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Biological aspects of social bonding and the roots of human violence.

The brain systems that motivate humans to form emotional bonds with others probably first evolved to mobilize the high-quality maternal care necessary for reproductive success in placental mammals. In these species, the helplessness of infants at birth and their dependence upon nutrition secreted from their mothers' bodies (milk) and parental body heat to stay warm required the evolution of a new motivational system in the brain to stimulate avid and sustained mothering behavior. Other types of social bonds that emerged subsequently in placental mammals, in particular monogamous bonds between breeding pairs, appear to have evolved from motivational brain systems that stimulate maternal behavior. This chapter focuses on aspects of the evolution and neurobiology of maternal and pair bonding and associated behavioral changes that may provide insights into the origins of human violence. The roles of the neuropeptides oxytocin and vasopressin as well as the neurotransmitter dopamine will be emphasized. Maternal and pair bonding are accompanied by increased aggressiveness toward perceived threats to the object of attachment as well as diminished fear and anxiety in stressful situations. The sustained closeness with mother required for the survival of infant mammals opened a new evolutionary niche in which aspects of the mother's care became increasingly important in regulating development in offspring. The quantity and quality of maternal care received during infancy determines adult social competence, ability to cope with stress, aggressiveness, and even preference for addictive substances. Indeed, the development of neurochemical systems within the brain that regulate mothering, aggression, and other types of social behavior, such as the oxytocin and vasopressin systems, are strongly affected by parental nurturing received during infancy. Evidence will be reviewed that the neural circuitry and neurochemistry implicated in studies of lower mammals also facilitate primate/human interpersonal bonding. It is hypothesized that neural bonding systems may also be important for the development in individuals of loyalty to the social group and its culture. Neglect and abuse during early life may cause bonding systems to develop abnormally and compromise capacity for rewarding interpersonal relationships and commitment to societal and cultural values later in life. Other means of stimulating reward pathways in the brain, such as drugs, sex, aggression, and intimidating others, could become relatively more attractive and less constrained by concern about violating trusting relationships. The ability to modify behavior based on negative experiences may be impaired. Unmet needs for social bonding and acceptance early in life might increase the emotional allure of groups (gangs, sects) with violent and authoritarian values and leadership. Social neurobiology has the potential to provide new strategies for treating and preventing violence and associated social dysfunction.

Adolescent↗

Roles and relationships: a psychoeducational approach to reviewing strengths and difficulties in adulthood functioning.

The authors developed a psychoeducational protocol to help psychiatric patients review their patterns of interpersonal relationships. The conceptual framework is based on the Adult Personality Functioning Assessment (Hill, Fudge, Harrington, Pickles, & Rutter, 1995; Hill, Harrington, Fudge, Rutter, & Pickles, 1989). Seven domains of functioning are addressed: friendships, romantic relationships, family relationships, social contacts, therapeutic relationships, relationships with addictive substances and activities, and work. The intervention aims at fostering participants' reflectiveness about their relationships to enhance their capacity for social support. The introduction sets the protocol in context; an annotated version of patient materials includes commentary on each domain.

Female↗

[The prevalence of and factors associated with depression in Colombia].

OBJECTIVES: To analyze the prevalence of depression and the factors associated with it in Colombia in 2000 and 2001. METHODS: For this descriptive cross-sectional study a survey was conducted between November 2000 and January 2001 with 1,116 men and women 18 years of age or older who were living in private homes that were selected through a multistage national representative sampling, stratified according to the degree of urbanization of the area included in the sampling. Depression was classified as brief recurrent depression, subclinical depression, or mild, moderate, or serious clinical depressive episodes in the 30 days and in the 12 months prior to the interview. Simple and stratified frequencies of over 500 variables, along with their 95% confidence intervals (95% CIs), were calculated by age and gender. The association that the selected variables had with depressive episodes was evaluated through a multivariate logistic regression model. RESULTS: Of the persons studied, 10.0% of them (95% CI: 9.2% to 10.7%) had had a depressive episode in the 12 months prior to the survey, and 8.5% (95% CI: 7.8% to 9.2%) had suffered a depressive episode in the preceding month. There was a higher proportion of women with depression in both of the periods. More than 50% of the episodes were moderate, in both men and women. There were higher prevalences of depression in persons older than 45 years. The factors associated with depression in the preceding month were: female gender; considering one's health to be moderate or bad; suffering from pain or discomfort; having difficulties in interpersonal relations; consuming marijuana, addictive substances, stimulants, or tranquilizers; being dependent on alcohol; and being unemployed and unable to work. CONCLUSIONS: Depression is a frequent disorder in Colombia. Measures directed at reducing the risk of depression should be implemented, especially among women and in persons over 45 years old.

Adolescent↗

Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts.

OBJECTIVES: The goal of this study was to identify differences between gay, lesbian, bisexual, and transgender (GLBT) homeless youths and their heterosexual counterparts in terms of physical and mental health difficulties. METHODS: A sample of 84 GLBT adolescents was matched in regard to age and self-reported gender with 84 heterosexual adolescents. The 2 samples were compared on a variety of psychosocial variables. RESULTS: GLBT adolescents left home more frequently, were victimized more often, used highly addictive substances more frequently, had higher rates of psychopathology, and had more sexual partners than heterosexual adolescents. CONCLUSIONS: Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.

Adolescent↗

Analgesic abuse in the elderly. Renal sequelae and management.

Nephropathy caused by the use of 'classical' analgesics [paracetamol (acetaminophen), salicylates and pyrazolone derivatives] and renal impairment associated with nonsteroidal anti-inflammatory drugs (NSAIDs) are important health problems in the elderly. Classical analgesic nephropathy is a chronic renal disease characterised by renal papillary necrosis and chronic interstitial nephritis. The nephropathy is caused by the excessive consumption of analgesic mixtures containing at least 2 antipyretic analgesics combined with caffeine and/or codeine. The use of NSAIDs is associated with a wide range of tubular, interstitial, glomerular and vascular renal lesions. Despite the well-characterised acute biological effects of NSAIDs on the kidney, there is only limited evidence that they are associated with an increased risk of chronic renal failure. Classical analgesic toxicity can be effectively prevented by limiting the availability of over-the-counter analgesic mixtures containing 2 analgesic compounds in combination with potentially addictive substances (e.g. caffeine and/or codeine). In the elderly in particular, the prolonged, regular use of NSAIDs should be discouraged. Patients starting NSAID therapy should be monitored regularly and drug interactions should be avoided.

Aged↗

[Alcohol consumption in pupils of Compulsory Secondary Education].

BACKGROUND: The consumption of addictive substances by adolescents is a growing problem with a considerable social and health impact, with alcohol being the drug of greatest consumption. The aim of this paper is to analyse the consumption of alcohol in pupils attending Compulsory Secondary Education in our health care milieu in order to understand the dimension of the problem in our context. METHODS: Randomized distribution, stratified by school year, of a semi-quantitative questionnaire on the frequency of consumption of alcoholic drinks. Distributed to 406 pupils in Compulsory Secondary Education: 194 males and 212 females, with ages between 13 and 16 years. RESULTS: Alcohol consumption increased with school year (p<0.05), with differences existing between the two sexes. From figures for consumption in the 1st year of Compulsory Secondary Education of 27.8% in males and 11.4% in females (p<0.05), figures were reached in the 4th school year of 81.5% in males and 54.7% in females (p<0.05). The regular consumption of alcohol (at least once a week) in males rose from 8.4% (1st school year) to 53.7% (4th school year); and in females from 5.8% (1st school year) to 24.6% (4th school year). In the 4th year of Compulsory Secondary Education, amongst the males who consumed alcohol, 18.2% did so on a daily basis, 47.7% at the weekend, and the remaining 34.1% occasionally; and amongst the females, 6.9% did so on a daily basis, 37.9% at the weekend, and the remaining 55.2% occasionally. In the 4th year of Compulsory Secondary Education, the average quantity of alcohol ingested by the males at the weekend was 130.7 grams, and by the females 98.8 grams. In both sexes, the proportional contribution to the total ingestion of alcohol was in the majority of cases by consumption of spirits (46.1% in males and 55.4% in females) and beer (30.9% in males and 31.6% in females). CONCLUSIONS: The prevalence of alcohol consumption amongst Secondary School pupils is very high, especially starting in the 3rd year of Compulsory Secondary Education in males and the 4th school year in females. On the completion of studies in Compulsory Secondary Education, there is a generalised consumption of alcohol amongst our adolescents that is mainly circumscribed to the weekend, although there is an important and relevant number of pupils who refer to daily consumption.

English Abstract↗

Analgesic nitrous oxide in neuropsychiatry: past, present and future.

We highlight the distinction between analgesic and anesthetic concentrations of nitrous oxide, with special reference to the safety of analgesic nitrous oxide. We present evidence that the gas at analgesic concentrations is an opioid agonist. Its extremely low abuse potential, despite its opioid properties, is discussed with regard to its evanescent action and possible partial agonistic effects, making it the least addictive of all mind-altering addictive substances. The activities of analgesic nitrous oxide make it an almost ideal agent with which to investigate the functions of the opioid system in man. We also discuss its use as a diagnostic and therapeutic agent in neuropsychiatry.

Humans↗

Tobacco control for clinicians who treat adolescents.

Smoking remains the most common preventable cause of death in the developed world, and is rapidly becoming an important cause of death in the developing world. Nicotine is a powerfully addictive substance, and the tobacco industry spends billions annually promoting it in the United States. It is therefore important for clinicians to understand why people smoke, to address smoking in patients of all ages, and to lobby for health-preserving tobacco control policies at the community level. Children take up smoking in response to social influences: smoking by friends, parents, and family, and through exposure to smoking in media. Parents who smoke not only model the behavior, but also often make the product available by leaving cigarettes around the house. Media influences include the dollar 10 billion spent per year on tobacco marketing, but more importantly, the modeling of the behavior on screen by movie and television stars. Once children start smoking, many rapidly lose autonomy over the behavior. Youth can get hooked after smoking just a few cigarettes. The most effective community efforts for reducing tobacco use are: raising the price of tobacco; halting the sale of tobacco to minors; enforcing strict school tobacco policies; and making public places smoke free through local ordinances. Working with individuals, clinicians should support cessation in all smokers, including parents of children and adolescents. They should screen children for smoking risk factors beginning at age 10. They should teach parents to maintain smoke-free households, to set nonsmoking expectations early on, and to monitor adolescents for signs of smoking. Parents should limit exposure to adult media (e.g., R-rated movies) and use family television time to discuss the effect of seeing screen depictions of smoking on adolescent behavior. Adolescents who smoke should be assessed for signs of nicotine dependence and counseled about quitting. Clinicians are effective community voices; they should participate in efforts to raise tobacco taxes, limit the display of tobacco advertising, and make public places smoke free because of the adverse health effects of passive exposure to cigarette smoke.

Adolescent↗

Antismoking products.

Nicotine is the addictive substance in tobacco and its withdrawal is responsible for a range of unpleasant symptoms after smoking cessation. Although it produces acute physiological effects, nicotine alone is not carcinogenic and does not appear to cause the vascular disease associated with smoking. Nicotine replacement has been shown to be a safe and effective pharmacological treatment for tobacco dependence in certain smokers. Its efficacy is greatest when prescribed for those who are motivated and highly nicotine-dependent. It is probably not indicated for smokers with a low degree of nicotine dependence. Studies of nicotine chewing gum conducted in special referral clinics have generally produced positive results, whereas those conducted in community practice settings have shown a smaller benefit when compared with placebo. When the results of all published placebo-controlled trials are pooled the typical improvement in smoking cessation rate is 40% (odds ratio continued smoking 0.6; 95% confidence interval 0.5-0.71; P less than 0.00001). The best results with nicotine chewing gum have been obtained with multicomponent programmes which have included some counselling and ongoing follow up and support. Early reports of success with a transdermal nicotine preparation suggest that it may have similar efficacy to nicotine gum. Clonidine administered orally or transdermally has also been shown to reduce tobacco withdrawal symptoms but requires more convincing evidence of long-term efficacy before it can be recommended for routine use. Currently available over-the-counter products, apart from nicotine chewing gum, have not been shown to be effective.

Chewing Gum↗

A volunteer program at a supportive residence for people with AIDS.

Bonaventure House in Chicago is one of two adult licensed supportive residences in the State of Illinois for people living with AIDS. Residents have access to medical case management, pastoral care, social workers/counselors, and recovery programs for substance addiction. Over 120 volunteers provide practical and supportive services for the residents. This article reports on management procedures and challenges faced by the Bonaventure House volunteer program.

Acquired Immunodeficiency Syndrome↗

AANA Journal course: update for nurse anesthetists-accelerated detoxification from opioid addiction under anesthesia: the Midas touch or the emperor's new clothes?

Opioids are highly addictive substances that include natural and synthetic chemicals that mimic the effects of morphine or bind to morphine receptor sites. Traditional assisted withdrawal is a process that takes several days to weeks and is associated with a host of painful and difficult symptoms. Recently, accelerated detoxification using opioid antagonists administered while the patient is anesthetized has been promoted, with centers proliferating nationwide. Published studies of rapid detoxification under anesthesia are highly variable in quality and control, and long-term outcome data are incomplete. Well-controlled, carefully designed studies are needed to appropriately assess the efficacy, safety, and cost-effectiveness of the approach.

Anesthesia, General↗

[Nicotine replacement therapy and smoking cessation: what choice for its status?].

The behavioral and pharmacological mechanisms of nicotine addiction are comparable to those of other addictive substances such as heroine, cocaine.... Nicotine replacement therapy is the most efficient medication to help smoking cessation for dependent smokers. Nicotine products are sold over the counter (OTC) in many countries. This measure may enhance the number of abstinent smokers, but many precautions are necessary: doses and duration must be tailored to the type and intensity of dependence; a protracted follow-up is essential to prevent relapse; all cessation providers, physicians, pharmacists, nurses, dentists, psychologists ... are effective participants in smoking cessation.

Depression↗

Attitudes towards anti-smoking legislation in Israel: a Jerusalem study.

BACKGROUND: With smoking on the rise among teenagers, the United States has recently implemented anti-smoking legislation, though with questionable success. OBJECTIVES: To examine the attitudes in Israel to such legislation. METHODS: An interviewer-administered questionnaire was completed by 505 adults: 217 undergoing general employment checkups and 288 amateur athletes requiring medical testing for certification. Smoking habits and attitudes toward anti-smoking legislation were examined. RESULTS: The overall rate of smoking was 25.3%, with a male:female ratio of 1:24 (P = 0.232). Most smokers (65.6%) started smoking before the age of 20, and only 47.7% tried to quit at least once. Both the smokers and the non-smokers who were interviewed were in favor of legislation that recognized cigarettes as an addictive substance, restricted the sale of cigarettes to people aged 18 and older, and banned cigarette advertisements. CONCLUSIONS: Anti-smoking legislation is looked upon favorably by Israelis, though the true benefit of such measures is questionable. Priority must be given to primary prevention through education and empowering youth to choose not to smoke.

Adult↗

Health and service utilization patterns among homeless men in transition: exploring the need for on-site, shelter-based nursing care.

Between September 1999 and May 2000, as part of a larger faculty/student teaching project, data describing the demographic, health problem and service utilization patterns of 183 newly sheltered homeless men (mean age = 42) seeking on-site nursing clinic services were collected and analyzed. Upon arrival to the transitional shelter, 46% of the study participants were medically uninsured or received state subsidized health benefits (49%). Almost all (99%) were in recovery from substance addiction. Despite numerous self-reported health problems, 44% had no primary care provider and 35% were seen only sporadically in local hospital clinics or in emergency departments. During the study period, nurse practitioner students and faculty managed most of the residents' episodic illnesses on-site, while assisting them to secure insurance coverage and medical appointments as a prelude to independent living. This was an attempt to curtail residents' previous pattern of waiting until medical problems became serious before seeking treatment. These findings mirrored those in studies of similar populations equating on-site delivery of health care to cost reduction. Unfortunately, many nurse-managed clinics, like our study site, fail to generate data supporting nurses' clinical efficiency and cost effectiveness in caring for homeless individuals. As such, nurses' work remains invisible and underappreciated. This article argues that future studies examining nurses' work and worth in caring for homeless individuals are necessary in determining future health care service planning with this vulnerable population.

Adult↗

[Self-destructive behaviour - occurrence and typological classification in an university psychosomatic unit]

The occurrence of self-destructive phenomena (direct self-harm; self-induced disease; self-harm delegated to medical staff) in all patients referred to the psychosomatic consultation service and all outpatients during 14 months and all discharged of the psychosomatic ward during 2 months (N=1057) is determined by the typological-descriptive assessment of Willenberg et al. (1997). Self-destructive behaviour was documented in n=79 cases (7.5%), in 40.5% of these on suspicion. 62% showed recurrent self-harm. In 15% there was a high risk to health, in 4% mortal danger. 51% hurt themselves overtly, 24% secretly. Direct self-harm occurred in 71%, self-induced disease in 48%, delegated self-harm in 35% of the cases (39% overlap). An average of 15 years passes between early precursor symptoms and the reference to the psychosomatic unit. Compared to the control group of psychosomatic patients, self-destructive patients are more often female (81%), younger, less frequently married (statistically confounded with age), more frequently medically certified and sick for more than one year. In sum, they have as many somatic diagnoses (M=0.75) but significantly more psychosocial diagnoses (ICD-10: F) (M=1.86 vs. M=1.40). Bulimia, addiction / substance abuse, and personality disorders proved to be more frequent co-diseases, anxiety disorders were underrepresented. Occurrence and relevance of self-destructive or facticious disorders are apparently underrated, so far. ICD-10 criteria are insufficient to cover all relevant types of self-destructive behaviour.

Journal Article↗

[Sexual abuse and chemical submission, a present-day problem].

CHEMICAL SUBMISSION: Certain forms of sexual abuse have recourse to molecules in order to obtain the victim's submission. These fast-acting, muscle-relaxing and sedative molecules, provoke anterograde amnesia that makes subsequent legal enquiries difficult. These products can be combined with alcohol or other addictive substances, therefore facilitating their administration, without the victim knowing, and enhancing their effects. THE MOLECULES USED: Among these molecules, hydroxybutyrate and its derivatives as well as benzodiazepines, with flunitrazepam, are frequently mentioned and detected. However, many other sedative molecules can be used to obtain chemical submission. MANAGEMENT OF THE VICTIMS: Knowledge of the facts and concomitant symptoms facilitates the medical and medico-legal management of the victims, generally encountered in hospital emergency wards. The quality and quantity of toxicological samples permit the use of efficient and validated techniques in organizing medico-legal enquiries.

Dominance-Subordination↗