication and to the level of discharge planning (well planned versus unplanned, or patient prematurely self-discharged against medical advice). Various demographic and clinical variables were unrelated to the length of post-discharge survival in the community.
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