Long-term outcomes in patients with restrictive filling following ST-segment elevation myocardial infarction.

This study evaluated the effect of restrictive filling pattern (RFP) on 5-year outcomes in patients following ST-segment elevation myocardial infarction (STEMI). A hundred STEMI patients treated either by rescue or primary percutaneous coronary intervention with an echocardiogram performed within 6 weeks of STEMI comprised the study group. Creatinine kinase (CK) and left ventricular ejection fraction were independent determinants of RFP, and RFP was an independent predictor of cardiac and all-cause mortality at median follow up of 5 years.

Relationship between physiological measures of excitability and levels of glutamate and GABA in the human motor cortex.

Magnetic resonance spectroscopy (MRS) allows measurement of neurotransmitter concentrations within a region of interest in the brain. Inter-individual variation in MRS-measured GABA levels have been related to variation in task performance in a number of regions. However, it is not clear how MRS-assessed measures of GABA relate to cortical excitability or GABAergic synaptic activity. We therefore performed two studies investigating the relationship between neurotransmitter levels as assessed by MRS and transcranial magnetic stimulation (TMS) measures of cortical excitability and GABA synaptic activity in the primary motor cortex. We present uncorrected correlations, where the P value should therefore be considered with caution. We demonstrated a correlation between cortical excitability, as assessed by the slope of the TMS input-output curve and MRS-assessed glutamate levels (r = 0.803, P = 0.015) but no clear relationship between MRS-assessed GABA levels and TMS-assessed synaptic GABA(A) activity (2.5 ms inter-stimulus interval (ISI) short-interval intracortical inhibition (SICI); Experiment 1: r = 0.33, P = 0.31; Experiment 2: r = -0.23, P = 0.46) or GABA(B) activity (long-interval intracortical inhibition (LICI); Experiment 1: r = -0.47, P = 0.51; Experiment 2: r = 0.23, P = 0.47). We demonstrated a significant correlation between MRS-assessed GABA levels and an inhibitory TMS protocol (1 ms ISI SICI) with distinct physiological underpinnings from the 2.5 ms ISI SICI (r = -0.79, P = 0.018). Interpretation of this finding is challenging as the mechanisms of 1 ms ISI SICI are not well understood, but we speculate that our results support the possibility that 1 ms ISI SICI reflects a distinct GABAergic inhibitory process, possibly that of extrasynaptic GABA tone.

Risk factors for adolescent suicide. A comparison of adolescent suicide victims with suicidal inpatients.

The characteristics of adolescent suicide victims (n = 27) were compared with those of a group at high risk for suicide, suicidal psychiatric inpatients (n = 56) who had either seriously considered (n = 18) or actually attempted (n = 38) suicide. The suicide victims and suicidal inpatients showed similarly high rates of affective disorder and family histories of affective disorder, antisocial disorder, and suicide, suggesting that among adolescents there is a continuum of suicidality from ideation to completion. However, four putative risk factors were more prevalent among the suicide victims: (1) diagnosis of bipolar disorder; (2) affective disorder with comorbidity; (3) lack of previous mental health treatment; and (4) availability of firearms in the homes, which taken together accurately classified 81.9% of cases. In addition, suicide completers showed higher suicidal intent than did suicide attempters. These findings suggest a profile of psychiatric patients at high risk for suicide, and the proper identification and treatment of such patients may prevent suicide in high-risk clinical populations.

Phenobarbital treatment and major depressive disorder in children with epilepsy.

The prevalence and severity of psychopathology in 15 epileptic patients treated with phenobarbital and 24 patients treated with carbamazepine were compared. The groups were similar across a wide range of demographic, seizure-related, and family-environmental variables. Patients treated with phenobarbital, when compared with those treated with carbamazepine, showed a much higher prevalence of major depressive disorder (40% v 4%, P = .02), and suicidal ideation (47% v 4%, P = .005) as determined by semistructured psychiatric interviews. The differential prevalence of depression between medication groups was only noted in those with a family history of a major affective disorder among first-degree relatives. Family discord and number of stressful life events were also associated with depression in this cohort. Patients treated with phenobarbital should be closely monitored for depression, and alternative treatments should probably be sought for patients with newly diagnoses epilepsy and a personal or family history of an affective disorder. The clinical and research implications of these findings are discussed.

Suicide in adolescents with no apparent psychopathology.

OBJECTIVE: To delineate the characteristics of adolescent suicide victims with no apparent psychiatric disorder. METHOD: Seven adolescent suicide victims with no apparent disorder were compared with 60 suicide victims with definite or probable psychiatric disorder, and with 38 community controls with no psychiatric disorder. RESULTS: Suicide victims without psychiatric disorder, compared with the remainder of suicides showed lower rates of past psychiatric treatment, previous suicide attempt, family history of affective illness, total life stressors over the previous 12 months, and a greater prevalence of the availability of a loaded gun in the home. The seven suicide victims compared with the 38 psychiatrically normal community controls, showed a higher rate of familial psychiatric disorder, past suicidal ideation or behavior, legal or disciplinary problems in the past year, and firearms in the home, particularly those that were loaded. CONCLUSION: Even suicide victims without apparent psychiatric disorder still show some evidence of psychiatric risk factors compared with community controls. However, prevention of suicide in this group is probably best achieved by restriction of the availability of firearms, particularly loaded ones. The clinician should pay particular attention to suicidal risk in youth who are confronting legal or serious disciplinary crises and should take suicidal ideation seriously even in the absence of clear psychopathology.

Psychiatric effects of exposure to suicide among the friends and acquaintances of adolescent suicide victims.

The friends and acquaintances (N = 58) of 10 adolescent suicide victims were interviewed 6 months after the death of the victims, and the rates of psychiatric disorders that had onset after the death were compared with the 6-month incidence of psychopathology in 58 demographically and psychiatrically matched unexposed controls. The exposed group showed higher rates of any new onset major depressive disorder, but the rate of incident suicide attempts was the same in both groups. The median onset of incident depression among the exposed group was within the first month after exposure, and the majority of those exposed youth with incident depression were still depressed at interview 6 months after the death. Adolescent friends and acquaintances of suicide victims experience considerable psychiatric morbidity subsequent to exposure to suicide, most consistent with pathological grief.

Bereavement or depression? The impact of the loss of a friend to suicide.

OBJECTIVE: To determine whether the depressive reactions experienced by youth exposed to suicide were uncomplicated bereavement or bona fide major depression. METHOD: In a sample of 146 friends and acquaintances of 26 adolescent suicide victims, 43 (29%) developed a depressive episode subsequent to exposure to suicide, 18 were depressed before exposure, and 85 were never depressed. The three groups were compared. RESULTS: Those who became depressed after exposure were similar to those who were depressed before exposure. Both depressed groups differed from the nondepressed exposed group with respect to functional impairment, depressive symptom pattern and severity, convergent validity with other measures of depression, personal and family history of depression, and stressful life events. Previous depressives showed greater comorbidity with nonaffective disorders than those who became depressed after exposure. Those who became depressed after exposure compared with both the previous and nondepressive had a closer relationship with the suicide victims, showed more severe grief, and showed more intense exposure to the suicide. CONCLUSIONS: Depressive reactions occurring after exposure to suicide appear to be bona fide major depression, occurring as a complication of bereavement. Youth exposed to suicide should be carefully screened and followed up. Should a symptomatic picture of depression and functional impairment ensue, such exposed youth should be treated accordingly for a major depressive episode.

Adolescent witnesses to a peer suicide.

OBJECTIVE: This case-control study attempts to evaluate the psychological impact of witnessing a suicide on high school students. METHOD: Twenty-eight high school students witnessed a firearms suicide and the serious injury of another student while riding a school bus. They were assessed 2 months after the event, and their responses were compared with 28 demographically similar adolescents from another community who had not been exposed to suicide. RESULTS: The exposed students, when compared with the controls, had higher rates of new-onset anxiety disorder and a trend for increased rates of new-onset post-traumatic stress disorder (PTSD). Within the exposed group, measures of the closeness of the relationship to both the suicide victim and the student who was injured were correlated with the severity of PTSD symptomatology. Within the exposed group, other factors that predisposed to new-onset disorder included family history of affective illness, family history of suicide attempt, and stressful life events occurring in the year before exposure. CONCLUSIONS: In combination with the extant literature, this study demonstrates that adolescents who witness a traumatic suicidal death are at risk for the development of psychopathology, specifically, anxiety disorders and PTSD.

Psychiatric sequelae to the loss of an adolescent peer to suicide.

OBJECTIVE: This study was designed to learn whether friends and acquaintances of suicide victims were at increased risk for depression, post-traumatic stress disorder, and suicidal behavior after exposure to suicide. METHOD: The social networks of 26 adolescent suicide victims, consisting of 146 adolescents, were interviewed 7 months after the death of the suicide victim and compared with 146 matched, unexposed controls. RESULTS: The rates of these disorders that had onset after exposure were elevated in the exposed group vs. controls: major depression, post-traumatic stress disorder, suicidal ideation with a plan or an attempt, but not suicidal attempts. Almost all of those exposed youth who developed new-onset suicidality did so in the context of a new-onset depressive episode. The majority of these new-onset depressive disorders began within 1 month of exposure. CONCLUSION: Postvention programs not only should focus on the prevention of imitation of suicidal behavior, but also should provide longer term follow-up for potentially bereaved and depressed youth exposed to suicide.

Psychiatric risk factors for adolescent suicide: a case-control study.

OBJECTIVE: The objective of this study was to determine the psychiatric risk factors for adolescent suicide. METHOD: Sixty-seven adolescent suicide victims were compared with 67 demographically matched community controls. Psychiatric disorder was assessed in suicide victims using a psychological autopsy protocol and in controls using similar semistructured psychiatric interviews. Risk factors were quantified by use of the odds ratio (OR), that is, the relative frequency of the occurrence of a given condition in the suicides compared with the controls. RESULTS: The most significant psychiatric risk factors associated with adolescent suicide were major depression (OR = 27.0), bipolar mixed state (OR = 9.0), substance abuse (OR = 8.5), and conduct disorder (OR = 6.0). Substance abuse was a more significant risk factor when comorbid with affective illness than when alone (OR = 17.0 versus 3.3). The majority of depressed suicide victims had a primary affective disorder (82%). A significant minority (31%) of depressed suicide victims had been depressed less than 3 months. Previous suicide attempts, suicidal ideation, and homicidal ideation also were associated with adolescent suicide. CONCLUSIONS: The development of effective treatments for youth who fit the above-noted risk profiles should be given high priority.

Psychiatric impact of the loss of an adolescent sibling to suicide.

Twenty-five adolescent siblings of 20 adolescent suicide victims were psychiatrically assessed 6 months after the suicide, and compared to 25 demographically matched controls. Siblings were much more likely to show a new-onset major depression subsequent to exposure to suicide. New-onset depression was associated with previous psychiatric disorder, family history of any psychiatric disorder, and family history of major depression. Mothers of suicide victims, compared to the mothers of controls, were also more likely to be depressed 6 months after the suicide of their child. The development of a family-based intervention for families of adolescent suicides is recommended.

Investigations of the origin of the furan fatty acids (F-acids).

The possible role of linoleic acid as a biogenetic precursor of the furan fatty acids (F-acids) was investigated in in vivo experiments in the rat, using a C19 analogue of linoleic acid and gas chromatography-mass spectrometry. No evidence of incorporation of this compound into the F-acids was found. Using an improved analysis procedure by converting F-acids into their tetrahydrofuran derivatives (enabling a separation from the large amounts of normal fatty acids), F-acids (F3, F4 and F6) were detected in rat food, correcting earlier results. Quantification of F-acid intake with food and excretion of furandicarboxylic acids in the urine, suggested the possibility that the F-acids are not produced de novo in the rat, but instead accumulate in tissue after nutritional intake.

Mosquitoes of West Virginia: an update.

Nineteen species of larval mosquitoes were collected from 209 sites in 47 of West Virginia's 55 counties over a 7-month period (April-October) in 1992. Aedes abserratus is recorded from the state for the first time.

Retention technique #2. Closing critical care beds.

The key to nursing retention is to be sensitive to the pressures and demands placed on staff nurses who want to provide and take pride in giving quality patient care. If an institution has many critical care nursing vacancies, it is important to avoid pushing the remaining nurses beyond human limits. It may even be necessary to close beds to keep the remaining nurses, rather than allow the stress of the nursing shortage to cause them to resign too.

Protecting urban home care workers.

Unfortunately, violence against home care workers is on the increase. The varied work schedules and plans of home care staff can present challenges when instituting a safety program; not all urban agency staff work in an office, nor do they all get to their job sites the same way. One agency has developed a comprehensive security and safety program to protect both office and field staff.

Crossing cultural barriers to care for people with AIDS.

The delivery of high-quality home care to HIV/AIDS patients is often complicated by the cultural barriers present when caring for minority populations. Developing trust, listening skills, and a nonjudgmental approach are essential to providers who care for people of varied cultural backgrounds.

Overcoming obstacles: challenges of caring for an urban pediatric population.

There are many challenges to working with pediatric patients at home, and they are complicated when the family lives in the inner city. The VNA of Boston has overcome many of the challenges through its unique Maternal Child Health team--a good model for any pediatric care team.

VNA of Boston addresses cultural barriers in home-based care.

Home care professionals know that communication is the key to successful treatment. But what if the patient speaks a different language? One home care agency addresses this problem with a culturally diverse staff and access to interpretation services.