Israel Medical Association Journal

Background: School closures due to the coronavirus disease 2019 (COVID-19) outbreak affected students physically, socially, and psychologically with an increase in the number of children and adolescent presenting with anxiety, depression, and drug abuse.

Objectives: To examine the impact of COVID-19 and lockdown on the mental health of minors during the pandemic period and to characterize the type and number of referrals to a regional psychiatric outpatient clinic.

Methods: This study included 380 children evaluated in an outpatient child psychiatric clinic. They were divided into two groups: before the lockdowns (BLD) (n=248), from January 2019 to February 2020, and during the lockdowns (LD) (n=132), from March 2020 to April 2021.

Results: When comparing the LD to BLD, there was increase in suicide attempts (9.8% vs. 2.8%) and in the use of psychotherapy (81% vs. 56%). There was a decrease in the diagnoses of behavior disorders (29.5% vs. 44.8%) and ADHD (29.5% vs. 50%); as well as a decrease in stimulant usage (22.7% vs. 38%). There was a statistically non-significant increase in the number of children with depression, anxiety, and drug-use disorder.

Conclusions: Many children developed educational, social, emotional, and behavioral gaps during LD, and they lost skills to deal with everyday problems due to social isolation. It is important to follow the long-term impact of the lockdowns and social isolation.

Background: Deliberate self-harm (DSH) increases the danger of future suicide death and the risk increases with age. Self-harm in older adults is often associated with greater suicidal intent and lethality. 

Objectives: To investigate clinical and psychosocial variables of older patients (age ≥ 65 years) assessed due to DSH, compared with younger adults.

Methods: Patients admitted to the Emergency Department following DSH during an 8 year period were included.

Results: Of 1149 participants, 187 (16.6%) were older adults (age ≥ 65) and 962 (83.4%) were younger adults (< 65). The older adults reported DSH closer to mid-day (P < 0.01) and suffered more frequently from adjustment disorder and depression. Personality disorders and schizophrenia were less commonly diagnosed (P < 0.001). Prescription medication (sedatives and hypnotics) were a more frequent means (88% vs. 71%) of DSH among older patients. Younger patients with DSH used over-the-counter medications (21.9% vs. 6.4%) three times more than did the older patients (P < 0.01). Past DSH was significantly more frequent in younger adults. Following DSH the older patients were frequently admitted for further general hospitalization (P < 0.001). 

Conclusions: Older adults with DSH are a unique group with different clinical characteristics. There is a need for targeted prevention strategies and education of caregivers regarding DSH in older adults.

 

Objectives: To examine the files of patients hospitalized in a tertiary hospital in Israel following a serious suicide attempt. Their mental conditions were determined and their unique demographic and clinical characteristics and needs compared to the other patients examined by the psychiatric service.

Methods: The study focused on 49 consecutive patients admitted after performing a life-threatening suicide attempt. They were compared to 389 non-suicidal patients assessed by the same psychiatric service during one year.

Results: Nearly half the patients hospitalized following a serious suicide attempt had only an axis II diagnosis (personality disorder). Non-violent methods of suicide were used predominantly by females, and violent methods mainly by males. All suicide attempts by Muslims used violent methods, while less than half the attempts by Jews were violent. Compared to the non-suicidal patients, the suicide-attempters group was younger, had greater representation of Jewish females and Muslim males. Compared to the non-suicidal patients, these patients required more intense psychiatric care, earlier commencement of treatment in the course of hospitalization, more psychiatric visits and treatment hours, and more referrals for further care. Several risk factors appear to be associated with a need for more intense in-hospital care and a greater need for referral: male gender, religion, method of suicide attempt (violent vs. non-violent), and the existence of a psychiatric diagnosis.

Conclusions: Suicide-attempt patients who are in need of hospitalization for further medical treatment have unique clinical characteristics and require more intense treatment provided by the Consultation-Liaison Unit. 

Background: Adolescent suicide has become increasingly more prevalent in recent years, with self-poisoning being a frequent means of suicide attempt.

Objective:  To investigate the factors associated with adolescent self-poisoning.

Methods: Data on adolescents referred for intentional self-poisoning to the Adolescent Medical Unit during the years 1990–1998 were evaluated retrospectively. Data were obtained from the hospital medical records and included the following factors: sociodemographic data, educational status, agent and route of intake, motivation for overdose, and the extent of serious suicidal intent.

Results:  We evaluated 324 cases of adolescent self-poisoners aged 12–18 years (mean ± SD 14.8 ± 1.5 years). The female/male ratio was 8:1. Most of the patients were attending school and lived in urban areas. Oral ingestion was the only route of intake; 84.5% of the patients ingested drugs and 10.5% non-medicinal compounds. The drug most commonly taken was acetaminophen. The non-medicinal compounds were mostly pesticides and household materials. The suicide attempts were most frequently associated with transient depression, stemming from defects in child-family communication. As based on clinical psychiatric evaluation, patients who had ingested polydrugs and non-medical compounds evidenced a significantly greater suicidal intent (c² =11.9, P < 0.001) compared to those who took only one or two kinds of drugs.

Conclusions: We found that self-poisoning attempts occur most frequently in depressed females at junior high and high school, usually in the context of family dysfunction.  Non-medicinal agents and polydrug ingestion are major risk factors for evaluating the seriousness of the suicidal intent.