Plasma free choline, betaine and cognitive performance: the Hordaland Health Study

Choline and betaine are nutrients involved in one-carbon metabolism. Choline is essential for neurodevelopment and brain function. We studied the associations between cognitive function and plasma concentrations of free choline and betaine. In a cross-sectional study, 2195 subjects (55 % women), aged 70–74 years, underwent extensive cognitive testing including the Kendrick Object Learning Test (KOLT), Trail Making Test (part A, TMT-A), modified versions of the Digit Symbol Test (m-DST), Block Design (m-BD), Mini-Mental State Examination (m-MMSE) and Controlled Oral Word Association Test (COWAT). Compared with low concentrations, high choline (>8·4 μmol/l) was associated with better test scores in the TMT-A (56·0 v. 61·5, P= 0·004), m-DST (10·5 v. 9·8, P= 0·005) and m-MMSE (11·5 v. 11·4, P= 0·01). A generalised additive regression model showed a positive dose–response relationship between the m-MMSE and choline (P= 0·012 from a corresponding linear regression model). Betaine was associated with the KOLT, TMT-A and COWAT, but after adjustments for potential confounders, the associations lost significance. Risk ratios (RR) for poor test performance roughly tripled when low choline was combined with either low plasma vitamin B12 ( ≤ 257 pmol/l) concentrations (RRKOLT= 2·6, 95 % CI 1·1, 6·1; RRm-MMSE= 2·7, 95 % CI 1·1, 6·6; RRCOWAT= 3·1, 95 % CI 1·4, 7·2) or high methylmalonic acid (MMA) ( ≥ 3·95 μmol/l) concentrations (RRm-BD= 2·8, 95 % CI 1·3, 6·1). Low betaine ( ≤ 31·1 μmol/l) combined with high MMA was associated with elevated RR on KOLT (RRKOLT= 2·5, 95 % CI 1·0, 6·2). Low plasma free choline concentrations are associated with poor cognitive performance. There were significant interactions between low choline or betaine and low vitamin B12 or high MMA on cognitive performance.publishedVersio

Suicidal Behavior and Alcohol Abuse

Suicide is an escalating public health problem, and alcohol use has consistently been implicated in the precipitation of suicidal behavior. Alcohol abuse may lead to suicidality through disinhibition, impulsiveness and impaired judgment, but it may also be used as a means to ease the distress associated with committing an act of suicide. We reviewed evidence of the relationship between alcohol use and suicide through a search of MedLine and PsychInfo electronic databases. Multiple genetically-related intermediate phenotypes might influence the relationship between alcohol and suicide. Psychiatric disorders, including psychosis, mood disorders and anxiety disorders, as well as susceptibility to stress, might increase the risk of suicidal behavior, but may also have reciprocal influences with alcohol drinking patterns. Increased suicide risk may be heralded by social withdrawal, breakdown of social bonds, and social marginalization, which are common outcomes of untreated alcohol abuse and dependence. People with alcohol dependence or depression should be screened for other psychiatric symptoms and for suicidality. Programs for suicide prevention must take into account drinking habits and should reinforce healthy behavioral patterns

Persons who attempt suicide - social characteristics, social network and significant others

A suicide attempt is one of the most powerful predictors of eventual suicide. The aim of this thesis was to investigate the social situation, including social support of suicide attempters. One part of the investigations concerned patients admitted to a psychiatric ward following a suicide attempt. Another part concerned significant others (SOs) of suicide attempters, interviewed directly after the suicide attempt and at follow-up one year later. Overall the patients rated their social networks to be weak and patients with dysthymia rated their social support as less satisfactory compared with patients with major depressive disorders. Relationship and vocational problems were common. More than half of the admitted patients (72/126) reported overconsumption of alcohol (47%) or sedatives (10%). Over-consumers of alcohol were comparatively younger, less often married/cohabiting and had a weaker social network. Half of the admitted patients (80/156) reported treatment of psychiatric disorders or suicidal behaviour of their parents. These patients were younger, had more often previously received psychiatric treatment, and had more often a diagnosis of dysthymia. They scored higher on KSP temperament ratings on anxiety and lower on ratings of socialization than other patients. SOs added valuable information to the assessment of the patient directly after the suicide attempt. At follow-up, SOs reported that a majority of the patients had psychiatric or other (mostly relationship) problems. Few SOs had been informed or involved in the patients´ treatment, which most of them had wanted. Nearly half of the SOs would like to have been offered professional counselling, preferably shortly after the suicide attempt. The social situation of suicide attempters treated as in-patients was often strained. Especially overconsumers with dysthymia and patients with parental psychiatric disorders seem to be socially vulnerable and in need of social intervention. SOs need information and support after a suicide attempt

Significant others of persons with mental health problems: The testing of a questionnaire on the burden of significant others

The importance of family and friends for patients with mental health problems has been recognized over the past few years. Significant others (SO) of patients admitted to a psychiatric ward specializing in affective disorders and suicide prevention filled in a self-rating questionnaire concerning their burden as SOs, the Involvement Evaluation Questionnaire (IEQ). The aims of this study were twofold: first, to test whether the questionnaire IEQ was applicable in psychiatric services in Sweden and second, to relate the IEQ results to socio-demographic data and diagnosis of the patients, and also to the situation of the SOs. We found the questionnaire useful. Nearly half of the SOs had difficulties in accepting and handling the patient's psychiatric problems. More than half had been worried that the patient was going to harm him/herself and because of this had kept close watch on the patient. Almost all SOs worried about the patient's general health and future. Most of them felt obliged to intervene in the patient's activities of daily living. More than half worried about the kind of medical and psychological treatment the patient was receiving. Most SOs concluded that they were burdened by their engagement in the patient. Our results were compared with a European study of schizophrenic patients also investigated with the IEQ. The comparison indicated that the perceived burden on SOs of these different kinds of psychiatric patients can be equally burdensome. SOs need information, help and support in their difficult support role. This questionnaire could be useful in finding new routines for increasing the involvement by SOs in the treatment of patients with mental health problems

Persons who attempt suicide - social characteristics, social network and significant others

Popular Abstract in Swedish Självmord och självmordsförsök orsakar mycket lidande för många människor i vårt samhälle. I Sverige begår ungefär 1800 personer självmord varje år. De flesta av dessa personer hade vid tiden för självmordet en psykisk sjukdom. Man har funnit att åtminstone hälften av dessa personer hade en depressionssjukdom, minst en fjärdedel hade alkoholproblem och c:a 5% led av schizofreni. Av de som dör i självmord har 30-50% gjort ett eller flera självmordsförsök tidigare. Det har vidare beräknats att c:a 20 000 människor årligen gör självmordförsök i Sverige. Uppföljningsstudier har visat att 10-15% av dem som gjort ett självmordsförsök senare dör i självmord, och ett självmordsförsök är den viktigaste enskilda riskfaktorn för att senare begå självmord. Risken för nya självmordsförsök är störst de närmaste två åren, och under första året gör c:a 20% ett nytt självmordsförsök. På psykiatriska kliniken i Lund bildades ett suicidpreventionsteam 1986 och samtidigt öppnades en avdelning,specialiserad på självmordsprevention och depressionssjukdomar, där det också bedrivs forskning. Riskgruppen självmordsförsökare utgör den kliniska tyngdpunkten. Studierna i denna avhandling utgår från arbetet på denna specialiserade avdelning och från arbetet i vårt konsultationsteam. Personer, som inkommer akut till universitetssjukhuset i Lund efter ett självmordsförsök, bedöms snarast av ett konsultationsteam (läkare och kurator från psykiatriska kliniken). Suicidalt beteende har många orsaker; biologiska, psykologiska och sociala faktorer samvarierar med situationsmässiga faktorer. Eftersom självmordsförsökare är en heterogen grupp söker man identifiera vissa undergrupper av dem för att kunna differentiera behandling och stöd. Denna avhandling rör några av de psykosociala faktorer, som bör beaktas efter ett självmordsförsök. Vi har också undersökt om man kan få ett bredare perspektiv på patientens situation genom att även kontakta patientens närmaste anhörig. Tre av fem delarbeten berör patienter inlagda på en psykiatrisk vårdavdelning efter ett självmordsförsök. Två av delarbetena berör närstående till de patienter, som bedömts akut efter ett självmordsförsök. Anhöriga har dels kontaktats i samband med konsultteamets bedömning av patienten, dels ett år därefter. I det första delarbetet undersökte vi den sociala situationen och det sociala nätverket hos inlagda patienter (n=75) genom semistrukturerade intervjuer respektive självskattningsformulär. En tredjedel av patienterna var gifta eller sammanboende och av dessa hade mer än hälften (62%) långvariga relationsproblem och var i behov av parsamtal. C:a 70% av patienterna hade arbete eller studerade, men mer än hälften av dessa hade så omfattande problem i sin arbetssituation att kuratorsinsatser krävdes. Samtliga patienter hade en psykiatrisk diagnos och en majoritet av patienterna hade dessutom en personlighetsstörning (68%). Suicidförsökare skattade sitt sociala stöd betydligt sämre än det man funnit hos friska personer. Patienter med diagnosen dystymi rapporterade sämre socialt stöd än patienter med egentlig depression. I arbete två analyserade vi inlagda patienters uppfattning om sin konsumtion av alkohol, tabletter och narkotika (n=126). Vi fann att 60% enligt egen uppfattning överkonsumerat dessa medel. Vanligast var överkonsumtion av alkohol (47%), som en mindre andel kombinerat med lugnande tabletter. Tolv procent hade överkonsumerat enbart lugnande medicin (oftast kvinnor) och endast någon enstaka person rapporterade att de använt narkotika. Överkonsumenter hade, i jämförelse med dem som inte rapporterade överkonsumtion, oftare gjort självmordsförsök förut och hade oftare fäder som behandlats för psykiska sjukdomar, varav behandling av alkoholism var vanligast. Överkonsumenter av alkohol var yngre, mindre ofta gifta/sambo och hade ett sämre socialt nätverk. Arbete tre undersöker (n=163) huruvida patientens temperament, aktuella diagnos och sociala karakteristika är relaterade till om patientens föräldrar har behandlats för psykisk sjukdom och/eller gjort självmordsförsök. Hälften av patienterna rapporterade att deras mor, far eller båda hade behandlats för psykisk sjukdom (42%) eller hade gjort suicidförsök/suiciderat (9%). Fäder hade oftare än mödrar haft psykiatrisk behandling och den vanligaste diagnosen bland fäder var alkoholism. Suicidalt beteende rapporterades hos 8 fäder, varav 4 hade suiciderat. Fem mödrar rapporterades ha gjort suicidförsök, men ingen av dem hade suiciderat. Patienter vars föräldrar hade suicidalt beteende och/eller har behandlats för psykisk sjukdom var, jämfört med andra patienter, yngre och hade oftare själva blivit behandlade inom psykiatrin tidigare. De hade också oftare dystymi och mer sällan en krisdiagnos (anpassningsstörning). Temperamentsmässigt hade de högre ångestbenägenhet och sämre anpassning till ett socialt sammanhang, även efter statistisk kontroll för diagnostiska skillnader. Arbete fyra inkluderar en närstående till patienter (n=81), som kommit in akut till sjukhuset i Lund efter ett självmordsförsök. Vi tog kontakt med den person som patienten, i anslutning till den akuta bedömningen, uppgivit som sin närmaste anhörig, och som fick kontaktas av oss. Samtliga anhöriga var villiga att delta i undersökningen. Vårt syfte var att få information om patientens situation, men även om den anhöriges egen situation och eventuella behov av stöd. Det framkom att anhöriga tillförde värdefull information angående patientens problembild och tidigare självmordsförsök; uppgifter som varken patienten själv uppgivit eller som var kända genom sjukhusjournalen. Dessa uppgifter bekräftades senare av patienten. Många anhöriga hade stöttat patienten såväl psykologiskt som praktiskt, vilket hälften av dem fann betungande. I samband med patientens självmordsförsök uttryckte hälften av de anhöriga att de själva behövde stöd i form av gemensamma samtal med patienten och ytterligare 1/3 ville ha eget individuellt stöd. Anhöriga var mycket positiva till att ha blivit kontaktade efter patientens självmordsförsök. Arbete fem (n=84) rör de anhörigas synpunkter på patientens situation, de anhörigas deltagande i patientens vård och även deras eget välbefinnande och behov av stöd ett år efter patientens självmordsförsök. Patienterna följdes upp av en oberoende intervjuare. Nästan samtliga anhöriga och patienter kunde nås för en uppföljningsintervju (93% resp 89%). Anhöriga rapporterade att 63% av patienterna hade psykiska problem vid uppföljningen och att 80% hade andra problem (oftast relationsproblem). De flesta anhöriga hade varit oroliga för att patienten återigen skulle göra sig själv illa, vilket hade varit pressande för dem. Många anhöriga bar fortfarande på obesvarade frågor om självmordsförsöket. Hälften meddelade att de inte kunnat beröra detta ämne med patienten. De flesta anhöriga hade inte blivit informerade om patientens situation eller blivit involverade i patientens vård, vilket en majoritet av dem hade önskat. Anhöriga var mer kritiska till vården än patienterna. Vi ställde frågor om de anhörigas hälsa bl.a. för att få en uppfattning om anhörigas förmåga att utgöra ett stöd för patienten. Vi fann att de närståendes psykiska hälsotillstånd inte skilde sig från andra personers i vårt upptagningsområde. En mindre andel anhöriga rapporterade att de inte mådde bra. De anhöriga påpekade dock, att för att förstå och kunna handskas med situationen efter en partners/släktings/väns självmordsförsök, behövde och önskade de professionellt stöd; antingen själva eller tillsammans med patienten, i vissa fall båda dessa alternativ.A suicide attempt is one of the most powerful predictors of eventual suicide. The aim of this thesis was to investigate the social situation, including social support of suicide attempters. One part of the investigations concerned patients admitted to a psychiatric ward following a suicide attempt. Another part concerned significant others (SOs) of suicide attempters, interviewed directly after the suicide attempt and at follow-up one year later. Overall the patients rated their social networks to be weak and patients with dysthymia rated their social support as less satisfactory compared with patients with major depressive disorders. Relationship and vocational problems were common. More than half of the admitted patients (72/126) reported overconsumption of alcohol (47%) or sedatives (10%). Over-consumers of alcohol were comparatively younger, less often married/cohabiting and had a weaker social network. Half of the admitted patients (80/156) reported treatment of psychiatric disorders or suicidal behaviour of their parents. These patients were younger, had more often previously received psychiatric treatment, and had more often a diagnosis of dysthymia. They scored higher on KSP temperament ratings on anxiety and lower on ratings of socialization than other patients. SOs added valuable information to the assessment of the patient directly after the suicide attempt. At follow-up, SOs reported that a majority of the patients had psychiatric or other (mostly relationship) problems. Few SOs had been informed or involved in the patients´ treatment, which most of them had wanted. Nearly half of the SOs would like to have been offered professional counselling, preferably shortly after the suicide attempt. The social situation of suicide attempters treated as in-patients was often strained. Especially overconsumers with dysthymia and patients with parental psychiatric disorders seem to be socially vulnerable and in need of social intervention. SOs need information and support after a suicide attempt

One-year follow-up of significant others of suicide attempters

Background: In a previous study we interviewed significant others (SOs) directly following a patient's suicide attempt as a part of the psychiatric assessment. SOs added important information to the assessment and they needed professional counselling themselves. In the present study the opinions of SOs were investigated 1 year after a suicide attempt. Methods: Semi-structured interviews of 84 SOs (93% of a consecutive series) were performed by telephone, focusing on the patient's situation, their own involvement in care and treatment as well as their own well-being and need for support. Forty-four percent of the SOs were parents, 27% partners and 29% persons with other relationships. An independent researcher interviewed the patients. Results: According to SOs, 63% of the patients had mental health problems and 80% had other kinds of problems (e.g. relationship problems, financial problems, unemployment and substance abuse) at follow-up. A majority of SOs were worried that the patient was going to hurt themself again. There were differences in the information given by patients and SOs concerning suicide attempts during the follow-up period. Many SOs had questions about the suicidal behaviour, and nearly half of the SOs reported that they had not talked to the patient about the index suicide attempt. Nearly half of the SOs would like to have had professional counselling, preferably shortly after the suicide attempt. Two-thirds of the inpatient SOs and 90% of the outpatient SOs had not been involved in the patient care and treatment, although a majority of them desired such involvement. The well-being of the SOs was generally good, except for a small subgroup. Conclusions: The findings of this study provide further evidence that SOs contribute valuable information about the patient after a suicide attempt. They also point strongly to the fact that SOs themselves need support. Insufficient communication between patient and SOs indicates the need for joint counselling directly after a suicide attempt in order to reduce some of the burden and stress experienced by SOs

Significant others of persons with mental health problems: The testing of a questionnaire on the burden of significant others

The importance of family and friends for patients with mental health problems has been recognized over the past few years. Significant others (SO) of patients admitted to a psychiatric ward specializing in affective disorders and suicide prevention filled in a self-rating questionnaire concerning their burden as SOs, the Involvement Evaluation Questionnaire (IEQ). The aims of this study were twofold: first, to test whether the questionnaire IEQ was applicable in psychiatric services in Sweden and second, to relate the IEQ results to socio-demographic data and diagnosis of the patients, and also to the situation of the SOs. We found the questionnaire useful. Nearly half of the SOs had difficulties in accepting and handling the patient's psychiatric problems. More than half had been worried that the patient was going to harm him/herself and because of this had kept close watch on the patient. Almost all SOs worried about the patient's general health and future. Most of them felt obliged to intervene in the patient's activities of daily living. More than half worried about the kind of medical and psychological treatment the patient was receiving. Most SOs concluded that they were burdened by their engagement in the patient. Our results were compared with a European study of schizophrenic patients also investigated with the IEQ. The comparison indicated that the perceived burden on SOs of these different kinds of psychiatric patients can be equally burdensome. SOs need information, help and support in their difficult support role. This questionnaire could be useful in finding new routines for increasing the involvement by SOs in the treatment of patients with mental health problems

Suicide attempters with and without reported overconsumption of alcohol and tranquillizers

The aims of the present study were to investigate the existence of overconsumption of alcohol and tranquillizers in suicide attempters and whether overconsumers differ from those with no overconsumption. One hundred and twenty-six patients, evaluated and treated after a suicide attempt in a psychiatric ward, took part in a comprehensive investigation. This included questions on consumption of alcohol and tranquillizers and use of illegal drugs, independently of the psychiatric diagnostic procedure. More than half of the patients (59%) reported overconsumption of any kind or use of illegal drugs; 47% overconsumed alcohol (13% in a combination with tranquillizers), 10% overconsumed tranquillizers only, and 2% had used illegal drugs. Compared with non-overconsumers, overconsumers had more often made previous suicide attempts, and psychiatric co-morbidity on DSM III-R was commoner among overconsumers. The parents of overconsumers had more often been treated for psychiatric disorders, and alcoholism among fathers was commoner. The overconsumers of alcohol were younger and less often married, had a weaker social network, and had lower platelet monoamine oxidase activity. The psychosocial characteristics found in overconsumers underline the need for identification of these subjects, to prevent an escalation of a self-destructive life-style. A thorough investigation concerning use of alcohol and other substances is therefore essential in all suicide attempters; otherwise there is a risk that overconsumers without a DSM III-R diagnosis of substance use disorder may be undetected

The social network of people who attempt suicide

Social characteristics and self‐rating of social support by means of the Interview Schedule for Social Interaction were investigated in 75 inpatients after a suicide attempt. We found that very few suicide attempters (13%) had a well functioning relationship, and two‐thirds had problems in their occupational situation. Divorced patients had unsatisfactory social interaction compared with those who were married or cohabiting and with those who were single or widowed. Employees and students more often had deep emotional relations than those who were unemployed or in vocational rehabilitation. The latter were also less satisfied with their social interaction than those who were retired or had a disability pension. Poor social interaction was more commonly reported by patients with dysthymia than by those in other diagnostic subgroups. We conclude that an evaluation of the social network should be an integral part of the clinical handling of suicide attempters, since it forms a basis for planning psychiatric treatment