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At least 1,549 records · Page 86Linked to original sources
PubMed1989

Attempted suicide by means of burns.

A study was made of the results of treatment of 57 patients who made 68 suicide attempts by means of burns in the period between 1979 and 1987. They formed 14 per cent of the total patient population older than 16 years of age. Attempted suicide was observed most frequently in patients between 20 and 39 years of age. The sex incidence was equal. Most patients were in contact with or had been in contact with mental health care institutions at the time of their attempt, half of the attempts took place in a psychiatric hospital. Twelve patients died, in nine the prognosis was considered to be so poor that in view of the seriousness of the burns or the accompanying injuries no treatment was initiated. Follow-up took place after an average 3.8 years (1-8.25 years). Information was obtained on all 45 surviving patients. Eight patients had died, six of natural causes and two had committed suicide. Eighteen patients were living at home, 13 were residents at a psychiatric hospital, three were living in a protective commune, two were being detained during Her Majesty's pleasure and one was in prison. It appeared to be difficult to incorporate these patients in a closed follow-up regimen.

Adult↗
PubMed1995

Activation of alpha 2-adrenergic receptors decreases nerve trauma-induced afferent barrage but not autotomy.

Effects of the selective alpha 2-adrenoceptor agonist, medetomidine, on a compound volley of a tibial nerve stimulation-evoked spinal reflex, pain-induced phrenic motor responses and on postoperative neuropathic pain behavior were studied in rats. Medetomidine (0.3 mg/kg) decreased the amplitude of the compound volley recorded from peroneal nerve in response to tibial stimulation in pentobarbital (40 mg/kg) anesthetized rats. Atipamezole, an alpha 2-adrenoceptor antagonist (1.5 mg/kg) fully restored the response when given 60 min after the medetomidine administration. Pain-evoked phrenic motor responses were completely inhibited upon combination anesthesia by pentobarbital (40 mg/kg) and medetomidine (0.3 mg/kg) (PB+M) but not upon plain pentobarbital anesthesia (50 or 60 mg/kg) (PB50,PB60). To study the effect of medetomidine on postoperative neuropathic pain behavior (autotomy), transection of sciatic nerve was done under PB+M, PB50 or PB60 anesthesia. No differences between the groups were found in the postoperative pain behavior during eight-week follow up. The results show that activation of alpha 2-adrenergic receptors by medetomidine under pentobarbital anesthesia mitigates trauma-induced afferent barrage, whereas it does not reduce the subsequent autotomy.

Adrenergic alpha-2 Receptor Agonists↗
PubMedDate not supplied

Intentional and unintentional abuse of infants and children.

Intentional abuse of an infant is usually apparent. External injuries such as burns, bites, and bruises, as well as the skeletal changes of fractures, frequently multiple and in various stages of healing, are obviously intentionally inflicted, and are impossible accidental injuries for the nonambulatory young infant. Similar injuries in young children may be more difficult to evaluate because of their fear of and intimidation by the person who inflicted the injury. Fortunately, the high degree of suspicion regarding the nature of the injury permits the physician to make his accusations with legal protection in our judicial system. Every radiologist should be concerned with the responsibility of reporting to the referring physician the possibility of intentional trauma to infants and children. In Harris County, where Houston is located, there are 1,500 reports per month of child abuse; in other words, this approximates 18,000 cases a year in our community, and the radiologist is frequently the first physician to see evidence of the abused child. Not only is it a moral responsibility for the radiologist to report his suspicions, but in the state of Texas, as in other states, "any person having cause to believe that a child's physical and mental health, or welfare has been or may be adversely affected by abuse or neglect shall report" to the appropriate agency. A more recent amendment to this law is a penalty for failure to report. A person commits an offense if the person has cause to believe that a child's physical and mental health or welfare has been or may be adversely affected further by abuse or neglect and knowingly fails to report it. It is hoped that any radiologist recognizing either pathognomonic or suspicious signs of child abuse will have the conscience and courage to take a strong stand for the protection of the abused infant or child. Accidental injuries in older children may offer problems in diagnosis if there is no history available or if there is a denial of an injury. Some of these injuries may produce radiographic findings suggesting some form of metaphyseal or diaphyseal dysplasia. Iatrogenic injuries are frequently the result of physiologic or anatomical response to proper and lifesaving treatment. The most serious of these are found in the premature infant, who may suffer chronic lung disease or, more seriously, brain damage.(ABSTRACT TRUNCATED AT 400 WORDS)

Bone Diseases, Developmental↗
PubMed1987

Functional and structural analyses of behavior: approaches leading to reduced use of punishment procedures?

A common approach to dealing with the serious misbehaviors of handicapped individuals is to use punishment procedures. Although punishment techniques are often effective, many claim that their use is restrictive. Emerging approaches for dealing with inappropriate behavior are to conduct a functional or structural analysis of behavior. These approaches allow practitioners to isolate and manipulate the factors responsible for aberrant behaviors. Such analyses may reveal that a maladaptive behavior results in adult attention, is associated with demand situations, or provides reinforcing sensory feedback. In each case corrective procedures relevant to the function of the inappropriate behavior or its associated stimuli, can be applied. In some cases the analysis will reveal alternative approaches to the use of punishment procedures. In other cases it may not. Presently, there have been relatively few examples of the functional and structural analysis approaches; results thus far, however, have been encouraging.

Behavior↗
PubMed1987

Naltrexone in treatment of self injurious behavior: a clinical study.

It has been suggested that the parenteral opiate antagonist, naloxone, might ameliorate self-injurious behavior. However, clinical studies have had conflicting results. We have evaluated whether a potent oral opiate antagonist, naltrexone, is effective in the treatment of this condition. The study was conducted on two young, profoundly mentally retarded adults, who exhibited intractable self-injurious behavior. A double-blind, placebo-controlled, within-subject-withdrawal design was utilized. One subject was studied for 12 weeks and the other one for 18 weeks. No measurable effects on the self-injurious behavior were observed.

Adult↗
PubMed1987

Caregiver perceptions of psychotropic medication in residential facilities.

Direct caregivers (designated as "psychopaedic nurses" in New Zealand) in two public residential facilities were surveyed regarding their perceptions, opinions, and knowledge of psychotropic drugs. Of 276 individuals contacted, 227 (82%) returned usable questionnaires. The results indicated that unit supervisors (charge nurses) and unit doctors were perceived as wielding most influence on decisions regarding psychotropic drugs, whereas caregivers based outside residential units were seen as having little influence. Aggressive/destructive behavior and, to a smaller extent, self-injurious behavior were seen as the most likely problem behaviors to lead to medication use. Subjective measures were generally favored for assessing drug effects although, in a hypothetical "ideal" situation, nurses gave increasing priority to more objective indices. Endorsement of behavior modification as an alternative to pharmacotherapy was generally high. A large majority of these caregivers (85%) expressed dissatisfaction with their training concerning psychotropic drugs. Finally, data were presented on drug topics about which respondents wanted to learn more and about changes they wished to see instated in their facilities. Our principal conclusion was that these data indicate a need for more education on a variety of social, pharmacological, and behavioral issues as they relate to medication use.

Adolescent↗
PubMed1989

A survey of self-restraint, self-injury, and other maladaptive behaviors in an institutionalized retarded population.

Psychologists of a state school for mentally retarded persons were surveyed to assess the prevalence of self-restraint, self-injurious behavior (SIB), and other maladaptive behaviors for clients in their facility. Results indicated that almost all clients reliably identified as engaging in self-restraint also engaged in self-injurious behavior while other maladaptive behaviors for self-restraining clients occurred much less frequently. The occurrence of SIB in the school's population was substantially lower than in the self-restraining population. Results are discussed in terms of future research investigating a functional relationship between self-restraint and SIB. Clinical implications for the use of self-restraint as an intervention for SIB also are discussed.

Adolescent↗
PubMed1990

"Harry": a ten year follow-up of the successful treatment of a self-injurious man.

The successful treatment of a self-injurious man is reported in a ten year follow-up. The client, Harry, is a 32-year-old man who was treated for self-injurious behavior (SIB) ten years ago with a multiphased program that included a) reinforcement with physical restraint for increasingly longer periods of noninjury and timeout from restraint for SIB, b) fading restraint, c) substituting appropriate forms of restraint, d) token reinforcement for adaptive behavior, and e) parent and vocational training. After ten years Harry's SIB remains infrequent and rarely results in any tissue damage. No negative consequences have been used for his SIB for over nine years. Harry now works all day in a community workshop, earns approximately $45.00 per month, visits his parents' home virtually every weekend and accompanied them two years ago on a four and a half week vacation by car that covered 7500 miles. Conceptual and practical considerations related to the client's success are discussed.

Adult↗
PubMed1990

A comparison of DRO to movement suppression time-out and DRO with two self-injurious and aggressive mentally retarded adults.

Movement Suppression Time-Out is a recently developed variant of physical restraint which may have applicability for serious behavior problems of developmentally disabled persons. However, the current debate over aversives and the argument by some that positives alone are sufficient to treat all behavior problems requires study. Initial trials with reinforcement alone, compared to reinforcement and punishers are necessary to empirically establish the limits of various treatment methodologies. This study was designed to evaluate reinforcement of other behavior (DRO) and verbal reprimands and Movement Suppression Time-Out, DRO and verbal reprimands with two severely mentally retarded males, 35 and 39 years of age. Using a multiple baseline design, self-injury was studied across setting with one client and across self-injury and aggression with the second person. Improvements were only apparent when Movement Suppression Time-Out was paired with verbal reprimands and DRO. With one client effects were maintained at an 8 month follow-up. The implications of these findings are discussed.

Adult↗
PubMed1991

Functional analysis and treatment of aberrant behavior.

This article reviewed and discussed various methodologies used for the analysis of variables maintaining aberrant behavior. Previous research had succeeded in identifying a wide variety of environmental events which may contribute to an individual's maladaptive responding. These general classes of variables are summarized and presented with relevant examples. We conclude with suggestions for conducting a comprehensive functional analysis using descriptive and experimental methods leading to the development and evaluation of analysis-derived interventions.

Behavior Therapy↗
PubMed1991

Self-restraint: a review of etiology and applications in mentally retarded adults with self-injury.

Self-restraint has been noted in studies of self-injurious behavior (SIB) in mentally retarded individuals. These studies have investigated self-restraint in the context of SIB, and as a result it has been difficult to isolate the function of self-restraint within this complex clinical situation. This article summarizes and critically analyzes the literature on self-restraint, particularly its identification, etiology, modification, and relationship to SIB. At present there is some empirical evidence to suggest that self-restraint is negatively reinforced by the termination or avoidance of SIB. Other studies have demonstrated that self-restraint can develop stimulus control properties for the absence of SIB. Finally, it has been suggested that self-restraint may function independently of SIB and be maintained by escape from demands or by conditioned reinforcement. Clinical concerns include the need for a functional analysis of self-restraint, the undesirable effects on SIB of reducing self-restraint, and the necessity of replacing self-restraint topographies with ones which do not interfere with daily activities.

Adult↗
PubMed2005

Optic nerve massaging: an extremely rare cause of self-inflicted blindness.

PURPOSE: To report a patient whose self-inflicted blindness was not clinically apparent by history or external signs of trauma. DESIGN: Observational case report. METHODS: A 12-year-old girl with a history of social and behavioral problems was noted to have visual loss in her right eye. Examination revealed no light perception, optic nerve atrophy, partial upper lid ptosis, exotropia, and hypoesthesia of the cheek, all on her right side. RESULTS: After undergoing extensive examinations which were unrevealing for a diagnosis, the patient admitted to a recurrent maneuver, which she secretly used to relieve anxiety and stress. This maneuver consisted of inserting her index finger under the right supraorbital rim and forcibly subluxating her globe out of the orbital space. CONCLUSIONS: Self-inflicted visual loss can occur in nonpsychotic and nonviolent patients. Accurate diagnosis is important, as there is a risk of similar involvement to the fellow eye, and referral for psychiatric counseling is mandatory.

Blindness↗