Prior Mental Illness Research Articles

One in Five Who Attempt Suicide Have No Prior Mental Illness

One in Five Who Attempt Suicide Have No Prior Mental Illness

Differing impact of the COVID-19 pandemic on youth mental health: combined population and clinical study.

Identifying youths most at risk to COVID-19-related mental illness is essential for the development of effective targeted interventions. To compare trajectories of mental health throughout the pandemic in youth with and without prior mental illness and identify those most at risk of COVID-19-related mental illness. Data were collected from individuals aged 18-26 years (N = 669) from two existing cohorts: IMAGEN, a population-based cohort; and ESTRA/STRATIFY, clinical cohorts of individuals with pre-existing diagnoses of mental disorders. Repeated COVID-19 surveys and standardised mental health assessments were used to compare trajectories of mental health symptoms from before the pandemic through to the second lockdown. Mental health trajectories differed significantly between cohorts. In the population cohort, depression and eating disorder symptoms increased by 33.9% (95% CI 31.78-36.57) and 15.6% (95% CI 15.39-15.68) during the pandemic, respectively. By contrast, these remained high over time in the clinical cohort. Conversely, trajectories of alcohol misuse were similar in both cohorts, decreasing continuously (a 15.2% decrease) during the pandemic. Pre-pandemic symptom severity predicted the observed mental health trajectories in the population cohort. Surprisingly, being relatively healthy predicted increases in depression and eating disorder symptoms and in body mass index. By contrast, those initially at higher risk for depression or eating disorders reported a lasting decrease. Healthier young people may be at greater risk of developing depressive or eating disorder symptoms during the COVID-19 pandemic. Targeted mental health interventions considering prior diagnostic risk may be warranted to help young people cope with the challenges of psychosocial stress and reduce the associated healthcare burden.

Costs for Long-Term Health Care After a Police Shooting in Ontario, Canada

Police shootings can cause serious acute injury, and knowledge of subsequent health outcomes may inform interventions to improve care. To analyze long-term health care costs among survivors of police shootings compared with those surviving nonfirearm police enforcement injuries using a retrospective design. This population-based cohort analysis identified adults (age ≥16 years) who were injured by police and required emergency medical care between April 1, 2002, and March 31, 2022, in Ontario, Canada. Police shootings compared with other mechanisms of injury involving police. Long-term health care costs determined using a validated costing algorithm. Secondary outcomes included short-term mortality, acute care treatments, and rates of subsequent disability. Over the study, 13 545 adults were injured from police enforcement (mean [SD] age, 35 [12] years; 11 637 males [86%]). A total of 13 520 individuals survived acute injury, and 8755 had long-term financial data available (88 surviving firearm injury, 8667 surviving nonfirearm injury). Patients surviving firearm injury had 3 times greater health care costs per year (CAD$16 223 vs CAD$5412; mean increase, CAD$9967; 95% CI, 6697-13 237; US $11 982 vs US $3997; mean increase, US $7361; 95% CI, 4946-9776; P < .001). Greater costs after a firearm injury were not explained by baseline costs and primarily reflected increased psychiatric care. Other characteristics associated with increased long-term health care costs included prior mental illness and a substance use diagnosis. In this longitudinal cohort study of long-term health care costs, patients surviving a police shooting had substantial health care costs compared with those injured from other forms of police enforcement. Costs primarily reflected psychiatric care and suggest the need to prioritize early recognition and prevention.

Prediction of psychopathology during the COVID-19 pandemic using linear and non-linear methodologies: Importance of COVID-19 threat perception, emotional competencies and resilience

The presence of a mental or physical illness prior to the pandemic, the perceived threat from COVID-19, resilience or emotional intelligence may influence the onset or increase of psychopathology during the COVID-19 lockdown. The aim was to assess predictors of psychopathology by comparing two statistical methodologies (one linear and one non-linear). MethodA total of 802 Spanish participants (65.50% female) completed the questionnaires independently after signing informed consent. Psychopathology, perceived threat, resilience and emotional intelligence were assessed. Descriptive statistics, hierarchical regression models (HRM) and fuzzy set qualitative comparative analysis (fsQCA) were conducted. ResultsThe data obtained through the HRM showed that the presence of a previous mental illness, low resilience and emotional clarity, high emotional attention and repair, and COVID-19 threat perception predicted 51% of the variance in psychopathology. Results obtained from QCA showed that different combinations of these variables explained 37% of high levels of psychopathology and 86% of low levels of psychopathology, highlighting how the presence of prior mental illness, high emotional clarity, high resilience, low emotional attention and low perceived COVID-19 threat play a key role in explaining psychopathology. ConclusionsThese aspects will help promote personal resources to buffer psychopathology in lockdown situations.

Psychiatric consequences and issues of long COVID on patients with prior psychiatric comorbidities: a scoping review.

SARS-CoV-2 is a growing field of research and mental health in long COVID is one of its interesting domains. This scoping review aims at studying the outcomes of mental health in patients already known for psychiatric illness. This was done by researching the literature in two databases (Embase and PubMed) for articles studying mental health consequences of long COVID in patients already known for psychiatric history. Eleven studies were included. 6/11 studies found an effect of long COVID, with varying severity of outcomes studied, with either a worsening in length or severity. 4/11 did not find any correlation between worsening symptoms and psychiatric history. The methods for assessing which psychiatric symptoms to include and how to determine prior history were heterogeneous, making direct comparison sometimes difficult. The data seem to show worse effects of long COVID on mental health of patients with prior mental illness, with limitations regarding the heterogeneity of the studies' designs and focuses. It also highlights how neglected this population of patients is in the current state of research.

THE IMPACT OF QUARANTINE AND SOCIAL ISOLATION ON THE MENTAL STATE OF THE POPULATION

The COVID-19 pandemic has led to an unprecedented crisis in mental health worldwide. Most of the affected countries, including Ukraine, have implemented physical distancing. Despite the efforts of many scientists over the past few months, research into the negative psychological effects of social isolation is still ongoing, and many questions remain unanswered.Purpose. To examine the data of scientific research on the impact of quarantine and social isolation on the mental state of the population.Materials and methods. In our search of the available literature, we identified 129 articles on the impact of the pandemic on mental health published between May 2020 and May 2022, and this review analyzes thirty-two articles (in this time range). In addition, data from six fundamental studies on loneliness and social isolation were used.Results. The 2019 coronavirus disease pandemic has affected the mental health of people around the world. The scientific publications we reviewed suggest that this large-scale health crisis has led to an increase in the prevalence of symptoms of anxiety, depression, and PTSD. According to the World Health Organization, the prevalence of conditions such as depression and anxiety increased by more than 25% in the first year of the COVID-19 pandemic. Research also suggests that measures to limit the spread of the disease (including physical distancing, quarantine, and isolation) can increase feelings of loneliness and withdrawal symptoms.Conclusions. The impact of the COVID-19 pandemic on mental health is unprecedented in its scale. Most notably, during the time period covered by this literature review, serious mental disorders were observed in the general population, with a particularly high risk among people with prior mental illness.

O010 Evaluating the Impact of COVID-19 Infection, Symptom Duration and Population Lockdown Measures on Sleep Quality and Mental Health

Abstract Background The effect of COVID-19 (both acute and post-acute infection) and of lockdown on sleep quality and mental health are largely unknown. Methods Between 9/2020 and 5/2021, the COVID Symptom Study Biobank recruited UK individuals with confirmed infection (symptom duration: asymptomatic, short [&amp;lt;2 weeks] or long [&amp;gt;4 weeks]); healthy uninfected controls, and uninfected individuals with short or long symptoms. Participants completed online sleep and mental health questionnaires at 9/2020 and 3/2021 (i.e., the equinoxes). Data were compared using one-way ANOVA, Chi-square and T-tests. Progress to date 3053 participants completed questionnaires. Infected individuals with long symptom duration were younger (p&amp;lt;0.008) and more likely had prior mental illness (p&amp;lt;0.001). Long symptom duration was associated with poorer sleep quality (Pittsburgh Sleep Quality Index [PSQI], p&amp;lt;0.001, Sleep Condition Indicator [SCI], p&amp;lt;0.001) and increased sleepiness and fatigue (Epworth Sleepiness Scale [ESS], p&amp;lt;0.010, Chalder Fatigue Scale [CFS], p&amp;lt;0.001). In uninfected individuals, long symptom duration was also associated with prior mental illness (p&amp;lt;0.001), worse sleep quality (PSQI [p&amp;lt;0.001], SCI [p&amp;lt;0.001]), and increased sleepiness/fatigue (ESS p=0.010, CFS p&amp;lt;0.001). Independent of symptom duration, infected individuals were sleepier and more fatigued than uninfected individuals (mean±SD ESS 6.6±4.5 vs 6.1±4.1 [p&amp;lt;0.001], CFS 16±6.0 vs 14±4.9 [p&amp;lt;0.001]). Intended outcome and impact Individuals with longer symptom duration (irrespective of infection) were more likely to have prior mental illness, with multiple markers of poor sleep and fatigue. Further analysis will determine the progression of sleep and mental health scores over time. Addressing these issues may help symptom management in individuals with long symptom duration.

Psycho-Covid

IntroductionThe COVID-19 pandemic generated a health emergency and led to the adoption of different measures, including home quarantine and social isolation, which, as we have seen, has had an impact on the mental health of the majority of citizens, with the possibility of psychiatric disorders appearing. in people without prior mental illness, such as acute decompensations in patients with known disorders, more vulnerable to environmental stressors.ObjectivesLearn and rethink alarm signals in extreme situations such as the one experienced in recent months, as well as observe the impact, negative in many cases, but positive in others, of the patients we treat daily.MethodsDescription through brief clinical cases of the impact of the COVID-19 pandemic on psychotic patients and the decompensation that it has entailed, including due to confinement measures and social isolation, associated with over-information through the media, chaos initial and the uncertainty that it caused and the associated fear.ResultsRestrictions as a result of COVID-19 have played a very relevant role as an external stressor for the appearance of psychopathological alterations, including psychotic symptoms. In addition, people who suffer from psychosis or at risk of psychotic disorder can be especially affected and trigger acute psychopathology with social isolation, loss of daily routines, unemployment, homelessness.ConclusionsThese cases are an example that shows the need for an early and effective approach to the rise in mental illnesses in circumstances of this caliber.DisclosureNo significant relationships.

Association of depression and COVID-induced PTSD with cognitive symptoms after COVID-19 illness

ObjectiveMany patients recovering from COVID-19 report persistent psychological and cognitive symptoms months after viral clearance. We examined the association of depression and COVID-induced PTSD with cognitive symptoms following COVID-19 illness. MethodsPatients treated for COVID-19 between March 26 and May 27, 2020 were surveyed three months later. Cognitive symptoms were assessed by asking “Since your COVID-19 illness, do you now have more difficulty: 1) Remembering conversations a few days later? 2) Remembering where you placed familiar objects? 3) Finding the right words while speaking?” Patients endorsing at least one such complaint were coded positive for cognitive symptoms. Logistic regression was used to estimate the association of depression (PHQ-8 ≥ 10) and COVID-induced PTSD (PCL-5 ≥ 30) with cognitive symptoms, adjusting for demographic and clinical factors. ResultsAmong 153 participants, 44.4% reported at least one cognitive symptom, 18.3% were depressed, and 23.5% had COVID-induced PTSD. Adjusting for covariates, depression (OR 5.15, 95% CI 1.30–20.35, p = 0.02) and COVID-induced PTSD (OR 3.67, 95% CI 1.13–11.89, p = 0.03) were significantly associated with cognitive symptoms; self-reported history of mental illness was also associated (OR 4.90, 95% CI 1.24–19.41, p = 0.02). ConclusionsDepression, COVID-induced PTSD, and prior mental illness were strongly associated with cognitive symptoms three months after acute COVID-19 illness.

Psychological impact of COVID-19 pandemic: A cross-sectional study of hospitalized COVID-19 patients in an urban setting, Bangladesh

AimThe deleterious impact of the COVID-19 pandemic on mental health has been reported by earlier studies globally. However, such studies are limited in Bangladesh; therefore, we performed a cross-sectional study to explore the psychological effects of COVID-19 among hospitalized patients. MethodologyThe cross-sectional study was performed from 1st June to 31st October, 2020, and included a total of 503 real time RT-PCR confirmed stable hospitalized adult (aged ≥18 years) COVID-19 patients using the convenience sampling approach. However, patients with prior mental illness, unstable vital signs, severely ill, oxygen saturation <92%, impaired consciousness were excluded from the study. We collected data by using a semi-structured questionnaire including Patient Health Questionnaire-9 (PHQ-9), General Anxiety Disorder-7 (GAD-7), Insomnia Severity Index (ISI-7), and Perceived Stress Scale (PSS-10). Descriptive analysis and multivariable logistic regression were carried out to determine the mental health outcomes. ResultsThe study found that about 42.5 %, 30.7%, 46.7%, and 28.5% of patients suffered from moderate to severe depression, anxiety, stress, and insomnia. The physical symptoms, fever, fatigue, loss of taste or smell, blurred vision, chest pain, and diarrhoea were significantly associated with augmented mental distress among the hospitalized patients. Furthermore, depression, anxiety, stress and insomnia were strongly linked with patients’ education, occupation, infected family members, exposure to COVID-19 patients, smoking, comorbidities, infection among the neighbors or acquaintances, and preexisting stress. ConclusionThe negative psychological impact of the COVID-19 pandemic comprising depression, anxiety, insomnia and stress worsened the physical condition of hospitalized COVID-19 patients. These patients' poor mental health status needed to be addressed by devising an integrated approach towards improving patients' wellbeing at the post-COVID period.

Management of Medication-Induced Psychiatric Disorders.

Management of Medication-Induced Psychiatric Disorders.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic.

Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Association of SARS-CoV-2 Infection With Psychological Distress, Psychotropic Prescribing, Fatigue, and Sleep Problems Among UK Primary Care Patients

Infection with SARS-CoV-2 is associated with fatigue and sleep problems long after the acute phase of COVID-19. In addition, there are concerns of SARS-CoV-2 infection causing psychiatric illness; however, evidence of a direct effect is inconclusive. To assess risk of risk of incident or repeat psychiatric illness, fatigue, or sleep problems following SARS-CoV-2 infection and to analyze changes according to demographic subgroups. This cohort study assembled matched cohorts using the Clinical Practice Research Datalink Aurum, a UK primary care registry of 11 923 499 individuals aged 16 years or older. Patients were followed-up for up to 10 months, from February 1 to December 9, 2020. Individuals with less than 2 years of historical data or less than 1 week follow-up were excluded. Individuals with positive results on a SARS-CoV-2 test without prior mental illness or with anxiety or depression, psychosis, fatigue, or sleep problems were matched with up to 4 controls based on sex, general practice, and year of birth. Controls were individuals who had negative SARS-CoV-2 test results. Data were analyzed from January to July 2021. SARS-CoV-2 infection, determined via polymerase chain reaction testing. Cox proportional hazard models estimated the association between a positive SARS-CoV-2 test result and subsequent psychiatric morbidity (depression, anxiety, psychosis, or self-harm), sleep problems, fatigue, or psychotropic prescribing. Models adjusted for comorbidities, ethnicity, smoking, and body mass index. Of 11 923 105 eligible individuals (6 011 020 [50.4%] women and 5 912 085 [49.6%] men; median [IQR] age, 44 [30-61] years), 232 780 individuals (2.0%) had positive result on a SARS-CoV-2 test. After applying selection criteria, 86 922 individuals were in the matched cohort without prior mental illness, 19 020 individuals had prior anxiety or depression, 1036 individuals had psychosis, 4152 individuals had fatigue, and 4539 individuals had sleep problems. After adjusting for observed confounders, there was an association between positive SARS-CoV-2 test results and psychiatric morbidity (adjusted hazard ratio [aHR], 1.83; 95% CI, 1.66-2.02), fatigue (aHR, 5.98; 95% CI, 5.33-6.71), and sleep problems (aHR, 3.16; 95% CI, 2.64-3.78). However, there was a similar risk of incident psychiatric morbidity for those with a negative SARS-CoV-2 test results (aHR, 1.71; 95% CI, 1.65-1.77) and a larger increase associated with influenza (aHR, 2.98; 95% CI, 1.55-5.75). In this cohort study of individuals registered at an English primary care practice during the pandemic, there was consistent evidence that SARS-CoV-2 infection was associated with increased risk of fatigue and sleep problems. However, the results from the negative control analysis suggest that unobserved confounding may be responsible for at least some of the positive association between COVID-19 and psychiatric morbidity.

Maternal psycho-social risk factors associated with maternal alcohol consumption and Fetal Alcohol Spectrum Disorder: a systematic review.

Fetal Alcohol Spectrum Disorder (FASD) is a preventable range of neurocognitive disorders associated with the biological mother's consumption of alcohol during pregnancy. However, on average, 45% of Australian women continue to consume alcohol during pregnancy resulting in a high rate of alcohol-exposed pregnancies and risk of FASD. This level of exposure is higher than the estimated global average of alcohol-exposed pregnancies (9.8%). This systematic literature review aims to identify demographic, health and psycho-social variables associated with alcohol consumption during pregnancy which may lead to FASD. Using PRISMA principles, this systematic literature review reports on psycho-social factors which increase the risk of alcohol consumption during pregnancy thereby increasing the risk of FASD. Fourteen studies were accepted into this review. Studies were conducted across several countries and included a total of 386,067 cases. Seven studies were case-controlled and seven were cross-sectional design. Multiple studies identified the significance of prior mental illness, anxiety, depression, exposure to abuse and/or domestic violence and alcohol consumption behaviours of partners and family members as strong predictors of risky alcohol consumption during pregnancy and therefore associated risk of FASD. Clinical services may be able to use the evidence-based findings from this review to improve assessment and treatment services for vulnerable women to reduce alcohol-exposed pregnancies.

Association Between ECG Abnormalities and Fatal Cardiovascular Disease Among Patients With and Without Severe Mental Illness.

BackgroundECG abnormalities are associated with adverse outcomes in the general population, but their prognostic significance in severe mental illness (SMI) remains unexplored. We investigated associations between no, minor, and major ECG abnormalities and fatal cardiovascular disease (CVD) among patients with SMI compared with controls without mental illness.Methods and ResultsWe cross‐linked data from Danish nationwide registries and included primary care patients with digital ECGs from 2001 to 2015. Patients had SMI if they were diagnosed with schizophrenia, bipolar disorder, or severe depression before ECG recording. Controls were required to be without any prior mental illness or psychotropic medication use. Fatal CVD was assessed using hazard ratios (HRs) with 95% CIs and standardized 10‐year absolute risks. Of 346 552 patients, 10 028 had SMI (3%; median age, 54 years; male, 45%), and 336 524 were controls (97%; median age, 56 years; male, 48%). We observed an interaction between SMI and ECG abnormalities on fatal CVD (P<0.001). Severe mental illness was associated with fatal CVD across no (HR, 2.17; 95% CI, 1.95–2.43), minor (HR, 1.90; 95% CI, 1.49–2.42), and major (HR, 1.40; 95% CI, 1.26–1.55) ECG abnormalities compared with controls. Across age‐ and sex‐specific subgroups, SMI patients with ECG abnormalities but no CVD at baseline had highest standardized 10‐year absolute risks of fatal CVD.ConclusionsECG abnormalities conferred a poorer prognosis among patients with SMI compared with controls without mental illness. SMI patients with ECG abnormalities but no CVD represent a high‐risk population that may benefit from greater surveillance and risk management.

Supportive maternity care services: A Danish study exploring parents’ experiences with perinatal mental health issues

Abstract Background Mental illness can have negative impact on pregnant women, their infants and their families, including adverse birth outcomes, as well as place children at risk of developing mental illness later in life. It is recommended to offer additional support in the ante - and postnatal period, but to be able to offer appropriate, timely and effective care, more knowledge is needed on women's own experiences. The aim of this paper is to explore women's experiences with mental illness in the context of pregnancy and early motherhood, and how they experience and engage with supportive services. Methods This paper presents selected findings from an ethnographic field study carried out in a Danish municipality. The findings are based on data from 22 women, who were recruited when they were pregnant or had a newborn baby. The women were currently facing or had previously suffered from one or multiple mental health conditions. Results Analysis found that women with current or prior mental illness experienced a high level of fear, worries and uncertainty during pregnancy and early motherhood, which shaped how they engaged with supportive maternity services. Some were deeply worried about their mental health and reached out for support to cope with this. Concerns about being a bad mother and about the potential influence of their mental illness on their infants were common. Furthermore, some women were scared of being judged as unfit mothers and losing custody of their children. Many experienced stigma surrounding mental illness, making some more hesitant about reaching out for support. Conclusions By providing new insight into women's own perspectives, this study contributes with in-depth knowledge on women's experiences with mental illness during pregnancy and early motherhood, and illustrates how engaging with supportive services may be an ambivalent experience.

Diet quality and depressive symptoms. Assessing the direction of the association in a population-based cohort study

BackgroundEmerging evidence links a poor diet with mental ill-health although the direction of this association is unclear. The aim was to examine the bidirectional prospective relationships between core (and non-core food consumption, and symptoms of depression. MethodsDepressive symptoms (Mental Health Index-5, MHI-5), current/prior depression and consumption of core (recommended food groups) and non-core (discretionary) foods were assessed in the population-based 2013 and 2017 Household Income and Labour Dynamics in Australia cohort study. Three cross-lagged linear models assessed associations between all three baseline variables in 2013, alternating 2017 variables as outcomes. ResultsIn the population (n = 10,003; 48.3% women; 48.5[15.7] years), core food score in 2013 was associated with MHI-5 (β:0.102, 95%CI: 0.010,0.193) in 2017, while the non-core food score was not (β:-0.030, 95%CI:-0.099,0.160). Depressive symptom score in 2013 was not associated with either food score in 2017. Current/prior diagnosis of depression in 2013 was associated with core (β:-0.198, 95%CI:-0.329,-0.067) but not non-core (β:-0.036, 95%CI: -0.151,0.080) food score in 2017. LimitationsResults may not be generalizable to the whole population due to some selection bias, self-report depression diagnosis may have led to misclassification of previous mental illness, and core and non-core food scores are not validated measures of diet quality. ConclusionsThere is a prospective association between core food consumption and depressive symptoms. This association is of small magnitude and we cannot discount insufficient core food consumption reflecting an effect of prior mental illness. Our results suggest that, for depression, public health focus should be on improving core food intake.

The association of insomnia with future mental illness: is it just residual symptoms?

ObjectivesTo evaluate whether the prospective association between insomnia and mental illness in the general population remained after controlling for multiple confounders, or whether this represented partly remitted prior mental illness. DesignCohort study. SettingAustralian general population. ParticipantsThe participants were 10,444 people aged 15 or older in the Household, Income and Labour Dynamics in Australia (HILDA) survey who did not meet K10 criteria for likely mental illness at baseline (2013–14). MeasurementsThe prospective associations of insomnia (yes/no) at baseline with mental illness (yes/no) approximately 2 years later (2015–16), determined from scores on the K10, were evaluated using logistic regression. These were then adjusted for potential confounders including sociodemographic factors, physical health and health behaviors, and baseline and past mental health. ResultsInsomnia at baseline increased risk of mental illness onset at two-year follow up (OR 2.23, 95% CI 1.91–2.59, P < .001). This relationship was attenuated but still significant after adjustment for confounding variables (OR 1.72 95% CI 1.46–2.02). Accounting for reverse causality from prior mental ill health and baseline symptoms reduced this further but the relationship remained (OR 1.30, 95% CI 1.09–1.55, P = .003). This effect appeared more robust among those <65 years of age. ConclusionsInsomnia has a consistent prospective relationship with mental illness at two-year follow-up. Insomnia did not appear to be simply a symptom of past, or baseline subclinical, mental illness. This supports the specific targeting of insomnia symptoms in selective preventive mental health initiatives, particularly among those under 65 years of age.

Case study: NAMI-NYC Metro

Mental illness is the most stigmatised issue in our society, leading millions of Americans to suffer in silence. Working with NAMI-NYC Metro, a leader in the mental health community, J. Walter Thompson New York, believed that in order to break the stigma, a new conversation needed to be had. Prior mental illness advocacy campaigns had drawn the same conclusion, but had attempted to normalise the illness, or they had asked those affected to speak up – loud and proud – to represent the community. The sad reality is that mental illness is so stigmatised, many people will not talk about it even with those closest to them. We needed to lower the prejudice rife in society, so that people would feel more comfortable discussing the issue, breaking the pervasive silence. We recognised that for a new conversation to take place, for people to want to speak up and to challenge the status quo, first, individuals and the community needed to promise three little words: I Will Listen. #IWillListen became an actionable way for people to advocate support for those they cared about, where it mattered most – on their social channels. To do this, we had to turn the largest social network into the biggest support network. This is #IWillListen.

Assumption of drugs with self-injurer purpose: a retrospective study about 111 patients hospitalized in Policlinico of Modena

AIM OF THE STUDY The aim of this work was to evaluate the epidemiology of suicidal attempts by ingestion of drugs in our area. MATERIALS AND METHODS This is a retrospective study considering all patients admitted to the hospital between January 2004 and December 2006 for suicidal attempts using drugs. RESULTS A total of 111 patients were seen in our Department in the evaluated period. The large majority of patients were women (75%). Suicidal attempt was more common in individuals aged 31 to 40 years. The more common drugs used were: BDZ (28%), anti-depressive (21%), anti-psychotics (10%) and anti-epileptics (8%). A gastric washout was performed in 65.8% of all patients admitted to the hospital. The most used antidote was flumazenil. Alterations of laboratory exams were seen only in a small percentage of the cases. In the majority of cases, suicide was at the first attempt. 71% of patients were followed by psychiatrist and were taking daily psychiatric pharmacologic therapy; 5% had a history of previous admission to the hospital in a psychiatric ward; only 24% had no a history of a prior mental illness. 43% of patients were admitted to a psychiatric ward after intensive treatment in our department. Self-discharging was not usual (10%), and only few patients were restrained against their will (3%). CONCLUSIONS Our study has identified some risk factors for a suicidal attempt. Family doctors should have a stronger control of their patients with mental illness especially during the first period of treatment. In future it should be very helpful to create an informatic network connecting all departments involved in the care of these patients. Moreover, it is crucial to increase the role of family doctors in the care of psychiatric patients after their hospitalization.