[Effect of the form of pathological tortuosity of the internal carotid artery on cerebral haemodynamics].

The prevalence of pathological tortuosity of carotid arteries according to the findings of angiographic studies varies from 10% to 43%. This pathology is morphologically diversified, requiring detailed verification of its forms in order to specify the character of impaired cerebral haemodynamics in each individual case. All patients presenting with manifestations of cerebral insufficiency underwent ultrasonographic duplex scanning of the vessels of the system of the brachiocephalic arteries according to the standard methods, measuring the volumetric velocity of blood flow before and after the pathological bend, the blood-flow linear velocity gradient. Revealing haemodynamically significant alterations was followed by contrast-enhanced computed tomography with subsequent 3-D reconstruction based on which we selected an optimal projection making it possible to measure the angles of the pathological bends. The second stage of the study consisted in mathematical calculations of the haemodynamic indices (the Reinolds number allowing of determining the regimen of the blood flow along the vessels, local losses of head according to the Weisbach formula, loss of pressure for local resistance), and statistical treatment of the data (two-tailed exact Fisher's test, Statistica 6.0). The obtained findings suggest a statistically significant increase in the prevalence of ischaemic stroke in patients with the angle of the pathological bend measuring 60° and less. Patients of this group are found to have an increase in the linear velocity of blood flow exceeding 150 cm/s and the value of the gradient over 2.4, thus suggesting haemodynamic significance. An increase in the acuity of the angle of a smooth turn from 60° to 30° was accompanied by a 3-fold increase in loss of pressure on the portion of local resistance from 509 to 1,466 Pa. Thus, in the vessels with the angle of a smooth turn of 90° and more haemodynamic alterations to a large extent depend on the internal surface of the vascular wall, in the bends of the vessel with a turning angle of less than 90° they depend on the value of the angle of a smooth turn.

Predictive algorithms for neuromuscular control of human locomotion.

The problem of quantifying muscular activity of the human body can be formulated as an optimal control problem. The current methods used with large-scale biomechanical systems are non-derivative techniques. These methods are costly, as they require numerous integrations of the equations of motion. Additionally, the convergence is slow, making them impractical for use with large systems. We apply an efficient numerical algorithm to the biomechanical optimal control problem. Using direct collocation with a trapezoidal discretization, the equations of motion are converted into a set of algebraic constraint equations. An augmented Lagrangian formulation is used for the optimization problem to handle both equality and inequality constraints. The resulting min-max problem is solved with a generalized Newton method. In contrast to the prevalent optimal control implementations, we calculate analytical first- and second-derivative information and obtain local quadratic convergence. To demonstrate the efficacy of the method, we solve a steady-state pedaling problem with 7 segments and 18 independent muscle groups. The computed muscle activations compare well with experimental EMG data. The computational effort is significantly reduced and solution times are a fraction of those of the non-derivative techniques.

Pork with a high content of polyunsaturated fatty acids lowers LDL cholesterol in women.

BACKGROUND: Animal products contribute significantly to the saturated fat and cholesterol content of the American diet. Contrary to dietary advice, consumers have not limited their consumption of animal products. Thus, an alternative approach might be to modify the fatty acid composition of animal products. OBJECTIVE: We tested the hypothesis that modified pork with a high content of polyunsaturated fatty acids (PUFAs) and a low content of saturated fatty acids (SFAs) would lower plasma LDL-cholesterol concentrations in women. DESIGN: Twenty women aged 19-24 y completed a crossover study with 2 diets. Nutritionally complete diets containing 42% of energy from fat differed only in the inclusion of either standard or modified pork. Venous blood samples were collected at weeks 0, 4, and 8. RESULTS: The diet containing modified pork significantly lowered total plasma (P < 0.0076) and LDL (P < 0.0382) cholesterol. The modified diet also resulted in an increase in the PUFA and a decrease in the SFA and monounsaturated fatty acid contents of the cholesteryl ester, free fatty acid, phospholipid, and triacylglycerol lipid classes in both plasma and erythrocytes. Plasma concentrations of glucose, insulin, triacylglycerol, and free fatty acids did not change significantly. CONCLUSIONS: Consumption of pork with a high PUFA content resulted in a decrease in the subjects' total plasma and LDL cholesterol and shifted the fatty acid composition from SFAs to PUFAs in the plasma and erythrocytes. Modification of the fatty acid composition of animal foods will be a useful approach to lowering the saturated fat consumption of Americans.

Energy-conserving impact algorithm for the heel-strike phase of gait.

Significant ground reaction forces exceeding body weight occur during the heel-strike phase of gait. The standard methods of analytical dynamics used to solve the impact problem do not accommodate well the heel-strike collision due to the persistent contact at the front foot and presence of contact at the back foot. These methods can cause a non-physical energy gain on the order of the total kinetic energy of the system at impact. Additionally, these standard techniques do not quantify the contact force, but the impulse over the impact. We present an energy-conserving impact algorithm based on the penalty method to solve for the ground reaction forces during gait. The rigid body assumptions are relaxed and the bodies are allowed to penetrate one another to a small degree. Associated with the deformation is a potential, from which the contact forces are derived. The empirical coefficient-of-restitution used in the standard approaches is replaced by two parameters to characterize the stiffness and the damping of the materials. We solve two simple heel-strike models to illustrate the shortcomings of a standard approach and the suitability of the proposed method for use with gait.

Hepatic microsomal and peroxisomal docosahexaenoate biosynthesis during piglet development.

The roles of peroxisomes and microsomes on the biosynthetic pathway for docosahexaenoic acid (DHA) from alpha-linolenic acid (ALA) were investigated. Microsomes and peroxisomes were prepared from livers of fetal and neonatal piglets by a combination of differential and gradient layer centrifugation. Microsomes, peroxisomes, and combined cell fractions were incubated with [13C-U]18:3n-3. The [M] and [M + 18] isotopomers of the fatty acids in the long-chain polyunsaturated fatty acid (LCPUFA) n-3 pathway were detected by gas chromatography-mass spectrometry. The quantity of each fatty acid was determined by gas chromatography, and synthesis of each fatty acid was calculated for a 30-min period. Synthesis of DHA was not detected in combined fetal liver fractions. The data suggest that DHA in the fetus is probably supplied from maternal sources through the placenta. In either singly incubated microsomal or peroxisomal preparations from neonatal livers, no DHA synthesis was detected. After combination of the microsomal and peroxisomal fractions, DHA synthesis was evident and increased rapidly between birth and 2 wk of age. This is the first demonstration of the entire biosynthetic LCPUFA n-3 pathway in subcellular organelles starting from isotopically labeled ALA to the final product, DHA, with all the intermediates present and isotopically labeled. The primary importance of the data is that it unequivocally demonstrates that peroxisomes are required for biosynthesis of DHA from ALA.

Dissociative symptomatology and aggressive behavior.

The present study examined the relationship between dissociative symptomatology and a range of aggressive behavior in a general psychiatric outpatient population. Of the total sample (n = 122), 29% scored above 25 on the Dissociative Experiences Scale (DES). Patients with high DES scores (> 25) were significantly more likely than patients with lower DES scores (< 25) to report a history of childhood sexual abuse, to have attempted suicide, and to report more assaultive behavior, irritability, and negativism. There were no differences between the patients with high versus low DES scores on homicidal behavior. To better manage and treat outpatients with dissociative symptomatology, it is important to clarify the association between outwardly aggressive behavior and dissociative experiences.

Soluble amylose cornstarch is more digestible than soluble amylopectin potato starch in rats.

In liquid enteral formulations, high molecular weight soluble starches may be able to replace glucose and low molecular weight glucose polymers that have high glycemic indices. Male rats were fed either commercial cornstarch, dextrose, modified soluble potato (70-75% amylopectin) starch, or modified soluble amylomaize-7 (70% amylose) starch for 4 wk. Body weights did not differ among the groups. Food consumption was significantly higher in the two modified starch-fed groups than in the two control groups. Commercial cornstarch, dextrose, modified potato starch and modified amylomaize-7 starch were 100 +/- 0, 100 +/- 0, 69.0 +/- 1.0 and 91.5 +/- 0.8% digestible, respectively (n = 9, mean +/- SEM). The modified potato starch-fed group deposited the least fat, protein and energy. In both modified starch-fed groups, liver weights were significantly greater than in the two control groups. In food-deprived rats, serum free fatty acid concentrations in the modified potato starch-fed group were significantly higher than in the two control groups, and serum glucose concentrations were significantly higher in the two modified starch-fed groups than in the controls. The insulin to glucagon ratios were significantly lower in the modified potato starch-fed and amylomaize-7 starch-fed groups than in the dextrose-fed control group. Serum protein concentrations, measured after food deprivation, were significantly lower in the modified potato starch-fed group than in the other three groups. Gluconeogenesis from fermentation products might account for the high serum glucose concentrations in the two experimental groups. These data indicate that only the modified amylomaize-7 starch may be useful in the development of food products for liquid nutritional supplements because of the high digestibility and the low resultant insulin levels.

Violence and homicidal behaviors in psychiatric disorders.

Our review evaluating the relationship between violent/homicidal behaviors and mental illness/psychiatric disorders used many different data including that assessing the prevalence of violent/homicidal behaviors in former psychiatric inpatients (just before hospitalization, during hospitalization, and after discharge) as outpatients and in community samples as well as evaluating the prevalence rate of psychiatric disorders in people who actually engaged in violent/homicidal disorders (jail detainees, prison inmates, and community samples). Irrespective of which line of investigation, there was convincing evidence that violent/ homicidal behavior was associated significantly with mental illness. Although earlier investigations failed to control for important variables, such as age and sociodemographics, most studies reviewed in this article did control for these items, further underlining the association of violence and mental illness. The question of whether specific psychiatric diagnostic categories are associated with violent/homicidal behavior is less definite across the various studies reviewed. The presence of substance abuse and dependence and alcohol abuse and dependence as well as antisocial personality disorder are particularly associated with an increased risk of violent/homicidal behaviors. The risk for these latter behaviors in schizophrenia, mood disorders, and anxiety disorders may appear somewhat greater than that for a general population but are not of the same magnitude of that for substance abuse or antisocial personality disorder. Interestingly, our outpatient study found that homicidal behaviors were not associated with any specific psychiatric diagnosis. Although understanding whether specific psychiatric diagnostic categories are more prone to violent behaviors may be of importance, most studies have been shortsighted regarding this evaluation. All the studies presented in this article except the ECA project, presented diagnostic data where either the presence of one psychiatric disorder did not preclude the diagnosis of another or assigned subjects/patients into the severest disorder of a predetermined hierarchy of diagnoses or only selected their principal/primary diagnosis. Thus, the effect of having a solitary psychiatric disorder (only one disorder present) as well as the effect of comorbidity per se on the relationship of psychiatric disorders and violent/homicidal behaviors were unexplored. Only the ECA study by Swanson and colleagues reported on the effect of comorbidity. As reviewed earlier in the article, Swanson et al found that comorbidity of psychiatric diagnostic categories further increased the risk of violent/ homicidal behaviors. In most cases, it was many more times than simply adding the rates of either diagnosis alone. Because more than 54% of respondents of the National Comorbidity Survey study who had one DSM-III-R diagnosis also had at least a second Axis I diagnosis, the association of violent/homicidal behaviors to mental illness may even be stronger than originally believed. Within the relationship of violent/homicidal behaviors and mental illness, this article suggests a number of particular risk factors. As just reviewed, substance/alcohol abuse and antisocial personality disorder as well as the presence of comorbid psychiatric disorders are significant risk factors. Which particular comorbid illness increases the risk still needs further elaboration. Studies must continue to try to define and understand the relationship of violent/homicidal behaviors in mental illness. Although mental disorders per se are significantly associated with violent/homicidal behaviors, it is reasonable to believe that targeting certain subgroups of patients should be helpful. Probably the presence of psychotic symptoms is a significant risk factor in violent/ homicidal behaviors in the mentally ill. Only one of the studies reviewed in this article evaluated this issue. (ABSTRACT TRUNCATED)

Childhood abuse, adult assault, and dissociation.

Recent studies have suggested an association between childhood physical and sexual abuse and adult dissociative experiences. The purpose of this study was to determine the relationship of both childhood and adult-onset abuse and their characteristics for adult dissociative symptoms. One hundred forty-four psychiatric outpatients completed self-report questionnaires on measures of dissociation (Dissociative Experience Scale [DES]) and histories of both past and current sexual and physical abuse (Traumatic Events Questionnaire [TEQ]). Of 114 subjects (30 men and 84 women) who completed both forms, 35% and 43% reported childhood physical and sexual abuse, respectively. Dissociative symptoms were significantly related to ethnicity and multiple episodes or combined types of abuse in childhood and adulthood. In terms of the characteristics of childhood abuse, numerous episodes of physical abuse (P = .01) and father-perpetrated sexual abuse (P = .02) were significantly related to the degree of dissociation. These findings emphasize the role of repeated childhood trauma and the combination of both childhood and adult traumatic experiences in the development of dissociative phenomena.

Prevalence and characteristics of physical and sexual abuse among psychiatric outpatients.

Eighty-six female and 34 male psychiatric outpatients completed a self-report questionnaire that retrospectively assessed their history of physical and sexual abuse and assault. Seventy percent reported an abusive experience in childhood or adulthood. Female subjects were more likely than male subjects to report childhood sexual abuse and adult physical and sexual assaults. For all subjects, childhood sexual abuse was associated with adult sexual and physical assault. The charts of several patients who reported abuse histories did not include any record of abuse.

Suicidal behavior and abuse in psychiatric outpatients.

The present study examines the relationship between suicidal behaviors and histories of abuse in psychiatric outpatients. Two hundred fifty-one psychiatric outpatients were evaluated for history of abuse, suicidal behavior, demographics, and clinical characteristics using self-report instruments and a face-to-face interview. Logistic regression analysis indicated that physical abuse (battering) in adulthood and histories of a combination of childhood and adulthood abuse were significant predictors of past suicide attempts and current suicidal ideation. Victims of abuse were more likely than nonvictim controls to have been suicidal at a younger age and to have made multiple suicide attempts. Among patients with a history of abuse, suicide attempters could be distinguished from nonattempters on the basis of higher levels of dissociation, depression, and somatization. Abusive experiences in adulthood appear to play an important role in suicidal behavior among psychiatric outpatients. High levels of specific symptoms (i.e., depression, somatization, and dissociation) among patients with a history of abuse can help to identify outpatients at risk for suicidal behavior.

Animal model for evaluating the effect of systemic estrogen deficiency on residual ridge resorption.

The rate of resorption of residual ridges after tooth extraction varies among subjects. Despite many human studies, the etiologic factors of severe forms of resorption of residual ridges are unknown and probably multifactorial. To facilitate investigations of resorption of residual ridges, it is preferable to use an animal model with a dentoalveolar component similar to that of human beings. This study developed a rapid, nonhuman primate model in which one could measure resorption of residual ridges at the most critical period, with the least amount of time, minimal operation, and the least interference with normal nutrition. Three female Macaca fascicularis monkeys, 7 to 9 years old, were selected for simple extraction of four maxillary incisors, four mandibular incisors, and two mandibular canines. Lateral cephalographs were taken at weeks 0, 1, 2 to 3, 5 to 6, 8 to 9, 11 to 12, and 26 to 28 after extraction with a newly constructed cephalostat that allowed easy reproducibility of animal placement in the prone position. Height and area measurements were made of maxillary and mandibular anterior residual ridges in the superimposed cephalographs. Sequential mean bone loss data produced bone loss curves similar to those observed in humans. One animal underwent ovariectomy. The plasma levels of both estrogen and progesterone decreased over 25 days and stayed below the detection limits thereafter. Tooth extraction was done 4 weeks after the ovariectomy and the bone resorption pattern was able to be observed longitudinally with the newly established monkey cephalostat. The results indicated that Macaca fascicularis need not be sacrificed when used in longitudinal studies of resorption of residual ridges in a relatively short period of experimental time. This model can provide an excellent opportunity to investigate a causal relationship between the rate of resorption of residual ridges and predisposing systemic factors such as estrogen deficiency.

Early treatment of obese (ob/ob) mice with triiodothyronine increases oxidative metabolism in muscle but not in brown adipose tissue or liver.

We explored the possibility that early replacement of low triiodothyronine (T3) may improve the low oxidative metabolism in metabolically important tissues of ob/ob mice. Triiodothyronine doses (2.5 to 25.0 micrograms/100 g body wt) were injected intraperitoneally into ob/ob and non-ob/ob mice daily from 3 wk until 6 wk of age. Untreated ob/ob and non-ob/ob mice were injected with saline (pH 9.1). Food intake was equalized across all groups. At 6 wk of age, the O2 consumption of muscle, white and brown adipose tissues, and hepatocytes was measured. The saline-treated ob/ob mice showed lower muscle weights, higher fat pad and liver weights, and larger fat cell sizes than saline-treated non-ob/ob mice. In ob/ob mice, tissue O2 consumption was the same in muscle, lower in brown and white adipose tissues, but higher in liver compared with values in non-ob/ob mice. Triiodothyronine treatment in ob/ob mice resulted in lower values for body weight, liver weight, hepatocyte number, liver protein, epididymal fat pad weight, and white adipocyte number and size than in saline-treated ob/ob mice. Triiodothyronine treatment increased soleus muscle, liver and brown adipose tissue O2 consumption in non-ob/ob mice. In ob/ob mice, triiodothyronine increased only soleus muscle O2 consumption and required higher doses than in non-ob/ob mice to achieve an effect. These data are consistent with the concept of tissue triiodothyronine resistance in ob/ob mice. Low triiodothyronine levels and tissue resistance to triiodothyronine might be important early defects in this obesity syndrome.

Early treatment of obese (ob/ob) mice with triiodothyronine increases oxygen consumption and temperature and decreases body fat content.

An early abnormality in the ob/ob mouse is a low circulating level of the thyroid hormone, triiodothyronine (T3). The possibility was explored that early T3 treatment of ob/ob mice will increase oxidative metabolism and lower body fat content. Doses of T3, ranging from 0.0 to 25.0 micrograms/100 g body wt were injected, ip, into ob/ob and non-ob/ob mice daily from 3 weeks until 6 weeks of age. Food intake was equalized across all groups to that consumed by non-ob/ob saline-treated group. At 6 weeks of age, body weight, serum concentrations of thyroxine (T4), T3, insulin and glucose, oxygen consumption, colonic temperature, and body composition were analyzed. T3 treatment decreased body weight, increased body oxygen consumption, increased colonic temperature, and decreased body fat without a significant change in body protein in ob/ob mice. T3 treatment also increased serum T3, and decreased serum T4, insulin, and glucose concentrations in ob/ob mice. Because total body protein did not change as a result of T3 treatment, the increased oxidative metabolism due to T3 treatment was probably via the change of metabolic activity of the total lean body mass or the specific metabolically active tissues in the ob/ob mice, such as brown adipose tissue, liver, or muscle.

Cardiac adaptations to chronic exercise in mice.

Transgenic mice can be created to serve as models of human cardiac disease. Despite the technology available to manipulate the cardiovascular system of the mouse, there is relatively little information available concerning the normal physiology of the mouse heart. Therefore, we have characterized the response of the adult mouse to chronic physical conditioning by swimming. Adult female C57/B16 mice were conditioned by swimming up to 90 min twice daily for 4 wk, resulting in a 10% increase in heart weight and a 16% increase in heart weight-to-body weight ratios compared with sedentary controls. The heart rate response to a submaximal work load decreased > 20% with this conditioning program. Succinate dehydrogenase activity increased markedly in the soleus muscles of the conditioned animals, from 28 +/- 3 to 44 +/- 3 nmol.mg-1.min-1. In contrast to these changes, which also characterize the exercise model in the rat, no increase in cardiac tissue norepinephrine content or in cardiac myosin or myofibrillar adenosinetriphosphatase (ATPase) activities was observed, and no change in the V1 predominant myosin isoform or alpha-myosin heavy chain mRNA profiles was seen in the hearts of the swimmers. This study establishes that mice are able to develop cardiac hypertrophy in response to chronic conditioning which is not associated with changes in the ATPase activities of cardiac muscle. These data should be of use to investigators using murine models to define the molecular basis of adaptive cardiac hypertrophy in vivo.

Tetracycline-regulated cardiac gene expression in vivo.

Tight regulation of foreign genes expressed in vivo would facilitate studies of many biologic processes and would be useful for gene transfer-based therapies. To test the ability of a tetracycline-regulated gene expression system to function in vivo, we directly injected chimeric tet repressor-VP16 transactivator expression plasmids and luciferase target genes into the hearts of adult rats. Cardiac luciferase activity increased over two orders of magnitude in response to small changes in input tetracycline-controlled transactivator DNA. Transactivation was repressed to background levels by subtherapeutic concentrations of tetracycline in a dose-dependent manner. Target gene expression could be rapidly and reversibly controlled by manipulating antibiotic administration. This system may be particularly useful for in vivo studies of gene function or gene therapies where the timing or extent of expression are critical variables.

Suicide assessment: clinical interview vs. self-report.

This study examined whether patients disclosed the same information about suicidal behaviors on a self-report instrument that they conveyed to a clinician in a face-to-face interview. The results indicated a generally high level of agreement between these two forms of suicide assessment. The one exception was the question that concerns recent suicidal ideation, where patients tended to disclose more on the self-report form.

Homicidal behaviors among psychiatric outpatients.

OBJECTIVE: Most studies of violent behavior among psychiatric patients focus on inpatients or patients recently discharged from psychiatric units. To explore violent behavior among patients living in the community, the authors examined the prevalence of homicidal behaviors in a general psychiatric outpatient population. METHODS: During an intake evaluation, 517 outpatients completed several self-report instruments that included a detailed survey of past and current homicidal behaviors covering homicidal ideation, plans, and attempts. Demographic and clinical characteristics of patients with and without a history of homicidal behaviors were compared. RESULTS: Twenty-two patients (4 percent) reported a past homicide attempt. Patients who reported homicide attempts could be distinguished from patients with no homicidal behaviors by the presence of other aggressive behavior such as suicidal ideation and suicide attempts by themselves and their family members and by elevated current measures of interpersonal sensitivity, hostility, and paranoid ideation. CONCLUSIONS: The rate of homicide attempts in the general outpatient population studied was considerably lower than the reported rates of assault among inpatients. The relationship between past and current episodes of aggressive behavior reinforces the importance of including a careful assessment of past history of violent behaviors as part of the routine psychiatric evaluation.

Distinct behavior of cardiac myosin heavy chain gene constructs in vivo. Discordance with in vitro results.

Transcriptional thyroid hormone responsiveness of the cardiac alpha-myosin heavy chain (alpha-MHC) gene has been demonstrated in transfections into fetal and neonatal cardiomyocytes and in transgenic mice. However, the correspondence between the regulation of MHC expression in dissociated cells with that in the intact heart is unclear. Given the cost and time involved in generating multiple transgenic lines for the characterization of gene regulatory elements, we used direct cardiac gene transfer to identify elements regulating both basal and thyroid hormone responsive cardiac alpha-MHC gene expression in the adult heart in vivo. Sequences upstream of the rat alpha-MHC gene linked to a luciferase reporter gene were injected into the hearts of adult rats subjected to various thyroid manipulations. The 161-bp sequence upstream of the transcription start site, which contains a TATA box, a CCAATT box, and a thyroid hormone response element, was transcriptionally active but not thyroid hormone responsive. The expression of a construct containing 388 bp of upstream sequence was increased by thyroid hormone administration, a response that required an intact thyroid hormone response element. However, expression of this construct failed to decrease to basal levels in a hypothyroid state. To confer complete (positive and negative) thyroid hormone regulation, 2,936 bp of upstream sequence was sufficient. These results demonstrate that, although necessary, the thyroid hormone response element is not sufficient for complete thyroid hormone regulation of this gene in vivo. In addition, DNA sequences regulating the quantitative expression of cardiac alpha-MHC in the euthyroid state have been demonstrated.(ABSTRACT TRUNCATED AT 250 WORDS)

Suicidal behaviors in adult psychiatric outpatients, I: Description and prevalence.

OBJECTIVE: Because the findings of previous studies of suicidal behaviors in psychiatric outpatients may not necessarily generalize to outpatients with a wide spectrum of psychiatric diagnoses, the authors evaluated the prevalence of suicidal behaviors in a large general psychiatric outpatient clinic whose patients represented a full spectrum of psychiatric illness. METHOD: A total of 651 patients participated in the study between 1987 and 1989. These patients had sought treatment at the outpatient psychiatry department of a private nonprofit hospital. Before being interviewed for treatment, all patients were given a comprehensive self-rating survey packet that included the Harkavy Asnis Suicide Survey and the Hopkins Symptom Checklist-90. The Harkavy Asnis Suicide Survey is a self-report questionnaire that assesses demographic variables, current and past history of suicidal behaviors of the patient as well as family members and peers, and a detailed description of each previous attempt. RESULTS: Fifty-five percent of the patients had a history of suicidal ideation, and 25% reported at least one previous suicide attempt. Approximately half of the suicide attempters reported multiple attempts. The predominant methods of attempt were overdose (53%), jumping (17%), and wrist cutting (17%). Suicidal behavior was prevalent in most diagnostic groups. The rates of suicidal ideation among patients with mood disorders (major depression, dysthymia, and bipolar disorder), adjustment disorders, and alcohol/substance abuse were significantly greater than that of the patients with generalized anxiety disorder. CONCLUSIONS: The authors conclude that suicidal behavior is prevalent among patients who seek treatment in a general outpatient department.