Coexistence of lower urinary tract symptoms (LUTS) with depressive symptoms in patients suffering from depressive disorders

OBJECTIVES

The aim of the present study was to investigate the correlation between lower urinary tract symptoms (LUTS) and severity of depressive symptoms in patients treated for depression.

METHODS

102 patients (43 males, 59 females) aged 20-67 (M = 46.1) treated for depression were included in this cross-sectional analysis. Depressive symptoms were assessed with the 17-item Hamilton Depression Rating Scale (HDRS) and Quick Inventory of Depressive Symptomatology - Self Report (QIDS-SR). LUTS were examined with the International Prostate Symptom Score (IPSS). In order to analyze the impact of presented symptoms, both urological and psychiatric, on quality of life of analyzed individuals the 30-item General Health Questionnaire (GHQ-30) was used.

RESULTS

The average IPSS score in women was significantly higher than in men (9.59 vs. 6; p = 0.04). Patients suffering from at least moderate depression assessed with QIDS-SR had significantly higher scores in IPSS (9.76 vs. 4.1; p = 0.002). Severity of all LUTS assessed with IPSS correlated with QIDS-SR score in examined men (p < 0.05). In women, the total IPSS score correlated with the QIDS-SR score (p < 0.05) and with the total GHQ-30 score (p < 0.05). Anumber of other significant (p < 0.05) correlations were observed between the total IPSS score and certain items' scores in the GHQ-30 both in men and women.

CONCLUSIONS

LUTS are common among patients with depression. There is a correlation between severity of depressive symptoms and LUTS. LUTS affect quality of life and well-being as well as cause marked distress in depressed patients. Comorbidity of LUTS and depression should draw attention of both psychiatrists and urologists and enhance interdisciplinary treatment approach. Further prospective and cohort studies are essential to reveal more details of the correlation between LUTS and depression.

Postpartum depression: bipolar or unipolar? Analysis of 434 Polish postpartum women

Objective

To assess the prevalence of soft bipolar features in a sample of women with postpartum depressive symptoms, as well as to compare the sociodemographic and obstetric characteristics of subjects with bipolar or unipolar postpartum depressive symptomatology.

Methods

Four hundred and thirty-four participants were enrolled in this cross-sectional study. Postpartum depression (PPD) symptoms were assessed using the Edinburgh Postnatal Depression Scale (EPDS), while the Mood Disorder Questionnaire (MDQ) was used to screen for bipolarity features.

Results

Of the 434 participants, 66 (15.2%) scored ≥ 13 points on the EPDS, thus fulfilling the screening criteria, and 103 scored ≥ 7 points on the MDQ. In comparison with non-depressed subjects, the women who scored positively on the EPDS were significantly more likely to exhibit symptoms of bipolar spectrum disorders (38 vs. 21%; chi-square test, p = 0.015). Women with bipolar PPD symptomatology were significantly younger than those exhibiting unipolar PPD symptoms (31.0±4.8 years vs. 28.5±4.1 years; t-test, p = 0.03). The groups did not differ in terms of obstetric characteristics.

Conclusion

Our findings suggest that patients with PPD symptomatology may be more likely to exhibit soft bipolarity features as compared with non-depressed women.

The Association of Recurrent Affective Disorders with Functional Capabilities in the Subjects Over 60 Yeras of Age. a Preliminary Findings

Introduction

Major depressive disorder (MDD) in the older adults is correlated with a significant decline in daily physical activity, consequently resulting in chronically impaired quality of life and an increased exposure to falls-risk.

Objectives

Establishing whether geriatric depression Scale (GDS) scores, found correlated with dual motor tasks (TUGTMAN), are also correlated under the cognitive test constraints (TUGCOG).

Aims

The study aimed to analyse the relationship of MDD symptoms, the number of depressive episodes and hospitalisations, with the efficiency of gait in single and dual task conditions, motor and cognitive, functional capabilities.

Methods

The study was conducted in the outpatient clinic, university hospital, department of psychiatry, Krakow, on 30 patients over 60 years of age presenting recurrent MDD. The assessment consisted of GDS, MMSE, TUGT, TUGMAN, TUGCOG, 30sChS, SLS. Spearman rho rank correlation was applied to determine the relationship between the variables.

Results

Statistical analysis showed a significant association between the intensity of depressive symptoms expressed in the GDS and the number of completed episodes and depression and TUGT. The number of hospitalisations was associated with gait under motor (TUGMAN) and cognitive (TUGCOG) constraints.

Conclusion

Duration of the disorder and the number of hospital admissions are related to the functional efficiency of the single and dual-task performance in the persons suffering from this disorder for at least 10 years. Aged persons should effectively be encouraged to undertake physical activities.

Disclosure of interest

The authors have not supplied their declaration of competing interest.

Zinc transporters protein level in postmortem brain of depressed subjects and suicide victims

BACKGROUND

Major depressive disorder (MDD) is a serious psychiatric illness, associated with an increasing rate of suicide. The pathogenesis of depression may be associated with the disruption of zinc (Zn) homeostasis. In the brain, several proteins that regulate Zn homeostasis are present, including Zn transporters (ZnTs) which remove Zn from the cytosol. The present study was designed to investigate whether depression and suicide are associated with alterations in the expression of the ZnTs protein.

METHODS

Protein levels of ZnT1, ZnT3, ZnT4, ZnT5 and ZnT6 were measured in postmortem brain tissue from two different cohorts. Cohort A contained 10 subjects diagnosed with MDD (7 were suicide victims) and 10 psychiatrically-normal control subjects and cohort B contained 11 non-diagnosed suicide victims and 8 sudden-death control subjects. Moreover, in cohort A we measured protein level of NMDA (GluN2A subunit), AMPA (GluA1 subunit) and 5-HT1A receptors and PSD-95. Proteins were measured in the prefrontal cortex (PFC) using Western blotting. In addition, Zn concentration was measured using a voltammetric method.

RESULTS

There was a significant increase in protein levels of ZnT1, ZnT4, ZnT5 in the PFC in MDD, relative to control subjects, while ZnT3 protein level was decreased in MDD. There was no significant difference in the Zn concentration in the PFC between control and MDD subjects. Similarly, in the PFC of suicide victims (non-diagnosed), an increase in protein levels of ZnT1, ZnT4, ZnT5 and ZnT6 was observed. Conversely, protein levels of ZnT3 were decreased in both suicide victims and subjects with MDD, in comparison with control subjects. There was also a significant decrease in the protein level of GluA1, GluN2A, PSD-95 and 5-HT1A in MDD.

CONCLUSIONS

Our studies suggest that alterations in Zn transport proteins are associated with the pathophysiology of MDD and suicide.

Decreased sensitivity to paroxetine-induced inhibition of peripheral blood mononuclear cell growth in depressed and antidepressant treatment-resistant patients

Major depression disorder (MDD) is the most widespread mental disorder. Selective serotonin reuptake inhibitors (SSRIs) are used as first-line MDD treatment but are effective in <70% of patients. Thus, biomarkers for the early identification of treatment-resistant (TR) MDD patients are needed for prioritizing them for alternative therapeutics. SSRI-induced inhibition of the growth of peripheral blood mononuclear cells (PBMCs) is mediated via their target, the serotonin transporter (SERT). Here, we examined whether antidepressant drug-induced inhibition of the growth of PBMCs differed between MDD patients and healthy controls. PBMCs from well-characterized 33 treatment-sensitive (TS) and 33 TR MDD patients, and 24 healthy volunteers were studied. Dose-dependent inhibition of PBMCs growth was observed for both the non-SSRI antidepressant mirtazapine and the SSRI antidepressant paroxetine. Significantly lower sensitivities to 20 μm paroxetine were observed in MDD compared with control PBMCs prior to treatment onset (13% and 46%, respectively; P<0.05). Following antidepressant drug treatment for 4 or 7 weeks, the ex vivo paroxetine sensitivity increased to control levels in PBMCs from TS but not from TR MDD patients. This suggests that the low ex vivo paroxetine sensitivity phenotype reflects a state marker of depression. A significantly lower expression of integrin beta-3 (ITGB3), a co-factor of the SERT, was observed in the PBMCs of MDD patients prior to treatment onset compared with healthy controls, and may explain their lower paroxetine sensitivity. Further studies with larger cohorts are required for clarifying the potential of reduced PBMCs paroxetine sensitivity and lower ITGB3 expression as MDD biomarkers.

[Others physical methods in psychiatric treatment based on electromagnetic stimulation]

In the last decades a few new physical methods based on the electromagnetic head stimulation were subjected to the clinical research. To them belong:--vagus nerve stimulation (VNS),--magnetic seizure therapy/magnetoconvulsive therapy (MST/MCT),--deep stimulation of the brain (DBS) and--transcranial direct current stimulation (tDCS). The paper presents a description of mentioned techniques (nature, advantages, defects, restrictions), which were compared to the applied electroconvulsive treatment ECT, earlier described transcranial magnetic stimulation TMS and the pharmacotherapy (the basis of the psychiatric treatment).

[The place of quetiapine extended release in the treatment of mental disorders]

This article presents a summary of available data on the use of quetiapine extended release (QUE-XR). QUE-XR is an example of an atypical antipsychotic drug that can be used in a single dose, thereby simplifying the treatment regimen. From the therapeutic standpoint, this issue is of paramount importance, since approximately 50% of patients have adherence issues. Therefore, availability of the drug which is comfortable in administration can significantly improve treatment outcomes. Due to its antipsychotic, antidepressive, mood stabilizing and anxiolytic efficacy, QUE-XR seems to be a promising drug with potentially broad spectrum of indications (in patients with schizophrenia, bipolar disorder, major depression and some anxiety disorders - both in the acute phase of treatment, and the maintenance treatment). Notably, QUE-XR seems to ameliorate sleep disturbances, and it may also improve patients' quality of life (as suggested by some studies). Due to the simple dosing regimen of QUE-XR, conducting therapy with this drug may contribute to the improvement of compliance. Yet, the primary clinical criterion for selection of the type of formulation of quetiapine should be the individual preferences of the patient, and the knowledge and experience of the treating physician.

[Contemporary place of the electroconvulsive therapy. Part 2. Clinical aspect]

Electroconvulsive therapy (ECT) is an important method of biological treatment in serious psychic disturbances. Similarly to drug therapy it is marked by a determined schematics of applying including the list of indications, contraindications, procedures of the performance, as well as the list of adverse invents. Applying defined schemas allows for minimizing the risk and influences the final effectiveness of therapy.

[Transcranial magnetic stimulation in psychiatric therapy]

Transcranial magnetic stimulation (TMS) is one of new techniques of the physical treatment in psychiatry. Its advantage is painlessness, so as lack of invasiveness and evoking a convulsive effect. The technique of TMS was introduced into the clinical practice in 1985--originally as a diagnostic method in neurology. Later TMS became a valuable tool in the basic research in neurophysiology and neuropsychology, so as in clinical examinations. In 1994 the first papers on TMS application in therapy of depression and schizophrenia were published. The research on the therapeutic TMS effectiveness encounters certain problems and restrictions: difficulties in determining a place of the stimulation, lack of the possibility of the selection of optimal parameters for the stimulation, problem in guarantying optimal conditions for the double-blind study, etc. During the last two decades TMS was applied in therapy of mood disorders and psychoses more on the principle of consuetude, than confirmations of the evident effectiveness. However recently a group of European experts presented the study, in which they regarded TMS as the effective method in therapy of depression and schizophrenia--presenting conditions to the optimal stimulation.

[The influence of long-term care on the health of caregivers of Alzheimer's disease patients]

The literature indicates that caregivers of patients with Alzheimer's disease experience a significant degree of burden that impacts on their health-related quality of life (HRQOL). AD caregivers experience significant changes in a social, family and professional life depending on diverse factors. Caring for a patient with dementia directly links to significant psychological stress. It also affects the caregivers' physical and mental health. The psychiatric morbidity is higher among the caregivers population. Depression, anxiety disorder and insomnia have been found to be the most common. The burden and the negative changes experienced by the caregivers predispose the lower quality of care and premature institutionalisation of AD patients. Excessive burden experienced by carers increases their rate of patients neglect and abuse. Life quality improvement becomes the main target of the proper care giving system.

[Contemporary place of the electroconvulsive therapy Part 1. The historical context arnd the biological basis]

Electroconvulsive therapy (ECT) is a former physical therapy method in psychiatry which is applicable up till today in relation to its high effectiveness and the safety. Centuries of applying nonconvulsive methods of the electric stimulation preceded introducing this method into the clinical practice. ECT is arousing a lot of controversies; populous myths are connected with its applying--that demands explanations. Numerous biological mechanisms explaining the clinical efficacy of ECT action are well-known.

[The efficacy of transcranial magnetic stimulation in the treatment of depression]

BACKGROUND

Transcranial magnetic stimulation (TMS) is known as method of depression therapy.

RESULTS

The paper presents the results of clinical 2nd phase investigation or safety and efficacy of TMS as compared to electroconvulsive therapy and standalone pharmacotherapy.

RESULTS

It was shown that in all three groups of patients a significant improvement of clinical state (decrease of depressive symptoms) was achieved. The strongest effect was observed in the group of patients treated with electroconvulsive therapy (as well as drugs). However, trans-cranial magnetic stimulation combined with pharmacotherapy did not prove to be more effective than standalons pharmacological treatment. The authors discuss possible explanations of inefficacy of transcranial magnetic stimulation therapy.

CONCLUSIONS

None antidepressive efficacy of TMS was observed. Forthcoming examinations of TMS are necessary for optimalization of stimulation parameters and conditions.

[Manfred Cierpka Questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia]

AIM

The mechanisms of the impact of family support on somatic diseases are still unclear and they are subject of research. Especially little is known about the role of family relations. This study discusses the meaning of social support in somatic disorders, particularly acute leukaemia in the context of family functioning. The aim of the study is the evaluation of usefulness of the Manfred Cierpka questionnaire as the assessment tool examining social support for leukaemic patients.

METHOD

The study included 36 subjects, 21 men and 15 women, with diagnosis of acute leukaemia. The level of depression symptoms was Manfred Cierpka questionnaire usefulness in the analysis of perception of familiar support in patients with acute leukaemia by the set of questionnaires. The level of disease symptoms was estabilished on the basis of several clinical variables and procedures, during a one year course of the disease. Family functioning and functioning of the patient within the family were evaluated by family assessment questionnaire of Cierpka.

RESULTS

The result of the overall family functioning assessment in the subgroup with depressive symptoms was significantly worse than in the group without depression. There was no such difference in self assessment of the patients' functioning in the family. The scores of the family assessment questionnaire does not differentiate the group according to severity of the illness and one year mortality. CONCLUSION. The Manfred Cierpka questionnaire is helpful as an assessment method of subjective perception of family support for leukaemic patients. The results of the family functioning questionnaire are related to the sustaining of depressive symptoms in the course of the disease. It may indicate the usefulness of early family intervention in the specific group of patients.

[Working memory disturbances in patients with major depression after ECT treatment]

INTRODUCTION

Electroconvulsive therapy (ECT) is the most effective treatment in a variety of psychiatric syndromes (especially mood disorders). However one of its adverse effects is neurocognitive dysfunction. Declarative memory impairment after ECT is unquestionable and well investigated. There are only few ambiguous studies focused on nondeclarative and immediate memory changes during ECT.

METHOD

A study of immediate (working) memory changes in depressed patients treated with ECT (n=10; bitemporal ECT 3 times a week) or imipramine or desipramine (150-250 mg/day; n=10) was conducted in patients who fulfilled DSM-IV criteria for major unipolar depression. Hamilton Depression Rating Scale (HDRS) and Beck's Depression Inventory (BDI) were used to assess the efficacy of antidepressant therapy. Cognitive functions were assessed with neuropsychological tests: Stroop A and B, TMT (Trial Making) A and B. The patients' status was evaluated 1 day before the treatment and 1 day, 2 weeks, 1 month and 6 months after the first ECT procedure.

RESULTS

1 day after first ECT treatment, patient's working memory was slightly impaired, but this was not statistically significant. Both groups showed statistically significant improvement in working memory I month after start of treatment. However there were statistically significant differences between ECT and pharmacologically treated groups at the first month of therapy.

CONCLUSION

ECT treatment only temporally affects working memory function. The improvement of function may be a result of clinical recovery from depressant symptomatology.

[The quality of life related to depressive symptoms in coronary artery disease patients after successful coronary angioplasty: one-year follow up]

AIM

The aim of the study was to assess how the comorbidity of depressive symptoms and cardiac ischemic disease (CAD) influences the quality of life (QoL) in patients after the successful coronary angioplasty (PCI).

METHOD

227 patients with CAD selected for PTCA were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the intervention were included in one year follow-up. Patients' status was assessed four times (one day before and at 1, 6 and 12 months after the intervention), with the Polish version of SF-36, Beck's Depression Inventory (BDI), Rosenberg's Self-Esteem Scale (RS), Beck's Hopelessness Scale (HS) and the Automatic Thoughts Questionnaire (ATQ).

RESULTS

In the whole study group (n=156) the quality of life at 1 month after PTCA was significantly improved. This tendency persisted in further examinations. There was a significant correlation between the quality of life (SF-36), severity of depressive symptoms (BDI) and parameters describing depressive changes in thinking (HS, RS, ATQ). On each occasion during the one-year follow-up' the presence of depressive symptoms was associated with the poorer quality of life, both with respect to the total SF-36 points and individual components of QoL measured by 8 subscales of the SF-36.

CONCLUSIONS

Present findings indicate that depressive disorders in patients with CAD--even after successful intervention--significantly affect the quality of life. Optimized comprehensive approach to CAD patients with concomitant depressive disorders may require the inclusion of psychological interventions, and in severe cases even psychiatric treatment.

[The evolution of depressive symptoms in coronary artery disease patients after successful coronary angioplasty]

AIM

The aim of the study was to investigate the spectrum and course of depressive symptoms in cardiac ischemic disease (CAD) patients before and after successful coronary angioplasty (PCI) in one year follow-up.

METHOD

227 patients with CAD selected for PTCA were enrolled. 156 patients with full clinical and angiographic success and without restenosis within 4 weeks after the intervention were included in further analysis. Patients' status was assessed four times (one day before and at 1, 6 and 12 months after the intervention), with Beck's Depression Inventory (BDI), Rosenberg's Self-Esteem Scale (RS), Beck's Hopelessness Scale (HS), Automatic Thoughts Questionnaire (ATQ).

RESULTS

Mild and moderate depressive disorders with the prevalence of non-specific somatic symptoms were observed one day before PTCA in 75 (48%) patients. One month after the PCI, depressive symptoms persisted in 33 subjects. Moreover in the group of patients who were free of depressive symptoms a day before PTCA, twelve patients (15%) developed depressive symptomatology. Depressive symptoms and depressive disorders of thinking (especially hopelessness) recognized 4 weeks after PTCA had a tendency to persist at 6 and 12 months. The tendency was associated with more severe affective-cognitive and somatic symptoms of the depressive syndrome, more frequent negative automatic thoughts and stronger hopelessness detected at the beginning of the study.

CONCLUSIONS

The results of the study suggest that successful PCI is not a sufficient determinant for the improvement of depressive symptoms. Diagnosis of depression in CAD patients needs special attention, because of a tendency to persist.

[The completed and attempted suicide in Krakow: similarities and differences]

The study presents the results of the interdisciplinary research conducted on the basis of cooperation between the Institute of Forensic Medicine, the Department of Clinical Toxicology, and the Clinic of Psychiatry in Kraków. The aim of the research was to determine similarities and differences between attempted and completed suicide from the point of view of socio-demographic and clinical traits. The authors analysed 220 cases of completed suicide committed in Kraków and its environs in the year 2000. The material presented in the study was based on the archive data from post mortem examinations conducted in the Institute of Forensic Medicine in Kraków. The sample consisted of 177 males and 43 females ranging in age from 13 to 89 years. The mean age was 43.6 years for the entire group, 42 years for males and 50 years for females. The majority of subjects were males, either unemployed, or pensioners. A similar tendency was observed in the group of female subjects. Mental disorders and alcoholic addiction in anamnesis were discovered in a significant number of cases, both in the group of males and in the group of females. Subjects, in whom serious somatic diseases had been detected, constituted a separate group of cases. According to the archive data, in the last century, suicide was most frequently committed by hanging. Similarly, in the sample examined, in 133 cases, suicide was committed by hanging. In 37% of cases, the level of alcohol in the suicides' blood was between 0.5 and 3 or more g/L. In 2000/2001, within the analogical period of 12 months, the group of 200 patients after a suicide attempt by drug intoxication was examined in the Department of Clinical of Toxicology Jagiellonian University College of Medicine. This group included 49 males and 150 females, ranging in age from 18 to 79 years (mean age 35). The examination was conducted by means of structured investigation and medical documentation. Contrary to completed suicide, in the group of suicide attempters, females outnumbered males. Young people under thirty, living in a large city, possessing elementary or secondary education, and either unemployed, or pensioners, constituted the majority of the examined group. A significant percentage of females was divorced and lived with their children only. The majority of the examined population of suicide attempters had used alcohol during the attempt, had suffered from depression, personality or behavioural disorders, had undergone psychiatric treatment, or had had cases of suicide among their friends or relatives.

[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. II. Clinical predictors]

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxi-cations) in the Department of Clinical Toxicology CM UJ from March to December 2000. Examined group was composed of 49 men and 131 women. The following tests were used in this study: structured questionnaire, psychological tests: Beck Depression Inventory, Hamilton Depression Scale, Hopelessness Scale, Suicidal Intent Scale, Life Events Scale, SOC 29 (by Antonovsky). Besides, we used data from patients' history. The aim of our study is to analyse clinical data of suicidal attempters--after first and repeated suicidal attempts. We took into consideration the severity of coma, severity of intoxication, the kind of substances used in the attempt, the presence of alcohol, previous psychiatric treatment, cases of suicide among the patients' close friends or relatives and duration of hospitalization. Then the psychiatric diagnosis was stated. The analysis of severity of intoxication (divided into three stages: severe, moderate, and light according to the Poisoning Severity Score (PSS) indicated that in the group of repeated suicide attempters the percentage of severe intoxications was greater (9.2%) then in first time attempters. In the population of second time female attempters there is a greater percentage of persons who took neuroleptics (15.4%) compared to group first attempters (5.4%). In both groups the majority were taking anxiolytisc, sleep-inducing and mixed drugs. There was a greater percentage of persons drinking alcohol during the attempt among repeated suicidal attempters (38.8%) than among the first time attempters (26%). The percentage of persons with diagnosis of mental disease (treated in ambulatory or in hospital) is higher in the group of repeated suicide attempters (25.9%) then after first attempters (6.3%). In both groups a lot of persons had reactive depression, often associated with personality disorders, rarely endogenic depressions or psychosis. We observed that addiction to alcohol is often a problem in men who attempt suicide (I group--32.3%, II group--33.3%). The analysis of medical documentation indicated in the group of repeated suicide attempters a high percentage of people with cases of suicide among their close friends or relatives.

[A trial for the complex risk assessment of repeated suicide predictors in patients after suicidal poisoning attempts, hospitalized in the Department of Clinical Toxicology CM UJ in Krakow. I. Influence of socio-demographic factors]

The study included 180 patients aged 18-79 (average 36) hospitalized for suicide attempts (drug intoxication) in Department of Clinical Toxicology CMUJ from March to December 2000. Examined group was composed of 49 men and 131 women. Structured investigation and medical documentation were used to estimate crucial socio-demographic risk factors of repeated suicide attempt. The following socio-demographic traits were taken into consideration in analysis: age, sex, marital status, place of living, education, employment, family background. We distinguished among patients under examinations: patients after first suicide attempt (I) and group after another suicidal attempt (II). The second group consisted of 15 men (27.8% of the total) and 39 women (72.2% of the total). Young people under 30 constituted 37.2% of the whole examined population. In population of women after repeated suicide attempt the percentage of divorced ones increased considerably (from 2.2% to 10.2%). Both in men and women after repeated suicide attempt the percentage of persons with only elementary education increased (from 34.1% to 53.7%). We observed high unemployment rate (from 26.6% to 29.6%) in both groups. Percentage of pensioners increased from 23.5% after first suicidal attempt to 33.3% after repeated suicidal attempt in men and from 25.5% to 35.9% in women. Men after repeated suicide attempt more often live with their parents, while women from the second group more often live alone with their children. It seems that some of the analysed predictors which are expression of social unadjustment may make risk factor for repeated suicidal attempts.

[The sense of coherence and risk of suicide attempt]

The analysis was based upon 79 patients hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków from July to December 2000. The purpose of the study was to estimate the sense of coherence level (according to Antonovsky) as a potential suicide attempt predictor. The population of patients was divided into two groups: patients after first suicide attempt (I) and group after reattempting suicide (II). The examination was based on structure interview, analysis of medical documentation and a number of tests including SOC 29 (by Antonovsky), Beck Depression Inventory (BDI), Hamilton Depression Rating Scale (HDRS), and Beck Hopelessness Scale (HS 20). The most important psychological and independent variable measured in the study was the sense of coherence, introduced first by Aaron Antonovsky as a significant predictor of mental health. The sense of coherence (measured by SOC 29 questionnaire) comprises comprehensibility, manageability and meaningfulness. Both in foreign and in polish studies the SOC 29 level was lower in clinical groups compared to healthy people. The norm in Polish population was 139 scores in SOC 29. In the present study the average total result (men and women) was 112 scores in the group of patients after first suicide attempt, and in the group of repeated suicide attempters the average total result was even lower--only 99 scores, which makes a statistically significant difference. We also observed a statistically significant dependence between the results of SOC 20 questionnaire, the level of depression measured by Beck Depression Inventory and Hamilton Depression Scale, and the level of hopelessness measured by Beck Hopelessness Scale. The above results indicate that the sense of coherence level may make significant risk factor for repeated suicide attempt.

[Significance of subjective evaluation of life events as risk factors for predicting future suicide attempts]

Among the total population of 180 patients undergoing medical examination between March and December 2000, hospitalized for suicide attempts (drug intoxication) in the Department of Clinical Toxicology CM UJ in Kraków, 159 persons were examined by means of modified questionnaire of life events based on a scale elaborated by Thomas Holmes and Richard Rache. The patients were divided into 2 groups--first group comprised patients after first suicide attempt and second group consisted of those who had reattempted suicide. In regard to sex and age there were no significant differences between these two groups and the total population of 180 patients. In order to obtain the patients' subjective evaluation of the influence of their course of life on their attempting suicide, we asked the patients to select from the list of life events those that had affected their mental and physical state during of whole their life. Objectivization of life events was based on the 'units of life change' by T. Holmes and R. Rache. The sum of units of life events was 373 scores (SD +/- 200, in the range of 39-1042 units). From the total list of life events (max. score--1513) we selected the events estimated at 40 and more units of life change. Those were; marriage, divorce, separation, marital reconciliation, patient's illness, change of behavior and illness of a close relative, death of a husband/wife, child, close relative, imprisonment, pregnancy, unemployment, retirement. In the patients' subjective evaluation part, the events most frequently selected by the patients as those that had affected their mental state were: death of a close relative (56.6%), illness of a relative (40.8%), patient's illness (37.7%). A high number of patients stated events testifying to a conflict in marriage--45.7% of patients stated marital separation, and reconciliation, and 27% of patients stated unemployment as a fact that had influenced their mental state. 30.6% of these patients belonged to the first group (after first suicide attempt) and only 18.7% belonged to the second group (after repeated attempt). The authors of the study have presented a discussion over the results of the analysis and demonstrated the need for cultural adaptation of so that it can be effectively used in General Practitioners' training.