A group of patients (N = 1630) hospitalized in Stockholm County with a diagnosis of substance abuse during 1971-1972 were followed through 1984 as regards mortality: 446 (296 males and 150 females) patients died. The excess mortality in the cohort was 5.3 (males 5.8, females 4.6) compared to the general population in Stockholm County. The highest mortality was found in opiate users, with an excess mortality of 18.3. Fifty-one percent of the causes of death belonged to ICD-8 chapter 17, injury and poisoning, and of these, 69% (155 patients) were definite or probable suicides. Since HIV entered the Stockholm drug addict population by the end of this follow-up, the excess mortality reported here can be even higher in the years to come. To follow and monitor the mortality among patients with substance abuse is an important aspect in the evaluation of programs for prevention and treatment.

By means of the Stockholm County inpatient care register we identified all cases treated with a diagnosis of cannabis dependence and psychosis, not necessarily at the same occasion, during 1971-1983. By scrutinizing medical records, we evaluated the diagnosis according to DSM-III-R and we assessed the history of substance abuse as well as the psychiatric history and clinical course. We identified 229 cases during the follow-up; 112 of these cases (49%) fulfilled the DSM-III-R criteria for schizophrenia. The majority of the schizophrenics had prominent positive symptoms and a sudden onset of disease, and 69% of the cases had a record of heavy cannabis abuse at least 1 year before onset of psychotic symptoms. The high number of verified DSM-III-R cases of schizophrenia in this cohort and the temporal relation between cannabis abuse and schizophrenia further support the hypothesis that cannabis abuse may be a risk factor for schizophrenia. We confirmed previous observations that cannabis-associated schizophrenia often has a sudden onset and prominent positive symptoms.

Copyright 0 Munksgaard 1993 Pnnred m Denmark all nghts resewed I C A N D I N * " I I N , O " I N A L 0 8 SOCIAL WELFARE lSSN 0907 2055 Risk groups for parasuicide -a survey of unselected people who attempt suicide treated in hospital Adamsson C, Wasserman D, Eklund G. Risk groups for parasuicide -a survey of unselected people who attempt suicide treated in hospital. Scand J SOC Welfare 1993: 2 178-185. 0 1993 Munksgaard.A registration survey of parasuicide patients seeking hospital care in a defined catchment area was conducted over 24 months (1989)(1990). In 1989, 475 individuals registered as residents in the catchment area were given care on 541 occasions, and in 1990,382 individuals received care on 426 occasions as a result of parasuicide. The parasuicide rates for the overall population in the catchment area were estimated by means of demographic variables. Parasuicide rates were highest among women 25-39 years old and among men 30-39 years old, i.e., in older age groups than previous studies (from the 1970s) have shown. Parasuicide rates are 3 times as high for single men as for married men and twice as high for single women as for married women. Among single men and women, divord(e)s show the highest parasuicide rates, especially in the 15-34 age group. The number of parasuicides among women decreased significantly between 1989 and 1990, which had the effect of evening out the fema1e:male parasuicide ratio (1.28:l). Moreover, for the first time it becomes clear that the Finnish citizens in Sweden, both men and women, show a high risk for parasuicide compared with the Swedish population. These results focus attention on deficient psychic and social I wellbeing of Finns in Sweden.