Zolpidem-Associated Consequences: An Updated Literature Review With Case Reports.

A post-2000 literature search reviewed prevalence of health consequences associated with zolpidem, plus two salient case reports. Common zolpidem-related harms encompassed accidents, falls, overdoses, delirium, and infections. Risks to others included assaults, vehicular accidents, various crimes, and civil actions that occurred during zolpidem-induced delirium, withdrawal, and other impediments. Remarkably, much harm occurred while patients were taking therapeutic doses of licitly prescribed zolpidem (10-30 mg). Zolpidem-associated health, behavioral, and social problems comprise an international pandemic of preventable heath misfortunes.

Editorial Commentary: Is Anterolateral Ligament Reconstruction of the Knee Needed? The Debate Rages on.

A recent systematic review on the techniques, biomechanics, and clinical outcomes of anterolateral ligament reconstruction of the knee summarizes our current understanding of this hotly debated topic. In 2017, it is not clear if an anterolateral ligament reconstruction is needed in the setting of primary anterior cruciate ligament reconstruction.

Fuming with rage! Do members of low status groups signal anger more than members of high status groups?

Owuamalam, Weerabangsa, Karunagharan and Rubin found that Malaysians associate people in low status groups with anger more than their higher status counterparts: the hunchback heuristic. But is this belief accurate? Here, we propose the alternative possibility that members of low-status groups might deliberately suppress anger to counter this stigma, while members of high-status groups might disinhibit their anger to assert their superiority. To test these propositions, we manipulated undergraduate students' relative group status by leading them to believe that provocative comments about their undergraduate social identity came from a professor (low-status condition) or a junior foundation year student (high-status condition). Using eye-tracking, we then measured their gaze durations on the comments, which we used as a physiological signal of anger: dwelling (Experiment 1). Results revealed that dwelling was significantly greater in the high-status condition than in the low-status condition. Experiment 2 conceptually replicated this pattern using a self-report method and found that the suppression-disinhibition effect occurred only when reputational concerns were strong.

Shame as a compromise for humiliation and rage in the internal representation of abuse by loved ones: Processes, motivations, and the role of dissociation.

This paper examines one particular way a person abused may come to internally position themselves and the abuser to understand their abuse experience. It is based on a differentiation and exploration of the dynamic relationship between shame and humiliation associated with complex feelings the abused has to the abuser. Humiliation is described as denoting the naked self exposed by another, while shame is described as denoting the naked self exposed to another. From this lens, abusive events are conceived as humiliating experiences that come to be represented as shame experiences. Shame is argued to cover over humiliation in order to separate the abused from their internal representation of the abuser (i.e., conceal the self-other object-relationship). This process is facilitated by dissociation and serves several functions, including cloaking hostile feelings (e.g., humiliation fury) toward the abusive (though loved) object. Shame, with the assistance of dissociation, becomes a compromise formation. It punishes the self for the initial humiliation rage directed at the object, protects the object from further attack and blame for the abuse, and obscures awareness of the rage felt toward the object as well as the reparatory guilt possible from it. Dissociation maintains this position by isolating the interpersonal field, the self and object, from the narrative of abuse events. The potential for freedom comes from eroding dissociation, leaving the shame bubble, entertaining the abusive (though loved) object as etiologically significant, and facing the humiliation and humiliation rage that provides the path to reparatory guilt.

'Mastication rage': a review of misophonia - an under-recognised symptom of psychiatric relevance?

OBJECTIVE: To explore the condition of misophonia, its definition, possible neurological correlates, its associated morbidity, its possible psychiatric relevance and potential treatment. METHOD: Provision of an illustrative case vignette and a review of the limited literature. RESULTS: Misophonia is a symptom associated with obsessive-compulsive disorder and anxiety disorders and may be a syndrome in itself associated with significant distress and avoidance. Treatments are not well validated. CONCLUSION: Misophonia may be an under-recognised condition of psychiatric relevance.

Road rage in Sri Lanka: prevalence and psychiatric distress.

INTRODUCTION: Road traffic accidents are a major public health concern in Sri Lanka. Aggressive and reckless driving is an important contributor to the high rate of road traffic accidents. OBJECTIVE: We studied prevalence, nature, determinants and associated psychiatric morbidity of road rage among motorists in Sri Lanka. Methods Data were gathered from 238 randomly selected motorists in Sri Lanka using a modified questionnaire regarding road rage and the 6-item version of Kessler's psychological distress scale. RESULTS: While 98.7% participants reported being victims of road rage, 85.3% were involved in offending behaviour. However actual physical assault (0.8%) and damage to vehicles (2.5%) were rare. Male gender, young age, increased traffic density and driving a three-wheeler or bus were associated with daily road rage victimisation and perpetration. Psychiatric distress was associated with being a victim of road rage. CONCLUSIONS: High prevalence of road rage in Sri Lanka and significant psychiatric distress associated with it indicate the necessity of interventions at least for target groups.

Explaining seemingly paradoxical consumer experiences: conjoining weekly road rage and church attendance.

The purposes of the current study are threefold: Provide evidence that an extreme paradoxical group exists-people frequently attending church and exhibiting road rage, profile this group, and frame possible explanations for the seemingly paradoxical behaviors. This study employs data from a national (USA) lifestyle survey conducted by Market Facts with 3,350 American respondents. The major questions asked about church participation and road-rage behavior ("giving a finger" and "flashing headlights"). Nomologically, relevant activities include 3 items for church goers and 3 items for road-rage givers. Additionally, 14 items profiled the lifestyles of the unique paradoxical behavior segment. Utilizing cross-tabulation tables, property space analyses identify the double extreme (XX) group (18 people) and other 6 groups with a significant chi-square test, confirming the extreme group exists. Analyses of variance test results show that comparing nomologically relevant activities among the seven groups is all statistically significant, indicating the nomological validity is met. Overall, the XX group tends to have more males, be younger, and have a higher proportion of people working in sales. The profile of lifestyle analyses shows the XX group members have both high ambitions and expectations, might be very frustrated individuals, and equip with the adventurous and masculine traits related to aggression. The XX behavior group's demographic and psychographic characteristics portray similar lifestyles that differ from other groups. Case-based analyses provide further contextual information of nuances to XX segment individuals. The limited energy theory, the Eagleman's theory of unconscious mind, and justification theory help to explain why people conjointly go to church and commit road rage. Addressing chronic paradoxical behaviors provides implications for social de-marketing to reduce aggressive anti-social behavior such as road rage. Frequent church attendance may help make people more sensitive to their wrongdoings and gradually revise the anti-social behavior.

[Children's Aggressive Behaviour and Therapeutic Interventions on the Parental Couple Level]. / Aggressives Verhalten von Kindern und Interventionen auf der elterlichen Paarebene.

Parents go to see child guidance counselling services for many different reasons. Behavioural problems or rather enraged or aggressive behaviour of children and adolescents towards their siblings or parents is a frequent issue in counselling practice. The current article takes a closer look at the range of problems around defiance, anger and aggression from a developmental and systemic point of view. The meaning of these negative affects within the family system is elaborated. Empirical studies show a clear connection between children's problem behaviour and frequent and destructive interparental conflict. So called spill-over-effects play a crucial role in explaining this connection. From a systemic perspective thus the child is seen as a symptom carrier, which shifts the focus of counselling on the interaction between parents as well. Consequently, family therapeutic sessions on the couple level are often indicated. Do parents succeed in constructively solving their conflicts, typically the aggressive behaviour of the children is reduced, too. On the basis of a compound single case such a process is illustrated.

Acute stress show great influences on liver function and the expression of hepatic genes associated with lipid metabolism in rats.

BACKGROUND: The theory of Chinese medicine believes rage harms normal liver function, namely 'raged impairing liver' in short. The purpose of this study is to investigate the impact of acute stress on liver lipid metabolism in rats. METHODS AND RESULTS: Comparison of liver function indicators, serum lipid level of rats under acute stress and normal rats, as well as detection of liver tissue in the SR - BI, ABCG5 and ABCG8 protein and gene expression changes. Acute stressed rats had shown a lower serum levels of albumin (P<0.01), HDL- cholesterol (P<0.01) than normal rats, with higher serum levels of globulin (P<0.01) and LDL-cholesterol (P<0.05). Acute stressed rat's liver tissue exhibited a lower protein expression of ABCG5 (P<0.05), ABCG8 (P<0.01) and a higher level of SR-BI (P<0.05), compared with to normal rats. Furthermore, liver gene expression of ABCG5 (P<0.01) and ABCG8 (P<0.05) were lower in acute stressed rats than in normal rats, while SR-BI was higher in acute stressed rats than in normal rats (P<0.01). CONCLUSIONS: Acute stress had a direct influence on rat's liver lipid metabolism.

Toward a conceptual model of motive and self-control in cyber-aggression: rage, revenge, reward, and recreation.

Despite widespread public attention to cyberbullying, online aggression and victimization have received scant conceptual development. This article focuses on how opportunities for aggression are distinct online from those of offline social contexts. The model developed here is informed by a recent aggression typology, which extends the reactive-proactive distinction by distinguishing aggression based on the affective motive (appetitive vs. reactive) and the recruitment of self-control. This typology informs an analysis of psychological processes linked to individual differences that are relevant to adolescents' aggressive activities. Processes implicated include hostile schema activation, anger and fatigue effects on self-control, anger rumination, empathic failure, excitation transfer, and thrill-seeking. With these processes established, the proposed model focuses on how features of online social platforms may afford opportunities for distinct types of aggression by engaging these processes in adolescent users. Features of online settings that present distinct opportunities for activation of these processes are reviewed for each process, including social cue ambiguity, temporal lag, cue permanence, anonymity, the continual perception of audience, and the availability of online gaming and online pornography. For each of the conceptually grounded cyber-aggression-relevant processes, implications for innovative research directions on adolescent cyber-aggression are presented.

Victims of road rage: a qualitative study of the experiences of motorists and vulnerable road users.

OBJECTIVE: To gain an in-depth understanding of road rage incidents from the victims' perspectives. METHODS: The data consisted of 30- to 60-min in-depth semistructured phone interviews with 29 self-identified victims of road rage. Twenty of the participants were in a motor vehicle, whereas 9 were pedestrians/cyclists. A qualitative Grounded Theory approach was used to inductively code and analyze the transcripts. RESULTS: Victims reported a correlation between their vulnerability and the perceived intensity/severity of the road rage incidents. The most vulnerable victims (pedestrians and cyclists) were the least likely to view road rage incidents as a random event and the most likely to feel that they were specifically targeted. Road rage incidents tended to evolve more rapidly when there was a greater real or perceived power imbalance between the victims and perpetrators. The most vulnerable victims were the most likely to have long-term physical and mental health consequences from the incident, and to significantly modify their behavior after the incident. CONCLUSIONS: Our analysis suggests that issues of victim vulnerability play a major role in determining the intensity, severity, and psychological consequences of road rage incidents. This seems particularly true for the most vulnerable of road users, such as pedestrians and cyclists.

Driving frequency and Its impact on road rage offending and victimization: a view from opportunity theory.

Road rage has been described as a key criminal justice and public health concern. Although research attention to this issue has expanded dramatically, most of this work has focused on the identification of predisposing individual factors. It is equally important to begin to assess those factors that may modify the likelihood of road rage including the broader structural opportunities that are connected with the propensity to be involved in a road rage incident. Drawing on opportunity theory, this article examines whether there is a relationship between increased opportunities to be involved in road rage and an increased likelihood of being a road rage victim or offender. The analysis is further extended to specifically test whether this relationship is linear, thereby examining the applicability of the opportunity saturation hypothesis. Using data from the Centre for Addiction and Mental Health (CAMH) Monitor, our findings support both the application of opportunity theory to understanding road rage and the presence of opportunity saturation. Although a clear relationship exists between kilometers driven and experiences of road rage, evidence emerged suggesting there may be a threshold whereby increased opportunities for road rage do not lead to road rage behavior.

Family consultation for psychiatrically complicated health problems.

We describe a social cybernetic view of health behavior problems and a team-based family consultation (FAMCON) format for strategic intervention based on that view. This approach takes relationships rather than individuals as the primary unit of analysis and attaches more importance to problem maintenance than to etiology. Treatment aims to interrupt two types of interpersonal problem maintenance-ironic processes and symptom-system fit (conceptualized, respectively, as positive and negative feedback cycles)-and to mobilize communal coping as a relational resource for change. A case example features a depressed husband and bipolar wife complaining of severe communication difficulties related to the husband's kidney cancer and diabetes. Over 6 consultation sessions, strategic interventions focused on interrupting ironic interpersonal patterns resolved the presenting complaint. Although cost-effectiveness is an open question, FAMCON may offer a useful alternative to psychoeducational and cognitive-behavioral treatments in the framework of stepped care.

Road rage and road traffic accidents among commercial vehicle drivers in Lahore, Pakistan.

Road rage and road traffic accidents increase the burden of morbidity and mortality in a population. A cross-sectional survey with convenience sampling was conducted among commercial vehicle drivers in Lahore, Pakistan (n = 901) to record their behaviours/experiences regarding road rage and road traffic accidents. Respondents were asked about incidents of shouting/cursing/rude gestures or threats to physically hurt the person/vehicle, by others or themselves, in the previous 24 hours or 3 months, and their involvement in road traffic accidents in the previous 12 months. Auto-rickshaw drivers were significantly more likely to report various road rage experiences/behaviours and involvement in accidents compared with bus and wagon drivers. A total of 112 respondents (12.4%) reported being involved in a road traffic accident in the previous 12 months but traffic police did not record the accident in 52.7% of cases. The results of this study underline the need to improve road safety in Pakistan.

[School shooting in statu nascendi]. / Schul-Amok im Status Nascendi.

In the last few years, amok-like killings and especially so-called "school shootings" have received a great deal of public attention both in the Old and the New world. Meanwhile, criminal psychological research has gained a thorough insight into this dangerous development in young people. Thus, the possibility to assess the concrete threat of such a multiple killing before it is carried out has been considerably improved, as many prognostic criteria have been worked out in the meantime. The case report presented shows that it is possible to exercise a favourable influence on this critical negative trend.

[Validity of the Reactive-Proactive-Aggression-Questionnaire for 5-10 Graders (RPA 5-10)]. / Befunde zur Validität des Reaktive-Proaktive-Aggression-Fragebogens für die fünfte bis zehnte Klasse (RPA 5-10).

A precondition of an appropriate treatment of aggressive children and youth is a specific diagnosis. The Reactive-Proactive-Aggression-Questionnaire for 5-10 Graders (RPA 5-10) assesses reactive and proactive aggression and different facets of the subtypes such as angry-aggression, defensive attribution of aggression, obtaining of resources and power/domination-aggression. This study proves the validity of the questionnaire by differential correlates based on a sample of 9 to 17 year-old students (N = 250). The scales of the RPA 5-10 were associated with anger, physical aggression, verbal aggression, conduct problems and decreased prosocial behaviour. Reactive aggression but not proactive aggression was related to hostility, emotional symptoms and peer relationship problems. The relations between reactive aggression and anger and emotional symptoms are based on angry-aggression. Contrary to predictions hyperactivity/inattention was associated with reactive but also with proactive aggression.

Pharmaco-genetically guided treatment of recurrent rage outbursts in an adult male with 15q13.3 deletion syndrome.

15q13.3 deletion syndrome (15q13.3DS) is a common recurrent genomic disorder associated with epilepsy, intellectual impairment, aggressive behavior, schizophrenia, and autism. A 39-year-old male presented with 15q13.3DS, epilepsy, intellectual impairment, psychosis, and recurrent episodes of aggressive rage. We hypothesized that the patient's aggressive behavior reflected deficits in α7 nicotinic cholinergic receptor (NChR)-mediated neurotransmission, arising from haploinsufficiency of the structural gene CHRNA7 due to the deletion. Treatment with the NChR allosteric modulator and acetylcholinesterase (AChE) inhibitor, galantamine, led to a dramatic decline in the frequency and intensity of rage outbursts, suggesting that enhancement of α7 NChR function can ameliorate 15q13.3DS-associated rage outbursts.

Pediatric CT sedation: comparison of dexmedetomidine and pentobarbital.

OBJECTIVE: Our institution replaced pentobarbital with dexmedetomidine for pediatric CT sedation. The purpose of this study was to compare the efficacy, incidence of adverse events, and cardiovascular and respiratory profiles of these two sedatives. MATERIALS AND METHODS: Quality assurance data were accessed for a review of demographics, outcome parameters, and adverse events among all children who received either pentobarbital or dexmedetomidine. RESULTS: From January 2004 through June 2009 there were 388 pentobarbital sedations and 1,274 dexmedetomidine sedations. Age, sex, weight, and duration of imaging study were similar in the two groups. Average time to achieve sedation was 12 ± 4 minutes with dexmedetomidine and 6 ± 3 minutes with pentobarbital (p < 0.001). Recovery time was 32 ± 18 minutes with dexmedetomidine and 95 ± 28 minutes with pentobarbital (p < 0.001). There were no differences between groups in incidence of oxygen desaturation and need for brief positive pressure ventilation. The odds of needing additional sedative agents to complete the study were significantly higher with pentobarbital than with dexmedetomidine (odds ratio, 4.0; 95% CI, 2.0-8.4; p < 0.001). There was a significantly lower incidence of agitation and rage with dexmedetomidine (p < 0.01) but higher risk of hypotension (p < 0.01). There was one failed sedation in each group (p = 0.99). CONCLUSION: Dexmedetomidine is a safe and effective alternative to pentobarbital for pediatric CT, being associated with a much shorter recovery time and less need for adjuvant sedatives.