RESUMO
BACKGROUND: The suicide rate has increased significantly among US Army soldiers over the past decade. Here we report the first results from a large psychological autopsy study using two control groups designed to reveal risk factors for suicide death among soldiers beyond known sociodemographic factors and the presence of suicide ideation. METHODS: Informants were next-of-kin and Army supervisors for: 135 suicide cases, 137 control soldiers propensity-score-matched on known sociodemographic risk factors for suicide and Army history variables, and 118 control soldiers who reported suicide ideation in the past year. RESULTS: Results revealed that most (79.3%) soldiers who died by suicide have a prior mental disorder; mental disorders in the prior 30-days were especially strong risk factors for suicide death. Approximately half of suicide decedents tell someone that they are considering suicide. Virtually all of the risk factors identified in this study differed between suicide cases and propensity-score-matched controls, but did not significantly differ between suicide cases and suicide ideators. The most striking difference between suicides and ideators was the presence in the former of an internalizing disorder (especially depression) and multi-morbidity (i.e. 3+ disorders) in the past 30 days. CONCLUSIONS: Most soldiers who die by suicide have identifiable mental disorders shortly before their death and tell others about their suicidal thinking, suggesting that there are opportunities for prevention and intervention. However, few risk factors distinguish between suicide ideators and decedents, pointing to an important direction for future research.
Assuntos
Transtorno Depressivo/epidemiologia , Transtornos Mentais/epidemiologia , Militares/estatística & dados numéricos , Ideação Suicida , Suicídio/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Multimorbidade , Prevalência , Pontuação de Propensão , Fatores de Risco , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: The U.S. Army uses universal preventives interventions for several negative outcomes (e.g. suicide, violence, sexual assault) with especially high risks in the early years of service. More intensive interventions exist, but would be cost-effective only if targeted at high-risk soldiers. We report results of efforts to develop models for such targeting from self-report surveys administered at the beginning of Army service. METHODS: 21 832 new soldiers completed a self-administered questionnaire (SAQ) in 2011-2012 and consented to link administrative data to SAQ responses. Penalized regression models were developed for 12 administratively-recorded outcomes occurring by December 2013: suicide attempt, mental hospitalization, positive drug test, traumatic brain injury (TBI), other severe injury, several types of violence perpetration and victimization, demotion, and attrition. RESULTS: The best-performing models were for TBI (AUC = 0.80), major physical violence perpetration (AUC = 0.78), sexual assault perpetration (AUC = 0.78), and suicide attempt (AUC = 0.74). Although predicted risk scores were significantly correlated across outcomes, prediction was not improved by including risk scores for other outcomes in models. Of particular note: 40.5% of suicide attempts occurred among the 10% of new soldiers with highest predicted risk, 57.2% of male sexual assault perpetrations among the 15% with highest predicted risk, and 35.5% of female sexual assault victimizations among the 10% with highest predicted risk. CONCLUSIONS: Data collected at the beginning of service in self-report surveys could be used to develop risk models that define small proportions of new soldiers accounting for high proportions of negative outcomes over the first few years of service.
Assuntos
Vítimas de Crime/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Transtornos Mentais/epidemiologia , Militares/estatística & dados numéricos , Modelos Estatísticos , Abuso Físico/estatística & dados numéricos , Medição de Risco/métodos , Autorrelato , Delitos Sexuais/estatística & dados numéricos , Tentativa de Suicídio/estatística & dados numéricos , Adolescente , Adulto , Feminino , Seguimentos , Humanos , Masculino , Prognóstico , Estados Unidos/epidemiologia , Adulto JovemRESUMO
Posttraumatic stress disorder (PTSD), a trauma-related mental disorder, is associated with mitochondrial dysfunction in the brain. However, the biologic approach to identifying the mitochondria-focused genes underlying the pathogenesis of PTSD is still in its infancy. Previous research, using a human mitochondria-focused cDNA microarray (hMitChip3) found dysregulated mitochondria-focused genes present in postmortem brains of PTSD patients, indicating that those genes might be PTSD-related biomarkers. To further test this idea, this research examines profiles of mitochondria-focused gene expression in the stressed-rodent model (inescapable tail shock in rats), which shows characteristics of PTSD-like behaviors and also in the blood of subjects with PTSD. This study found that 34 mitochondria-focused genes being upregulated in stressed-rat amygdala. Ten common pathways, including fatty acid metabolism and peroxisome proliferator-activated receptors (PPAR) pathways were dysregulated in the amygdala of the stressed rats. Carnitine palmitoyltransferase 1B (CPT1B), an enzyme in the fatty acid metabolism and PPAR pathways, was significantly over-expressed in the amygdala (P < 0.007) and in the blood (P < 0.01) of stressed rats compared with non-stressed controls. In human subjects with (n = 28) or without PTSD (n = 31), significant over-expression of CPT1B in PTSD was also observed in the two common dysregulated pathways: fatty acid metabolism (P = 0.0027, false discovery rate (FDR) = 0.043) and PPAR (P = 0.006, FDR = 0.08). Quantitative real-time polymerase chain reaction validated the microarray findings and the CPT1B result. These findings indicate that blood can be used as a specimen in the search for PTSD biomarkers in fatty acid metabolism and PPAR pathways, and, in addition, that CPT1B may contribute to the pathology of PTSD.
Assuntos
Tonsila do Cerebelo/metabolismo , Carnitina O-Palmitoiltransferase/genética , Ácidos Graxos/metabolismo , Mitocôndrias/genética , Receptores Ativados por Proliferador de Peroxissomo/metabolismo , RNA Mensageiro/metabolismo , Transtornos de Estresse Pós-Traumáticos/genética , Adolescente , Adulto , Animais , Encéfalo/metabolismo , Carnitina O-Palmitoiltransferase/metabolismo , Estudos de Casos e Controles , Modelos Animais de Doenças , Feminino , Humanos , Metabolismo dos Lipídeos , Masculino , Militares , Mitocôndrias/metabolismo , Análise de Sequência com Séries de Oligonucleotídeos , Ratos , Reação em Cadeia da Polimerase em Tempo Real , Transtornos de Estresse Pós-Traumáticos/metabolismo , Transcriptoma , Adulto JovemAssuntos
Fator Neurotrófico Derivado do Encéfalo/sangue , Fator Neurotrófico Derivado do Encéfalo/genética , Regulação da Expressão Gênica , Metionina/genética , Polimorfismo de Nucleotídeo Único/genética , Transtornos de Estresse Pós-Traumáticos/sangue , Transtornos de Estresse Pós-Traumáticos/genética , Valina/genética , Adolescente , Adulto , Campanha Afegã de 2001- , Animais , Modelos Animais de Doenças , Feminino , Genótipo , Humanos , Guerra do Iraque 2003-2011 , Masculino , Pessoa de Meia-Idade , Militares , Escalas de Graduação Psiquiátrica , Ratos , Reflexo de Sobressalto , Transtornos de Estresse Pós-Traumáticos/etiologia , Adulto JovemAssuntos
Leucócitos/metabolismo , Acontecimentos que Mudam a Vida , Transtornos de Estresse Pós-Traumáticos/genética , Estresse Psicológico/genética , Encurtamento do Telômero/genética , Adolescente , Adulto , Fatores Etários , Estudos de Casos e Controles , Humanos , Pessoa de Meia-Idade , Transtornos de Estresse Pós-Traumáticos/patologia , Estresse Psicológico/patologia , Adulto JovemAssuntos
Antipsicóticos/uso terapêutico , Hospitalização , Transtornos Psicóticos/tratamento farmacológico , Anticonvulsivantes/uso terapêutico , Antidepressivos/uso terapêutico , Antimaníacos/uso terapêutico , Quimioterapia Combinada , Lítio/uso terapêutico , Transtornos Psicóticos/diagnóstico , Ácido Valproico/uso terapêuticoRESUMO
We present a 46-year-old patient with Ph-chromosome negative, bcr-negative chronic myeloid leukaemia (CML) in accelerated phase with a clonal trisomy 21 in the leukaemic blast cells. A rapid progress of disease with appearance of monocytosis is described, showing similar features to chronic myelomonocytic leukaemia (CMML). Heterogeneous characteristics and possible distinction of these two entities are discussed.
Assuntos
Cromossomos Humanos Par 21 , Leucemia Mielogênica Crônica BCR-ABL Positiva/genética , Trissomia , Humanos , Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico , Leucemia Mielogênica Crônica BCR-ABL Positiva/patologia , Leucemia Mielogênica Crônica BCR-ABL Positiva/fisiopatologia , Masculino , Pessoa de Meia-IdadeRESUMO
Members of the U.S. military and their families represent a unique subsection of the American culture. The U.S. Constitution, federal law, and military regulations establish guidance for the conduct of service members during peacetime and wartime. This same hierarchy of law and regulation sets forth the legal rights and directs the provision of medical care for service members and their families. The fact that the military population is concurrently subject to a body of military law, as well as to the broader guidelines of the civilian sector, creates distinct roles for the military forensic psychiatrist. An understanding of the medical and legal framework in which the military forensic psychiatrist operates will facilitate the interactions of the civilian expert witness with the military justice system. In this report, the legal issues most relevant to the practice of forensic psychiatry in the military are discussed. In addition, the roles and responsibilities for psychiatrists specifically trained in aspects of military medical and mental health law are identified.
Assuntos
Psiquiatria Legal/legislação & jurisprudência , Militares/psicologia , Humanos , Estados UnidosRESUMO
The military has developed specialized mental health teams to evaluate and treat soldiers diagnosed with stress reactions and neuropsychiatric disorders. The response of these mental health teams in support of the year-long peace enforcement mission to Bosnia-Herzegovina is reviewed. Demographics and operational stressors are examined. Stress control doctrine is tested and revised. Credibility with leaders, chaplains, and medical personnel is achieved through rapid response to serious injury or fatality. Emphasis is placed on successful marketing strategies, stress management and suicide prevention classes, prompt access to care, and decreasing the stigma of mental health through education. Coordination of mental health assets promotes synergy and mission accomplishment.
Assuntos
Serviços de Saúde Mental , Militares , Estresse Psicológico/prevenção & controle , Guerra , Humanos , Estados Unidos , IugosláviaRESUMO
BACKGROUND: The authors designed a randomized, double-blind, crossover study to assess the efficacy of sertraline in the treatment of premenstrual dysphoric disorder (PMDD) when given only during the luteal phase of the menstrual cycle. METHOD: Thirty-one subjects were selected for a 7-month study period that included an initial 2 months of screening, 2 months of treatment with placebo or sertraline, 1 washout month, and 2 months of crossover treatment with either placebo or sertraline. Eleven subjects completed the study. Symptoms were monitored with daily reports using the Calendar of Premenstrual Experience (COPE). For each study phase, premenstrual COPE scores (7 days prior to menses) were examined using repeated measures analysis of variance. Scores were logarithmically transformed. Comparison of baseline scores between the luteal and follicular phases was examined using the paired t test. RESULTS: Analysis of COPE results during the treatment periods of the luteal phase showed a significant treatment effect, with higher scores during the placebo cycles compared with the sertraline-treated cycles (p = .0052 behavioral, p = .014 physical). CONCLUSION: This study is the first to demonstrate a significant response to a serotonin selective reuptake inhibitor used only during the luteal phase. The authors point out the importance of this finding both in terms of economic cost of patients as well as how it may add to the growing understanding of the etiology of PMDD.
Assuntos
1-Naftilamina/análogos & derivados , Síndrome Pré-Menstrual/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , 1-Naftilamina/administração & dosagem , 1-Naftilamina/uso terapêutico , Adulto , Comorbidade , Transtorno Depressivo/tratamento farmacológico , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/psicologia , Método Duplo-Cego , Esquema de Medicação , Feminino , Humanos , Fase Luteal , Prontuários Médicos , Inventário de Personalidade , Placebos , Síndrome Pré-Menstrual/epidemiologia , Síndrome Pré-Menstrual/psicologia , Inibidores Seletivos de Recaptação de Serotonina/administração & dosagem , Sertralina , Inquéritos e QuestionáriosRESUMO
We explored the relationship between psychiatric diagnosis and the presence of stuffed animals at the bedside in a population of adult female psychiatric inpatients. One of the authors made approximately weekly surveys of the wardrooms of adult psychiatric inpatients over twelve months for the presence of displayed stuffed animals. The observer was blind to the diagnosis of 80% of the patients, and the study or its hypothesis was not known to other physicians. The discharge diagnoses of patients displaying stuffed animals were recorded and compared with those of the ward population in general. Among 36 female patients who displayed stuffed animals in their rooms, Borderline Personality Disorder was diagnosed in 22 (61%) of these patients. Of 447 adult female patients admitted to the same unit over the same period, only 17% were noted to be diagnosed Borderline Personality Disorder. Stuffed animals as a bedside clinical clue may suggest evaluation for Borderline Personality Disorder.
Assuntos
Transtorno da Personalidade Borderline/psicologia , Fantasia , Vínculo Humano-Animal , Apego ao Objeto , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Admissão do PacienteAssuntos
1-Naftilamina/análogos & derivados , Choro/psicologia , Transtornos do Humor/tratamento farmacológico , Inibidores Seletivos de Recaptação de Serotonina/uso terapêutico , 1-Naftilamina/uso terapêutico , Idoso , Transtornos Cerebrovasculares/complicações , Humanos , Masculino , Transtornos do Humor/etiologia , Transtornos do Humor/psicologia , SertralinaRESUMO
Experiences of the diagnostic value of ultrasonography of pyometra in the bitch are reported. The different ultrasound scans of the uterus are illustrated. Results are compared with clinical diagnosis and pathophysiological findings after laparotomy and surgical removal of the uteri. Very close correlation (r: 0.985, p < 0.001) was found between the postoperative macroscopic and the ultrasound scan measurements of the uterus. Accuracy of the ultrasound diagnosis and reasons for false and questionable results are discussed. In summary, ultrasonography is an accurate procedure for the qualitative and quantitative examination and diagnosis of canine pyometra.