OBJECTIVES: The aim of this study was to identify risk factors and possible predictors of severity of suicidal behavior of children and adolescents. METHODS: Seventy-seven patients (15 boys and 62 girls) aged 15.5+/-1.6 years on average, hospitalized due to a suicidal attempt in the department of pediatric psychiatry, were examined. Structured interviews with patients and their parents were used to clinically assess circumstances of suicidal behavior, relevant risk factors and severity of suicidal behavior. RESULTS: The results indicated that patients with any previous traumatic experience tended to have somatically less severe suicidal attempts (p=0.050). Intensity of suicidal intent was associated with a history of depression (p=0.014) and anxiety disorders (p=0.004), and the current stress from a mental disorder (p=0.014). Somatic severity of suicidal behavior was significantly associated with intensity of suicidal intent (p=0.014). A history of any trauma (previous traumatic experience predicted less severe suicidal behavior, p=0.053) and the current stress from sexual problems (p=0.067) were identified as predictors of somatic severity of suicidality. These two predictors showed only a trend level of significance. The only significant predictor of intensity of suicidal intent was the current stress from a mental illness (p=0.017). CONCLUSIONS: Several risk factors of somatic severity of suicidal behavior and intensity of suicidal intent were described. The most important finding of the study was the association between a history of psychological trauma and a tendency to have less somatically severe suicidal behavior.

• MeSH
• chování dětí psychologie   MeSH
• chování mladistvých psychologie   MeSH
• dítě hospitalizované psychologie   statistika a číselné údaje   MeSH
• dítě MeSH
• genetická predispozice k nemoci MeSH
• lidé MeSH
• mladiství hospitalizovaní psychologie   statistika a číselné údaje   MeSH
• mladiství MeSH
• pokus o sebevraždu * psychologie   statistika a číselné údaje   MeSH
• poruchy chování u dětí diagnóza   epidemiologie   etiologie   genetika   MeSH
• posttraumatická stresová porucha komplikace   diagnóza   epidemiologie   genetika   MeSH
• prognóza MeSH
• rizikové faktory MeSH
• stupeň závažnosti nemoci MeSH
• životní změny MeSH
• Check Tag
• dítě MeSH
• lidé MeSH
• mladiství MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH

The objective of this study was to ascertain changes in symptoms of patients with borderline personality disorder undergoing psychodynamic day treatment with a duration of 9 months and the factors that predict clinical outcome or dropouts from the program.In an observational study, demographic characteristics (age, number of psychiatric hospitalizations, number of suicide attempts, current involvement in work or study activities), day doses of antipsychotic and antidepressant medication, psychiatric symptoms, and social functioning (Health of the Nation Outcome Scales), and symptoms of dissociation (Dissociative Experiences Scale) were assessed in patients at the beginning of treatment (N = 105). Further, psychiatric symptoms and social functioning were assessed at 3 stages: beginning of the program, end of the program, and 1-year follow-up. To study the differences between baseline values and values at the end of the treatment and follow-up values, the Wilcoxon signed-rank test was used. To discover baseline factors related to the effect of the treatment, Spearman correlation coefficients were calculated. To evaluate the differences between patients who completed the program (N = 67) and patients who dropped out (N = 38), differences in baseline factors between both groups were compared, using the Mann-Whitney test for independent samples.Improvement in symptoms (Health of the Nation Outcome Scales - version for external evaluators) at the end of the therapy (N = 67, P < .001) and at the 1-year follow-up (N = 46, P < .001) was found. Experience of an intimate relationship was positively related to clinical improvement at follow-up examinations (P < .001). Predictors of dropout included a higher number of psychiatric hospitalizations (P = .004), suicide attempts (P = .004), more severe pretreatment symptoms (P = .002), and symptoms of dissociation (P = .046).The results indicate that a psychodynamic day treatment is feasible for the treatment of less clinically disturbed patients with a history of intimate relationships. Patients with a higher number of previous psychiatric hospitalizations, more suicide attempts in the past, more severe pretreatment symptoms, and symptoms of dissociation are more likely not to complete the program.

• MeSH
• denní péče o pacienty metody   MeSH
• dospělí MeSH
• hraniční porucha osobnosti terapie   MeSH
• lidé MeSH
• neparametrická statistika MeSH
• pokus o sebevraždu statistika a číselné údaje   MeSH
• psychiatrické posuzovací škály MeSH
• psychodynamická psychoterapie metody   MeSH
• regresní analýza MeSH
• rizikové faktory MeSH
• studie proveditelnosti MeSH
• ukončení terapie pacientem statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

AIM: To determine the mortality in a cohort of very young injecting drug users (IDUs), and the factors associated with it. DESIGN: A database linkage prospective (follow-up) cohort study. SETTING: A convenience sample of clients of 2 low-threshold facilities, 1 drug treatment clinic, and one special facility for children with severe behavioural disorders, who were all younger than 19 and older than 15, was interviewed one or more times in 1996-8 and asked to agree with their being interviewed again after 10 or more years. PARTICIPANTS: 151 (65 male, 86 female) IDUs recruited in October 1996 - December 1998. MEASUREMENT: Database linkage study compared unique identifiers (IDs) of the recruited subjects with the general register of deaths to determine the life status, and the causes of death of those deceased. Where necessary, we examined the death protocols directly. FINDINGS: Altogether, 8 deaths were registered between recruitment and 31st December 2008 (1,660 person-years). All the deceased were male, and all their deaths were "unnatural"--that is, caused by drug overdose or accident. This translates into the crude mortality rates for the whole cohort being 4.8 deaths per 1,000 person-years (PY), and into a specific mortality ratio in the males SMR=14.4 with the peak at the age of 15-20 (SMR=60.1), declining to SMR=8.2 at the age of 25-30. Except gender, we found no "predictors of death" in this high-risk cohort. CONCLUSION: The overall mortality in the cohort was substantially higher than in the general population; in the male part of the cohort of young injecting drug users it was excessively high in the first three years after recruitment, and caused by external causes exclusively; the mortality in the female sub-cohort was zero, i.e. lower than in the general population of the same age range. Our findings suggest a need to develop targeted prevention of overdoses and other unnatural deaths in young male drug injectors.

• MeSH
• chorobopisy - spojování MeSH
• dospělí MeSH
• intravenózní abúzus drog mortalita   MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• následné studie MeSH
• předávkování léky mortalita   MeSH
• příčina smrti * MeSH
• rizikové faktory MeSH
• rozložení podle pohlaví MeSH
• sebevražda statistika a číselné údaje   MeSH
• věkové rozložení MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mladiství MeSH
• mladý dospělý MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Geografické názvy
• Česká republika epidemiologie   MeSH

We report here on a patient who attempted suicide four times by ingesting a lethal dose of antifreeze. Reversibility of renal damage due to ethylene glycol (EG) ingestion is not complete in all patients, and its predictor factors are not well understood. A 30-year-old man suffering from a depressive disorder repeatedly attempted suicide between 2002 and 2005. In December 2002 the patient was admitted in a coma. EG intoxication was confirmed (serum EG level 1.025 g/l) and intensive therapy was started (sodium bicarbonate, ethanol, haemodialysis). After treatment he recovered. In February 2003 this patient again drank EG (serum EG level 0.257 g/l). On admission he had no symptoms of intoxication and received only ethanol i.v. Only mild metabolic acidosis (pH = 7.365) developed. In May 2003 the patient arrived at the hospital six hours after ingestion of 500 ml of EG (serum EG level 0.282 g/l). Metabolic acidosis (pH = 7.176) and signs of nephrotoxicity (serum creatinine 168 micromol/l) had developed, for which he received intensive therapy. In May 2005 the patient was found comatose on the street. Laboratory monitoring on admission showed severe metabolic acidosis (pH = 6.899) and a serum EG level of 2.877 g/l. Intensive therapy was performed again. This case report describes for the first time the repeated ingestion of a large amount of EG by a single patient and documents the improvement of renal functions. These findings support the opinion of full recovery in patients with intensive treatment and no history of kidney damage.

• MeSH
• dospělí MeSH
• ethylenglykol otrava   MeSH
• ledviny účinky léků   patofyziologie   MeSH
• lidé MeSH
• pokus o sebevraždu * MeSH
• Check Tag
• dospělí MeSH
• lidé MeSH
• mužské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• kazuistiky MeSH
• práce podpořená grantem MeSH
• Názvy látek
• ethylenglykol MeSH