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Suicide is a major public health problem worldwide and continues to be one of the main causes of death. Implementing surveillance strategies for suicidal thoughts and behaviours would make it possible to identify individuals at high risk of ending their lives by suicide. While a universal screening would be controversial, the increasing use of the 9-item version of the Patient Health Questionnaire (PHQ-9) in different healthcare settings, such as primary care or hospital emergency departments, offers an opportunity for testing its performance for suicide surveillance. Beyond being a screening of depression, the PHQ-9 has shown merit as a marker of suicidal thinking, thoughts of self-harm, and suicide. Implementing systematic surveillance strategies for suicide in different healthcare settings including data from the PHQ-9 might be an effective way to improve case detection. This could help to enhance the identification of highest risk population groups and, consequently, to avoid potentially preventable suicides.

Background: Despite the strong links between mental disorder, self-harm and suicide, there is little prospective data on risk factors for later suicide in women who experience perinatal mental disorders. We aimed to examine later suicide in a cohort of women in contact with a mental healthcare provider perinatally and whether self-harm increased suicide risk. Methods: Via data-linkage, de-identified service-user electronic healthcare records, national hospital episode statistics and mortality data generated a clinical cohort of women who gave birth in hospital and were in contact with a mental healthcare provider in London, UK, perinatally. Using Natural Language Processing and structured field extraction, we identified clinical, socio-demographic characteristics, self-harm, and suicide. Outcomes: Among 5204 women, crude rate of suicide 9·69/100 000 person-years (95% CI 3·64 - 25·82) within one year of delivery; 27·56 (15·26 - 49·77) within two, and 55·12 (36·29 - 83·71) during total follow up time (39,912·9 person-years). Characteristics of women who did and did not die by suicide were similar apart from illness severity indicators, which were more common in women who died by suicide. In a Cox regression model, lifetime self-harm was not associated with later suicide. Suicides occurred most frequently in the second year after delivery, most commonly by violent means. Suicides beyond two years were most commonly by poisoning. Interpretation: This study provides support for the extension of perinatal mental healthcare to two years post-delivery, particularly for women with severe mental disorders. Funding : The National Institute for Health Research, King's College London Biomedical Research Council, Health Foundation, Academy of Medical Sciences. Declaration of Interests: None. Ethics Approval Statement: CRIS has pre-existing ethical approval via the Oxfordshire Research Ethics Committee C (ref 18/SC/0372). The use of HES data is included in the CRIS REC approval and the BRC also have approval through the Health Research Authority’s support under Section 251 of the NHS Act 2006 (Ref: ECC 3- 04(f)/2011). Linkage between CRIS and ONS Mortality data is approved via the Health Research Authority’s support under Section 251 of the NHS Act 2006. Individual CRIS projects require ethical approval from the CRIS Oversight Committee (approval 16-069), which is chaired by a service-user and member of the SLAM BRC Stakeholder Participation theme.

Aims We aimed to test whether specific insight dimensions are associated with suicidality in patients with psychotic disorders. Methods 143 patients with schizophrenia spectrum disorders were recruited. Suicidality was assessed by item 8 of the Calgary Depression Scale for Schizophrenia (CDSS). Insight was measured by the Scale of Unawareness of Mental Disorder (SUMD) and the Markova and Berrios Insight Scale. Bivariate analyses and multivariable logistic regression models were conducted. Results Those subjects aware of having a mental illness and its social consequences had higher scores on suicidality than those with poor insight. Awareness of the need for treatment was not linked with suicidality. The Markova and Berrios Insight scale total score and two specific domains (awareness of “disturbed thinking and loss of control over the situation” and “having a vague feeling that something is wrong”) were related to suicidality. However, no insight dimensions survived the multivariable regression model, which found depression and previous suicidal behaviour to predict suicidality. Conclusions Suicidality in psychosis was linked with some insight dimensions: awareness of mental illness and awareness of social consequences, but not compliance. Depression and previous suicidal behaviour mediated the associations with insight; thus, predicting suicidality.

Background: There is considerable interest in cannabis use in psychosis. It has been suggested that the chronic psychosis associated with cannabis use, is symptomatically distinct from idiopathic schizophrenia. Several studies have reported differences in psychopathology and family history in people with schizophrenia according to whether or not they were cannabis users. We set out to test the hypotheses arising from these studies that cannabis use is associated with more bizarre behaviour, more thought disorder, fewer negative symptoms including blunted affect, more delusions of reference, more paranoid delusions and a stronger family history of schizophrenia. Method: We used a case register that contained 757 cases of first onset schizophrenia, 182 (24%) of whom had used cannabis in the year prior to first presentation, 552 (73%) had not and 3% had missing data. We completed the OPCRIT checklist on all patients and investigated differences in the proportion of people with distractibility, bizarre behaviour, positive formal thought disorder, delusions of reference, well organised delusions, any first rank symptom, persecutory delusions, abusive/accusatory hallucinations, blunted affect, negative thought disorder, any negative symptoms (catatonia, blunted affect, negative thought disorder, or deterioration), lack of insight, suicidal ideation and a positive family history of schizophrenia, using chi square tests. Logistic regression modelling was then used to determine whether prior cannabis use affected the presence of the characteristics after controlling for age, sex and ethnicity. Results: There was no statistically significant effect of cannabis use on the presence of any of the above. There remained however a non-significant trend towards more insight (OR 0.65 p=0.055 for “loss of insight”) and a finding of fewer abusive or accusatory hallucinations (OR 0.65 p=0.049) of borderline significance amongst the cannabis users. These were in the hypothesised direction. There was no evidence of fewer negative symptoms or greater family history amongst cannabis users. Conclusion: We found few appreciable differences in symptomatology between schizophrenic patients who were or were not cannabis users. There were no differences in the proportion of people with a positive family history of schizophrenia between cannabis users and non-users. This argues against a distinct schizophrenia-like psychosis caused by cannabis. © 2007 Elsevier B.V. All rights reserved.

The three secondary amino nitrogens of a heteroditopic cryptand have been derivatized with acetylpyrene to have a fluorophore–spacer–receptor configuration. The localized monomer fluorescence intensity is reduced in this system due to quenching via photoinduced intramolecular electron transfer from nitrogen atoms in the receptor cryptand moiety to the fluorophores. The system also exhibits a red-shifted broad structureless emission in different solvents which is assigned to intramolecular exciplex formation. Among the different metal ions, which bind in the cryptand cavity, the local monomer emission can be recovered to different extents in the presence of Zn(II), Co(II) and Mn(II) ions while binding of Ni(II) or Cu(II) did not result in any fluorescence enhancement. Presence of protons, however, facilitates intramolecular excimer formation in the free ligand. The intensity ratio of monomer and excimer emission is found to be a function of proton concentration. The system is thus a rare one exhibiting monomeric, excimeric and exciplex emissions depending on the environment.

The complexation reaction between anthracene (AN) and perfluoronaphthalene (PFN) has been found to be magnetically sensitive. The various characteristics of magnetic field effect in the radical ion pair system, namely wavelength, field and dielectric constant dependence, were investigated. The mismatch between theoretically estimated and experimentally determined B 1/2 , has been ascribed to the out-of-plane floppy motion of the perfluoranaphthalene radical anion, which bestows a σ character on the latter thereby affecting the hyperfine coupling constant. The low magnetic sensitivity of this exciplex system has been ascribed to a combined effect of static complexation of AN-PFN and an out-of-plane butterfly motion of the PFN radical.

Addition of small amphiphiles such as 1,4-dioxane is found to affect radical recombination and escape rates in micelles such as sodium dodecyl sulphate (SDS). This has been demonstrated with the hydrogen-abstracted product of triplet benzophenone as the probe molecule. This result has been interpreted on the basis of the ability of dioxane to form “mixed” micelles, which thereby affect the size, viscosity and reflectivity of the boundary of SDS. Studies in presence of magnetic fields up to 15 kG show that the magnetic field effect remains unaffected by the addition of dioxane. This his been explained as due to the combined effect of size, viscosity and reflectivity of the boundary of the micelle.

The magnetic response of the radical pair generated by the hydrogen abstraction of the photoexcited benzil triplet from sodium dodecyl sulphate is studied. It is found that radical decay curves, with or without magnetic field, are affected on addition of small amphiphiles such as 1,4-dioxane. The results have been interpreted on the basis of the ability of the latter to change the micellar aggregation number and intramicellar viscosity.

The response of pyrene-polystyrene-dimethylaniline (Py-PS-DMA) polymer (Mn = 4770) to an externally applied magnetic field has been examined in different solvents. Although the dielectric-constant (ϵ) effect is similar to that for the unlinked system, a closer look shows an interesting dependence on the nature of the solvent mixture. In pure acetone Δφ/φ is higher than that in a mixed solvent (tetrahydrofuran/dimethylformamide) of the same ϵ. The results have been explained on the basis of the fact that the influences of coil extension on the magnetic-field effect and the dielectric-constant effect compete with each other, resulting in different behaviours depending on the nature of the solvent mixture.

The magnetic field sensitivity of the pyrene-dimethylaniline (Py-DMA) system, linked by a polystrene (PS) spacer, was examined. It was found that isodielectric mixtures of tetrahydrofuran (THF) and dimethylformamide (DMF) and benzene and dimethylsulphoxide (DMSO) behave differently, the latter quenching the magnetic field effect more than the former; this is opposite to that found for the unlinked Py-DMA system. These studies demonstrate the importance of the solvent-dependent polymer backbone conformation. It was found that, in both of the above solvent mixture, the normal luminescence (φ) and the magnetic-field-modulated luminescence (Δφ) exhibit a shift in wavelength, indicating conformers with different magnetic sensitivities. The spectra taken at different times after excitation also support this conclusion.

The effect of a magnetic field on the luminescence of unlinked as well as linked exciplex systems has been discussed. The magnetic field modulated luminescence. (Δφ/φ) is not only dictated by the hyperfine interaction in the radical ion pair, but also by the environment, such as viscosity and dielectric constant (ϵ) of the medium and presence of other molecules in the neighbourhood of the exciplex. A complex interplay between spin evolution, radical pair recombination and diffusion determine the magnitude and nature of the magnetic field effect (MFE). The dependence of (Δφ/φ) on the ϵ could be explained on the basis of simple theoretical models. The concept of Heisenberg spin exchange has been invoked to rationalise the quenching of MFE by lanthanide ions. Time-resolved studies provide useful information regarding the dynamics of the spin-evolution of the system. In viscous medium the rotational diffusion slows down and the MFE becomes dependent on the direction of the field with respect to the exciplex.

The excited state complexation reaction between 1,4-diphenyl-1,3-butadiene and N,N-dimethylaniline was studied. In a sufficiently polar medium, 1: 2 complexes (or exterplexes) were formed. This exterplex system is magnetic field (MF) sensitive. The various parameters which characterize the MF effect in radical ion pair systems, namely wavelength dependence of the MF, field dependence, dielectric constant dependence and time dependence, were studied. The anomaly between the theoretically estimated and experimentally determined B 1 2 values was explained on the basis of the hopping mechanism.

The exciplex formed between diphenyl hexatriene and dimethyl aniline has been found to be magnetic-field sensitive. The effect of the dielectric constant of the medium and of addition of an alcohol on the magnetic-field modulated luminescence of the exciplex has been discussed. Theoretical B 1 2 values have been calculated by the INDO-UHF method. The lack of correspondence between the theoretical and the experimental B 1 2 values has been explained on the basis of electron hopping. In a viscous polymeric medium, anisotropic interactions between the radical partners have been observed. A qualitative explanation of this novel phenomenon, emphasizing the importance of anisotropic dipolar interactions, has been discussed. To the best of our knowledge, this is the first report on magnetic anisotropy of exciplex luminescence.

Excited benzil, encaged in sodium dodecylsulphate (SDS) surfactant in aqueous solution, generates a radical pair (benzil ketyl radical and SDS radical) on hydrogen abstraction from the micelle. The lifetime of this triplet-born radical pair is dependent on the magnetic field, reaching saturation at fields greater than 1 kG. An intermediate radical pair, as demonstrated by the occurrence of a magnetic field effect, is also observed on ππ* excitation of this fairly labile molecule. In addition, Cu2+ ions quench the effect of the magnetic field on the decay of the radical pair. From the temporal response and the magnetic field effect, it is concluded that radicals initially generated by nπ* and ππ* excitation are different.

Background: The long term risk of suicide following first onset of psychosis is unknown, because previous studies have (1) been based on prevalence cohorts, (2) been biased to more severely ill, hospitalised patients, (3) extrapolated from short follow–up times and (4) made a distinction between schizophrenia and other psychoses. Previous research has identified risk factors in the period leading up to suicide in psychotic illness, but little is known about whether factors identifiable early in the course of illness might be markers for later suicide. Objectives: (i) To determine the epidemiology of suicide and (ii) to investigate potential early risk factors for suicide in a clinically representative, retrospective inception cohort of n=2,723 first onset psychosis patients. Method: All 2,723 patients who presented for the first time to secondary care services with psychosis in three defined geographical catchment areas in London (1965-2004; n=2056), Nottingham (1997-1999; n=203) and Dumfries and Galloway (1979-1998; n=464) were traced after a mean follow-up period of 11.5 years and death certificates were obtained to identify deaths by suicide and open verdicts according to ICD-7-10. Potential early risk factors for suicide were identified from the Operational Checklist for Psychotic Disorders rated for the first year following presentation. Results: Overall there were 53 suicides and 391 deaths from other causes. Case fatality from suicide was considerably lower than expected from previous studies: 1.9% (53/2723); proportionate mortality was 11.9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with median time to suicide being 5.6 years. Suicide occurred approximately 12 times more than expected from the general population of England and Wales (SMR 11.65; 95%CI 8.7315.24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation, suicide risk remained almost 4 times higher than in the general population (SMR 3.92; 95%CI 2.22-6.89): a time when there may be less intense clinical monitoring of risk. Male gender (RR 2.84, 95% CI 1.206.69, p=0.02) and a cumulative threshold effect of symptoms early in the illness (RR 6.81, 95% CI 2.33-19.85, p

Background The long-term risk of suicide after a first episode of psychosis is unknown, because previous studies have often been based on prevalence cohorts, have been biased to more severely ill, hospitalised patients, have extrapolated from a short follow-up time, and have made a distinction between schizophrenia and other psychoses. The aim of this study was to determine the epidemiology of suicide in a clinically representative, retrospective inception cohort of patients with a first episode of psychosis. Methods All 2723 patients who presented for the first time to secondary care services with psychosis in three defined geographical catchment areas in London (1965–2004, n=2056), Nottingham (1997–1999, n=203), and Dumfries and Galloway (1979–1998, n=464) were traced after a mean follow-up of 11·5 years. The main outcome measure was number of deaths by suicide and open verdicts according to International Classification of Diseases, editions 7–10. Findings Case fatality from suicide was considerably lower than expected from previous studies: 1·9% (53/2723); proportionate mortality was 11·9% (53/444). Although the rate of suicide was highest in the first year after presentation, risk persisted late into follow-up, with median time to suicide being 5·6 years. Suicide occurred nearly 12 times more than expected from the general population of England and Wales (standardised mortality ratio 11·65, 95%CI 8·73–15·24), and 49 of the 53 suicides were excess deaths. Even a decade after first presentation, suicide risk remained almost four times higher than in the general population (3·92, 95%CI 2·22–6.89), a time when there may be less intense clinical monitoring of risk. Interpretation The highest risk of suicide after a psychotic episode occurs soon after presentation, yet clinicians should still be vigilant in assessing risk a decade or more after first contact. The widely held view that 10–15% die from suicide is misleading because it refers to proportionate mortality rather than lifetime risk. Nonetheless, after a first espisode of psychosis, risk of suicide is substantially increased compared with that in the general population. Funding UK Medical Research Council.

Emission spectra of p -N,N-dimethylamino benzonitrile (DMABN) in aqueous β-cyclodextrine (β-CD) solutions are reported. In β-CD two distinct kinds of emission are observed, one with enhanced nonpolar emission (at 355 nm) and the other exhibiting enhanced TICT emission (at 480 nm). The former is attributed to those DMABN molecules which are totally inside the β-CD cavity while the latter is due to DMABN molecules only partially enclosed in the cavity.

The excited state proton transfer reaction was studied for carbazole (CAZL) in non-ionic (Triton X-100), cationic (cetyltrimethylammonium bromide (CTAB)) and anionic (sodium dodecylsulphate (SDS) micelles. The micelles strongly affect the equilibrium quotient of the process. Taking the excited state proton transfer reaction as a probe, the critical micelle concentrations (CMCs) for the three micellar solutions were estimated. Furthermore, a phase transition was observed at high ionic strengths for Triton X-100.