Self-inflicted gunshot wounds: lethality of method versus intent.

The authors studied 30 patients treated at an urban trauma center for self-inflicted gunshot wounds, most or all of which would have been fatal without emergency treatment. About half the patients had used alcohol or drugs immediately before wounding themselves, and slightly more than half had experienced interpersonal conflict just before the incident. Thirteen of the 30 were women. Only nine were given diagnoses of major depressive episode or dysthymia; none of the patients had written suicide notes. These data indicate that the reported demographic and clinical characteristics of impulsive, violent self-injury must be reexamined.

Effectiveness of a meditation-based stress reduction program in the treatment of anxiety disorders.

OBJECTIVE: This study was designed to determine the effectiveness of a group stress reduction program based on mindfulness meditation for patients with anxiety disorders. METHOD: The 22 study participants were screened with a structured clinical interview and found to meet the DSM-III-R criteria for generalized anxiety disorder or panic disorder with or without agoraphobia. Assessments, including self-ratings and therapists' ratings, were obtained weekly before and during the meditation-based stress reduction and relaxation program and monthly during the 3-month follow-up period. RESULTS: Repeated measures analyses of variance documented significant reductions in anxiety and depression scores after treatment for 20 of the subjects--changes that were maintained at follow-up. The number of subjects experiencing panic symptoms was also substantially reduced. A comparison of the study subjects with a group of nonstudy participants in the program who met the initial screening criteria for entry into the study showed that both groups achieved similar reductions in anxiety scores on the SCL-90-R and on the Medical Symptom Checklist, suggesting generalizability of the study findings. CONCLUSIONS: A group mindfulness meditation training program can effectively reduce symptoms of anxiety and panic and can help maintain these reductions in patients with generalized anxiety disorder, panic disorder, or panic disorder with agoraphobia.

Trauma and posttraumatic stress disorder in subjects with anxiety disorders.

Trauma histories were obtained from 711 subjects in a large study of anxiety disorders, with the intent of determining the prevalence and nature of psychological trauma in this group. Twenty-seven percent of subjects reported significant trauma; 35% of these (10% of all subjects) met DSM-II-R criteria for posttraumatic stress disorder (PTSD). Subjects reporting sexual trauma were significantly more likely to have PTSD. The rate of PTSD was not higher in subjects with panic disorder than in those with other anxiety disorders.

Individual differences in changes in mood and platelet monoamine oxidase (MAO) activity during hormonal replacement therapy in menopausal women.

Estrogen replacement treatment in menopausal women has been reported to have a positive effect on mood states. However, the addition of a progestin partially negates this positive effect in some women. The opposite effects of estrogen and progestin on mood may relate to their opposite effects on adrenergic and serotonergic neural function. In a double-blind, placebo-controlled, crossover study, 38 nondepressed menopausal women were cyclically treated with estrogen and estrogen plus progestin, or with placebo, for five 28-day cycles. This paper identifies the pretreatment attributes of women who do and do not have negative mood responses to progestin, and examines the relationship of these adverse side-effects to platelet monoamine oxidase (MAO), a marker of adrenergic and serotonergic functioning. Adverse mood responses to progestin occur in women with a long duration of menopause, low pretreatment serum estradiol and testosterone levels, high pretreatment serum FSH levels, low pretreatment platelet MAO activity, and pretreatment mood abnormalities. We conclude that adverse mood response to the addition of a progestin occurs in menopausal women who have low pretreatment gonadal hormone levels secondary to a long duration of menopause. Impaired central nervous system adrenergic and serotonergic functioning also may be a factor predisposing to a negative mood response to progestin.

Relationships of serum estradiol levels, menopausal duration, and mood during hormonal replacement therapy.

A study was undertaken in 38 menopausal women on-cyclic HRT (estropipate) and estropipate + nor-ethindrone). Serum estradiol levels during treatment were related to mood changes and platelet MAO activity. The relationship between serum estradiol levels and mood changes was found to be a function of the duration of menopause. Women with a short duration of menopause (12.9 months +/- 6.1) were compared to women with a long duration of menopause (76.6 months +/- 52.3). Women with a short duration of menopause had significantly lower mean serum estradiol levels during HRT compared to women with a long duration of menopause (216.9 +/- 62.3 vs. 291.13 +/- 118.12, respectively, p < .02). It had previously been reported that estrogen treatment in menopausal women had a positive effect on mood, whereas the combination of estrogen plus a progestin had a negative effect on mood. We found that the women with a long duration of menopause and higher treatment serum estradiol levels had significantly more dysphoria when receiving a combination of estrogen plus progestin than did the women with a short duration of menopause and lower serum estradiol levels. However, both short and long duration menopausal groups showed improvement in mood when estrogen was administered alone. Platelet MAO levels, a marker of adrenergic and serotonergic function thought to relate to mood, were negatively correlated with serum estradiol levels during HRT. We suggest that these paradoxical findings may be secondary to a prolonged estrogen deficiency state in women with a long duration of menopause.

Trazodone overdose: four years of experience from voluntary reports.

The details of 88 cases involving trazodone overdose, either alone or in combination with other drugs, have been forwarded to the manufacturer by reporting physicians since trazodone was made available in March 1982. In 73 of these cases, recovery was uneventful; in 6 cases unexpected complications developed. Nine deaths occurred in patients who had taken trazodone in combination with other drugs and/or alcohol. These case reports are supplemented by data from the American Association of Poison Control Centers and the National Institute on Drug Abuse. Of 206 reported overdose exposures to trazodone, no deaths were recorded. For comparison, 2263 reported tricyclic and tetracyclic overdoses resulted in 16 deaths, and 125 reported monoamine oxidase inhibitor overdoses produced 3 fatalities. When taken alone in overdose, trazodone appears to have limited toxicity. Nevertheless, treatment should be monitored closely in patients who present with a history of seizures or who suffer from cardiovascular or respiratory disease.

Comorbidity of panic and major depressive disorder.

The objective of this report is to determine whether those patients with panic disorder who have current major depression disorder (MDD) differ from those who do not in terms of demographics, comorbid disorders, severity of illness, nature of symptoms of panic attacks and psychosocial functioning. The sample consisted of 182 patients with current or history of panic disorder measured by standardized interview techniques. For analysis these patients were then divided by presence or absence of current MDD. The two groups were not different in age, sex, or marital status, age of onset, or symptom characteristics of panic attacks. However, patients with MDD were more likely to have Social Phobia and Generalized Anxiety Disorder, been hospitalized, made suicide attempts or gestures, have poorer psychosocial functioning, and currently be experiencing panic with more severe symptoms. These findings are discussed in terms of previous literature in the area.

Suicidal behavior in patients with panic disorder: retrospective and prospective data.

This paper examines factors associated with suicidal behavior in patients with anxiety disorders. HARP is a naturalistic, prospective, longitudinal follow-up study. This paper examines 527 subjects with panic disorder (with or without agoraphobia). 9% of the subjects reported past suicidal behavior. Factors associated with suicidal behavior were depressive disorders, substance abuse, eating disorders, PTSD and personality disorders as well as having early onset of the first anxiety or depressive disorder. Subjects had a 4.5% P of suicidal behavior during the first 30 months of follow-up. All prospectively recorded suicidal behavior occurred in subjects with depressive disorders. In these panic disorder patients, suicidal behavior rarely occurred in the absence of affective disorders. Certain nondepressive disorders also substantially increased the risks of suicide attempts/gestures.

Navane versus Haldol. Treatment of acute organic mental syndromes in the general hospital.

A single blind study design was used to evaluate the efficacy and safety of Navane versus Haldol in acute organic mental syndromes in a general hospital setting. Seventeen patients were entered into the study; only 14 remained in the study long enough to complete the protocol. Most patients treated with either neuroleptic agent improved. Only one patient was worse. Improvement occurred rapidly (2-3 days), and few significant side effects were observed. There was a trend toward lower BPRS scores in patients treated with Navane (thiothixene).

Psychotropic medications in patients with cancer.

Psychotropic drug use in the patient with cancer is reviewed from the perspective of the practicing oncologist and the consulting psychiatrist. Guidelines are offered for use of psychotropic agents for specific symptoms, such as nausea and vomiting, pain control, treatment of depression, delirium, anxiety, and psychosis. The importance of careful assessment and treatment of the causes of psychiatric symptoms is stressed. Recommendations for use of specific psychotropic agents are reviewed, including dosage range and route of administration as well as possible drug interactions and other factors affecting the use of these agents in patients. Anecdotal uses of these agents are also considered.

Psychiatric symptoms in endocrine diseases. Keys to identifying the underlying disorder.

Several important points should be considered regarding psychiatric symptoms in endocrine disorders. The presence of cognitive deficits in a patient presenting with anxiety, depression, or another apparently "functional" psychiatric complaint should raise the index of suspicion of organic etiology, with endocrine disorders high on the list. Psychiatric symptoms secondary to endocrine disturbance generally reverse, albeit slowly, with treatment of the primary hormonal abnormality. When significant disruption of cognitive functioning is evident, residual deficits may develop. Treatment with psychotropic agents for symptomatic relief of psychiatric complaints should be undertaken with great caution in patients with endocrine disorders.

Rate response of 1,3-dichloropropene for nematode control in spring squash in deep sand soils.

The soil fumigant 1,3-dichloropropene (1,3-D) formulated with chloropicrin is viewed as a likely alternative for replacing methyl bromide in Florida when the latter is phased out in 2005. Therefore, it behooves us to learn more about using 1,3-D in deep, sand soils. Two trials were conducted on spring squash to determine the most effective rate of 1,3-D for the control of Meloidogyne spp. Rates tested included 0, 56, 84, 112, and 168 liters/ha of 1,3-D applied broadcast with conventional chisels 30 cm deep. The chisel traces were sealed by disking immediately after fumigant application. Cucurbita pepo cv. Sunex 9602 was sown 7 days after fumigation. The population density of plant-parasitic nematodes in soil and root-knot nematode galling severity was determined at 34 and 65 days after planting (DAP), and the number of marketable fruit and yield were determined. The number of fruit and yield were higher in all plots that received 1,3-D than in untreated controls. The number of Meloidogyne spp. second-stage juveniles was lower in all fumigated plots in trial 1 at both 34 and 65 DAP, and in trial 2 at 65 DAP, than in the untreated control. The severity of root galling was decreased with all treatments in both trials, with broadcast rates of 84, 112, and 168 liters/ha providing the best control of root-knot nematodes in spring squash grown in sandy soil. Satisfactory management of root knot on squash grown in early spring months in north Florida can be achieved with low rates of 1,3-D.

Efficacy of 1,3-dichloropropene in soil amended with compost and unamended soil.

1,3-Dichloropropene (1,3-D) is a likely alternative soil fumigant for methyl bromide. The objective was to determine root-knot nematode, Meloidogyne incognita, survival in microplots after exposure to 1,3-D for various periods of time in soil that have previously been amended with compost. The treatments were 1,3-D applied broadcast at 112 liters/ha and untreated controls in both compost-amended and unamended soil. Soil samples were collected from each microplot at 6, 24, 48, 72, and 96 hours after fumigation at three depths (0-15, 15-30, and 30-45 cm). One week after fumigation, six tomato seedlings were transplanted into each microplot and root galling was recorded 6 weeks later. Plants grown in fumigated compost-amended soil had more galls than plants from fumigated unamended soil at P

Spontaneous proteus nephritis among male C3H/HeJ mice.

The spontaneous occurrence of nephritis and resultant mortality was investigated among 2,836 control or treated (dermal carcinogenesis bioassays) C3H/HeJ male mice. Overall incidence of nephritis putatively caused by Proteus mirabilis was 1.2%. Incidences were similar in control and treated mice and ranged from 2.5--32.5% among 73 unrelated treatment or control groups. Diagnosis was based upon characteristic gross or histologic renal lesions. Grossly affected kidneys contained either multiple, discrete tan foci or elevated pale tan patches. Histologic renal lesions consisted of a multifocal necropurulent nephritis with numerous gram negative bacteria present in affected tubules. Necrotizing pyelitis and papillitis usually was present, an necropurulent cystitis was present in half of the cases examined histologically. Proteus mirabilis, isolated in pure culture from an affected kidney, produced similar renal lesions after intraperitoneal or intravenous inoculation of clinically normal C3H/HeJ males. The organism was reisolated from the kidneys of the experimentally produced cases. It was concluded that nephritis putatively caused by Proteus mirabilis was an important cause of mortality in male C3H/HeJ mice.

Repetitive suicidal crises: characteristics of repeating versus nonrepeating suicidal visitors to a psychiatric emergency service.

The present study involves a retrospective chart review of all patients who visited the Emergency Mental Health Service during the period of July 1, 1985 to June, 30, 1986 (total visits = 2,772). It compares those 'suicidal' patients seen only once during the index year with those seen multiple times (comparison of first visit only for both 'one-timers' and 'repeaters'). The 'repeaters' were generally found to be older and were more likely to have a diagnosis of schizophrenia and personality disorder. Unlike previous studies, substance abuse and affective disorder did not significantly differentiate the two groups. The 'repeaters' were also more likely to be taking antipsychotic and antiparkinson medications, have histories of past psychiatric hospitalizations in the public sector, be living alone, and most importantly, to have made a previous suicide attempt.

Comparison of diagnostic tests for hymenoptera sting allergy.

The authors examined correlations among individual Hymenoptera venom skin tests, venom radioallergosorbent tests (RAST), venom-induced leukocyte histamine release (LHR) assays and individual Hymenoptera whole body extract (WBE) skin tests in 37 patients with histories of systemic reactions to Hymenoptera stings. Significant positive correlations were seen between the venom skin test results and results from either the venom RAST or the LHR assay for most venoms. There was a relatively high frequency of positive WBE skin tests in association with other negative tests. The ultimate diagnostic test for stinging insect sensitivity is a deliberate sting challenge; in lieu of such a sting the clinical history and the venom skin test appear to provide the best estimate of clinical Hymenoptera sting sensitivity.

Evaluation of udder preparations on intramammary infections.

Udder preparations of wet towel plus drying and .1% iodophor premilking teat dipping plus drying were compared with no preparation to determine effects on number of new intramammary infections. Teats of 84 cows were challenged (5 d/wk) for 18 wk with a culture broth of Streptococcus uberis 3 h prior to each p.m. milking to stimulate environmental contamination. Wet towel plus drying and premilking teat dipping plus drying significantly reduced number of new intramammary infections compared to no preparation. Cleaning with water or dipping with a premilking teat dip and manual drying of teats may have contributed to the reduction in number of new infections. Premilking teat dipping plus drying further reduced number of new infections compared to use of wet towel plus drying. Apparently, teat dipping was more effective in reducing the number of new infections than water used with the wet towel. This study showed that udder preparations can affect udder health when an experimental bacterial challenge is applied.

Psychiatric referral after head trauma.

This preliminary study of 22 patients referred for psychiatric consultation after HT requires further investigation to better define the trends observed regarding diagnosis, injury site, and medication choice. The absence of a control population of HT patients not referred for psychiatric evaluation limits our ability to make definitive conclusions. Further work is also planned to systematically explore the injury site-medication relationship.