Despite the rising concern with the increasing rate of violent and suicidal behaviors in this country and others, we remain relatively limited in our ability to rigorously define, classify, and measure these behaviors. In addition to our previous work in developing self-rating scales assessing aspects of aggressive behaviors, we have developed the Suicide and Aggression Survey (SAS), a new, comprehensive, semistructured interview and research tool, for the purpose of comprehensively evaluating and understanding the multiple constituents of these behaviors, and for assisting in predicting which individuals might be at high risk for suicide or violence. The present report describes the need for such an instrument and the theoretical models that have guided us in constructing it; one of these is a sequential description of the major classes of variables related to aggression and the other is a two-stage model of countervailing forces. Preliminary reliability data and a description of the structure of the interview are included.

Adolescent↗

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The treatment of kleptomania with serotonin reuptake inhibitors.

Kleptomania is characterized by an irresistible impulse to steal objects not needed for personal use or for their monetary value. Several recent case reports have shown that Serotonin Specific Reuptake Inhibitors (SSRIs) could be effective in the treatment of kleptomania just as it is in other obsessive-compulsive spectrum disorders. We report five cases of kleptomania patients who were successfully treated with fluoxetine or paroxetine in combination with a psychotherapeutic intervention. In one case, the discontinuation of the medication repeatedly led to the resurgence of the kleptomanic behavior. Our case series illustrates the effectiveness of SSRIs in kleptomania. It thus supports the assumption that this syndrome involves a dysfunctional serotoninergic mechanism.

Adult↗

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The impact of clozapine treatment on serum lipids in chronic schizophrenic patients.

The aim of this retrospective study is to determine whether lipid levels rise in neuroleptic-resistant chronic schizophrenic patients during clozapine treatment and if this rise is correlated with a decrease in aggressive and suicidal behavior. Seventy neuroleptic-resistant schizophrenic patients treated with clozapine for at least 6 months were compared with 30 chronic schizophrenic patients treated with classic antipsychotic agents for the same length of time. Data on serum levels of cholesterol and triglycerides and on aggressive and suicidal behavior, as measured by the Overt Aggression Scale (OAS), were collected in both groups before treatment and 6 months later. A significant reduction in aggressive and suicidal behavior was noted in the clozapine-treated group but not in the classical antipsychotic-treated group. Clozapine treatment was associated with an elevation in serum triglyceride level, whereas classic antipsychotic treatment was associated with an increase in serum cholesterol level. We conclude that serum cholesterol level does not play a role in the clozapine-induced attenuation in aggressive and suicidal behavior in neuroleptic-resistant schizophrenic patients, though the accompanying elevation in triglycerides may be relevant to a behavioral effect.

Adolescent↗

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Combined electroconvulsive-clozapine therapy.

We reviewed 36 reported psychiatric patients who were treated with a combination of electroconvulsive therapy (ECT) and clozapine. The indication of the ECT-clozapine treatment was resistance to classical antipsychotic agents, clozapine, or ECT alone. Sixty-seven percent of the patients benefited from the combined treatment. In most of the patients, the combined treatment was safe and well tolerated. Adverse reactions occurred in 16.6% of the patients and included prolonged ECT-induced seizures (one case), supraventricular (one case) and sinus tachycardia, and blood pressure elevation. It seems that combined ECT-clozapine treatment is effective and safe. This strategy may be a therapeutic option in treatment-resistant patients.

Adult↗

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Serum vitamin B6 in schizophrenic and schizoaffective patients with and without tardive dyskinesia.

There are several reports regarding the efficacy of vitamin B6 in the treatment of tardive dyskinesia (TD). Vitamin B6 plays a key role in the synthesis of several neurotransmitters, including serotonin, dopamine, norepinephrine, and gamma-aminobutyric acid, all of which have been proposed to be involved in the development of TD. The purpose of this study was to examine whether there are special markers to distinguish long-term neuroleptic exposure patients who have TD from those patients who do not develop this side effect. In view of the pivotal role of vitamin B6 in the synthesis of all neurotransmitters believed to take part in the pathogenesis of TD, we decided to examine whether basal levels of vitamin B6 might explain the difference between these two groups. Such a finding could provide a predictive marker for vulnerable patients. The active metabolite of vitamin B6 is pyridoxal phosphate (PP). Pyridoxal phosphate blood levels were measured in 15 schizophrenic and schizoaffective patients with TD and compared with 15 patients without evidence of TD (matched by sex, age, smoking, and diagnosis). We found that, although patients in the TD group were exposed to neuroleptic drugs for significantly longer periods of time, there were no differences in serum PP levels between the groups. The reports of the effectiveness of vitamin B6 supplementation in the treatment of TD could therefore be explained by the assumption that central nervous system or intracellular vitamin B6 levels, which are involved in the pathogenesis of TD, are not the same as vitamin B6 peripheral serum levels. There is need for further studies, which will clarify the relationship between vitamin B6 and TD.

Adult↗

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Myotoxicity and neurotoxicity during clozapine treatment.

Some recent studies have shown that clozapine (CLZ) has myopathic side effects and causes alterations in motor force control. The aim of this study was to evaluate the neurologic and electrophysiologic characteristics of patients with schizophrenia who are undergoing long-term CLZ treatment. Ninety-four patients with schizophrenia treated with CLZ for 18.2 +/- 15.5 months were studied retrospectively and prospectively (40% and 60%, respectively) for serum creatine kinase (CK) levels before and after initiation of CLZ treatment. An electrodiagnostic study was performed on patients with CK elevation above normal limits, complained of general weakness or muscle pains, and/or had abnormal clinically significant findings. In 13 patients (13.8%), abnormal CK levels were found. Six patients complained of some muscular weakness. In two patients, clinical assessment revealed mild general muscular weakness; one revealed decreased tendon reflexes and, in both, CK levels were above 1,750 IU/L. On electrophysiologic examinations performed in the six patients with abnormal neurologic findings, the motor and sensory nerve conduction velocity were within normal range in all but one patient, who exhibited some prolongation of distal latency in the lower limbs. In two patients, the electromyography demonstrated a myopathic pattern. In 2.1% of medically healthy patients with schizophrenia treated with clozapine on a long-term basis, signs of myotoxicity were found. It seems warranted to discontinue CLZ therapy in patients who exhibit abnormal CK levels and myopathic features during treatment. Further studies are needed to provide more objective data on the impact of CLZ treatment on muscle tissue.

Adult↗

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Reversal of pathologic cardiac parameters after transition from clozapine to olanzapine treatment: a case report.

Antipsychotic medications have been associated with significant cardiovascular adverse effects and instances of sudden cardiac death. Recently, we started to evaluate cardiac parameters in medicated patients with schizophrenia using power spectrum analysis of heart rate variability. We present a case of a patient with long-standing schizophrenia who was treated with clozapine. His electrocardiogram revealed minor abnormalities, including a prolonged QT interval. Power spectrum analysis of heart rate variability demonstrated marked abnormalities in autonomic nervous system activity. Two years later, his treatment was switched to olanzapine. We reevaluated his cardiac parameters. Power spectrum analysis studies revealed that heart rate had significantly improved and that power spectrum cardiovascular parameters had returned to normal. Serial electrocardiograms revealed a minimally and asymptomatically prolonged QT interval. This case demonstrates the importance of screening electrocardiograms, even in healthy young patients. It also emphasizes how minor changes in electrocardiogram can be overlooked on standard electrocardiograms. Power spectrum analysis of heart rate variability is useful in this instance because it magnifies the trace and detects even minor disturbances. Care should be taken in prescribing antipsychotic drugs to patients who are prone to cardiovascular side effects, and alternatives to antipsychotics with prominent anticholinergic profile, in particular, should be sought.

Adult↗

PubMedDate not supplied

Power spectral analysis of heart rate variability in psychiatry.

Power spectrum analysis of heart rate variability (PSA of HRV) is a promising method, which can be used as an index of cardiac autonomic balance. PSA of HRV is a noninvasive technique, based on ECG sampling of RR interval variation, thus providing a dynamic assessment of sympathetic and parasympathetic tone, reflecting the interactions between the two. It has been shown to have potential value in various laboratory and clinical conditions. It is influenced by many factors such as age, sex, position, breathing, smoking, hour of the day and medications. Different methods of data processing by various authors have often elicited conflicting results. Standard values are not yet available to be used or compared in different settings. From the interest it has raised, it may be expected that this method will be in widespread use in clinical practice in the future, providing a useful tool, both for diagnostic and prognostic purposes, as well as serving as a further aid towards monitoring therapeutic interventions. This review highlights techniques of dynamic assessment of HRV and studies of its clinical applications in psychiatry in particular. It raises the potentially important prognostic implications of protracted autonomic dysfunction in psychiatric patient populations, especially for cardiovascular morbidity and mortality.

Analysis of Variance↗

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Suicide risk and coping styles in posttraumatic stress disorder patients.

BACKGROUND: Suicide and suicidal behavior have been found to be increased among posttraumatic stress disorder (PTSD) patients. The present study examined suicide risk and Plutchik's coping styles in PTSD patients. METHOD: 47 PTSD patients were compared with 42 patients with mixed non-PTSD anxiety disorders and 50 healthy control subjects, matched for age and gender, on a measure of suicide risk. RESULTS: The PTSD patients scored significantly higher than the two control groups on the suicide risk measure. Furthermore, in the PTSD group, suicide risk was significantly negatively correlated with the coping mechanisms of mapping, minimization and replacement and positively correlated with the coping style of suppression. Furthermore, the coping styles significantly explained the variance of the suicide risk measure for all three groups. CONCLUSIONS: The cognitive map of PTSD patients highly resembles other populations with high suicide risk. Clinicians treating victims of traumatic events should focus on problem-solving therapies in order to help these patients deal less rigidly with everyday stresses and by this decrease the suicide risk.

Adaptation, Psychological↗

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Alexithymia, affect intensity and emotional range in suicidal patients.

BACKGROUND: Although negative affect in general has been widely associated with suicide, the role of specific emotions and affect features in depression and suicidality is unclear. This study examined the potential of three major components of the affect structure as predictors of suicidal behavior. METHODS: Twenty suicidal depressed (SD) inpatients were compared with 20 nonsuicidal depressed (NSD) inpatients and 20 healthy controls for alexithymia, emotional range (ER; i.e. variety of emotions experienced by the subjects) and affect intensity (AI; i.e. the intensity of their emotional responsiveness). RESULTS: Both the SD and the NSD patients had a narrower range of emotions, a stronger AI and a higher degree of alexithymia than did the healthy controls. No differences were found between the scores of the two inpatients groups. CONCLUSIONS: The three affect components examined (alexithymia, AI and ER) did not prove to represent sensitive predictors of suicidal behavior. Hopelessness and depression severity were found to be more reliable in the prediction of suicidal risk. We discuss the implications of this study, particularly the possibility of early detection and intervention in patients at risk.

Adult↗

PubMedDate not supplied

Sexual dysfunction in male posttraumatic stress disorder patients.

BACKGROUND: Previous studies have suggested that sexual dysfunction may be associated with posttraumatic stress disorder (PTSD). Yet such studies have not examined a full range of sexual functioning and have not accounted for the possibility that medication used to treat PTSD may contribute to sexual dysfunction. OBJECTIVE: The current study compares the various components of sexual functioning among three groups of males: (1) untreated PTSD patients (n = 15), (2) PTSD patients currently treated with selective serotonin reuptake inhibitor (SSRI) agents (n = 27) and (3) a group of normal controls (n = 49). METHODS: All participants completed an 18-item questionnaire for assessment of sexual functioning. Those with PTSD also completed the Impact of Events Scale and the Symptom Check List-90 (SCL-90). RESULTS: Untreated and treated PTSD patients had significantly poorer sexual functioning in all domains (desire, arousal, orgasm, activity and satisfaction) as compared to normal controls. Those treated with SSRI had greater impairment in desire, arousal and frequency of sexual activity with a partner. There was a high correlation between sexual dysfunction among the PTSD group and the anger-hostility subscale of the SCL-90. CONCLUSIONS: PTSD appears to be associated with pervasive sexual dysfunction that is exacerbated by treatment with SSRIs. PTSD may represent a heterogeneous syndrome. Patients with PTSD have a high rate of comorbid panic disorder, major depression and anxiety, and it could thus be argued that these comorbid disorders, rather than PTSD, accounted for the observed result. Future research aimed at understanding comorbidity and heterogeneity should help to illuminate the psychobiology of PTSD and eventually guide both medication and psychosocial treatments.

Adult↗

PubMedDate not supplied

The use of ozone as an oxidizing agent to evaluate antioxidant activities of natural substrates.

Ozone, the main component of photochemical smog and air pollution, can damage the skin by oxidizing stratum corneum enzymes, lipids and structural proteins. We have developed a rapid screening assay to determine free radical scavenging capacity of various active ingredients that are frequently used in personal care products. Several known antioxidants including vitamin C, vitamin E analog Trolox, walnut seed extract, lipoic acid and ergothioneine inner salt were assayed for their ability to neutralize ozone-induced oxidation of beta-phycoerythrin, a fluorescent reporter protein derived from algae. The free radical scavenging capacities of these antioxidants were quantified and compared. The results demonstrate that this assay is a valuable primary screening tool for identifying antioxidant activity of natural or synthetic substrates that can be used in personal care products to protect the uppermost layer of our skin from oxidizing damage induced by O3.

Air Pollutants↗