Trends in Attempted Suicide in Adolescents and Young Adults in Gent, 1986–1995

This paper describes gender-specific trends in the occurrence and methods of attempted suicide in adolescents and young adults between 1986 and 1995 in Gent. The overall pattern emerging from this study is that following a decrease in the rates of attempted suicide in the second half of the 1980s, rates have clearly increased in the 1990s, especially among adolescent males. A slight predominance of female attempters was found in the 15 to 19 age group while among young adults the female to male ratio was approximately 1.0. Deliberate self-poisoning was involved in the vast majority of attempts, although among young adults significantly more males than females used deliberate self-injury to attempt suicide. In view of increasing rates of suicide among young people in many countries and of the association between attempted suicide and suicide, further study of trends and characteristics of attempted suicide among young people is warranted.     

Adrenomedullin 2/Intermedin in the Hypothalamo–Pituitary–Adrenal Axis

Adrenomedullin 2/intermedin (AM2/IMD) is a new member of the calcitonin/calcitonin gene-related peptide (CGRP) family. CGRP, adrenomedullin (AM), and AM2/IMD share the receptor system consisting of calcitonin receptor-like receptor (CRLR) and receptor activity-modifying proteins (RAMP). The CRLR/RAMP2 or CRLR/RAMP3 complex forms the AM receptor, whereas the CRLR/RAMP1 forms the CGRP receptor. AM2/IMD binds non-selectively to all three CRLR/RAMP complexes. AM2/IMD has various actions, such as a potent vasodilator action and a protective action against oxidative stress, like AM and CGRP. When administered intracerebroventricularly, AM2/IMD stimulates the sympathetic nervous system and increases blood pressure. In human hypothalamus, AM2/IMD is expressed in the paraventricular and supraoptic nuclei and colocalized with arginine vasopressin. Anterior pituitary cells were diffusely immunostained for AM2/IMD. AM2/IMD stimulates the release of ACTH, prolactin, and oxytocin, but suppresses GH release. Some of these pituitary actions of AM2/IMD have been supposed to be mediated by an unidentified unique receptor for AM2/IMD. In the adrenal gland, immunoreactive (IR)-AM2/IMD and IR-AM were detected in the medulla, while the degree of IR-AM2/IMD and IR-AM in the cortex was relatively weak or undetectable. Furthermore, AM2/IMD and AM were expressed in adrenocortical tumors, such as aldosterone-secreting adenomas, and pheochromocytomas. CRLR and RAMPs are expressed in the hypothalamus, pituitaries, adrenal glands, and adrenal tumors. Thus, AM2/IMD is expressed in every endocrine organ of the hypothalamo–pituitary–adrenal axis together with its receptor. AM2/IMD may act as a neurotransmitter or modulator in the brain and as a paracrine/autocrine regulator in the hypothalamo–pituitary–adrenal axis.     

Lesbian,Gay, Bisexual,and Transgender (LGBT) Service Members: Life After Don’t Ask,Don’t Tell

Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don’t Ask, Don’t Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.     

The Anxiolytic Effects of Moderate Hypoxia and Remote Ischemia in the Posttraumatic Stress Disorder Model Are Accompanied by Modification of Functioning of the Hypothalamic–Pituitary–Adrenal Axis

Using a model of posttraumatic stress disorder (PTSD) in rats, it has been shown that conditioning by moderate hypobaric hypoxia (360 mmHg, three times for 2 h with 24-h interval) or limb ischemia–reperfusion (three times for 5 min with 15-min interval) prevents premature suppression of release of the stress hormone corticosterone to the blood plasma, which is typical of the triggering of pathological fast negative feedback of the hypothalamic–pituitary–adrenal axis (HPA) in this pathology. Hypoxic or remote ischemic preand postconditioning also increased the basal level of this hormone, which is significantly reduced during the formation of experimental PTSD. Thus, the pronounced anxiolytic effect of these conditioning types in the PTSD model may be mediated by the normalization of HPA regulation by a feedback mechanism and prevention of a decrease in its basal activity. Further research on the decoding of neurohumoral mechanisms of the stress-protective action of conditioning will speed up the introduction of these effective non-drug ways of prevention and correction of stress-induced pathologies into medical practice.     

Recent Marijuana Use Among Young Adults, 2015–2018, USA

Marijuana is the most commonly used drug across all groups. A greater understanding of risk factors associated with recent use can inform health prevention messaging and behavioral interventions. Pooled data from the 2015–2018 National Survey on Drug Use and Health were utilized among 89,446 individuals ages 18–34. Weighted logistic regression analyses, controlling for covariates, were utilized to determine conditional associations to past-30-day use. A sizeable percentage (18.5%) of individuals reported smoking marijuana in the past 30 days. Individuals who identify as African American or multi-racial, gay/lesbian, bisexual, reported their health as poor, not covered by health insurance, reported prior drug use, or who had reported any thoughts/plans of suicide were at risk for use. Of concern, high rates of alcohol (14.7%) and cocaine (1.50%) were found among users. We believe our findings can inform harm reduction efforts and policy creation.

     

Binge Drinking Among Youths and Young Adults in the United States: 1979–2006

ObjectiveTo evaluate trends in the past 30–day prevalence of binge drinking by age, sex, and student status, among youths and young adults in the United States between 1979 and 2006, a period that encompasses the federally mandated transition to a uniform legal drinking age of 21 years, and other policy changes aimed at curbing underage drinking.MethodData were analyzed from 20 administrations of the National Survey on Drug Use and Health, yielding a pooled sample of more than 500,000 subjects. Trends in relative risk for four different age groups, stratified by sex, relative to the 24- to 34-year-old reference group were calculated. We also examined trends in risk for binge drinking associated with student status (among college-age students) and race/ethnicity.ResultsSignificant reductions in relative risk for binge drinking over time were observed for 12- to 20-year-old males, but no changes were observed for females in this age range, and binge drinking among minority females increased. Risk for binge drinking increased among 21- to 23-year-old women, with college women outpacing nonstudents in this age range. Trends also indicate that no reduction in binge drinking occurred for college men.ConclusionsAlthough the overall trend is toward lower rates of binge drinking among youths, likely a result of a higher legal drinking age and other changes in alcohol policy, little improvement has occurred for college students, and increases in binge drinking among women has offset improvements among youths. Understanding these specific demographic trends will help inform prevention efforts.     

“Straight Sex is Complicated Enough!”: The Lived Experiences of Autistics Who are Gay,Lesbian, Bisexual,Asexual, or Other Sexual Orientations

Autistics are more likely than neurotypicals to be gay, lesbian, bisexual, asexual, and other sexual orientations. Autistics and sexual minorities represent populations at high risk for depression, anxiety, and suicidality. Little is known about the experiences of individuals living at this intersection. In this phenomenology, 67 individuals who identified as autistic sexual minorities participated in online interviews to describe the meaning of their experiences. Six themes emerged, including: self-acceptance is a journey; autistic traits complicate self-identification of sexual orientation; social and sensory stressors affect sexual expression; feeling misunderstood and isolated; challenges finding mutually satisfying relationships; and difficulty recognizing and communicating sexual needs. Autistic sexual minorities experience a “double minority” status that complicates identity formation and increases vulnerability in sexual relationships.

     

Dramatic Effect of Lamotrigine in Young Adults Suffering from Intractable Absences and Generalized Tonic–Clonic Seizures Since Childhood

The purpose of this study was to evaluate the efficacy of adding lamotrigine to valproic acid in patients with refractory absence seizures starting in childhood and persisting into adulthood. Lamotrigine was added to previous anticonvulsants (always including valproic acid) in 10 patients aged 23–44 years, with intractable absence and generalized tonic–clonic seizures. Seven patients became seizure free, three patients had > 75% reduction in seizure frequency. The patients have remained on comedication with valproic acid and lamotrigine, after gradually discontinuing most other anticonvulsants, for a follow-up period ranging from 1–4 years. There has been no increase in seizure frequency during this period. None of the patients reported any side effects. This study supports the growing evidence of therapeutic synergy between lamotrigine and valproic acid. This combination may be the therapy of choice for refractory absence and generalized tonic–clonic seizures both in children and adults.     

A Replication and Extension of the PEERS® for Young Adults Social Skills Intervention: Examining Effects on Social Skills and Social Anxiety in Young Adults with Autism Spectrum Disorder

Young adults with ASD experience difficulties with social skills, empathy, loneliness, and social anxiety. One intervention, PEERS® for Young Adults, shows promise in addressing these challenges. The present study replicated and extended the original study by recruiting a larger sample (N?=?56), employing a gold standard ASD assessment tool, and examining changes in social anxiety utilizing a randomized controlled trial design. Results indicated improvements in social responsiveness (SSIS-RS SS, p?=?.006 and CPB, p?=?.005; SRS, p?=?.004), PEERS® knowledge (TYASSK, p?=?.001), empathy (EQ, p?=?.044), direct interactions (QSQ-YA, p?=?.059), and social anxiety (LSAS-SR, p?=?.019). Findings demonstrate further empirical support for the intervention for individuals with ASD.     

Acute Hypothalamic–pituitary–adrenal Response in Traumatic Brain Injury with and Without Extracerebral Trauma

Objective  Endocrine disturbances are common after traumatic brain injury (TBI). Hypothalamic–pituitary–adrenal (HPA) axis response in TBI patients may be related with hemodynamic status. However, its relationship with outcome is unclear. Our objective was to evaluate HPA axis response in the acute phase after TBI in patients with or without extracerebral trauma (ECT), and to investigate the impact of systemic injury and the mechanisms underlying HPA response. Methods  We prospectively studied 165 patients with moderate to severe TBI. Between 24 and 48 h after TBI, blood samples were taken for plasma adrenocorticotrophin hormone (ACTH) and baseline cortisol measurements. Afterwards, a short corticotrophin hormone test (250 μg Synacthen) was performed and samples were obtained at 30 and 60 min. We compared HPA response in TBI patients presenting with and without ECT and investigate potential mechanisms underlying this response. Results  One hundred and eight patients presented with isolated TBI, whereas 57 patients presented associated ECT. Both groups were comparable. Overall, 23.6% of patients fulfilled adrenal insufficiency (AI) criteria. Patients with plasma ACTH <9 pg/ml and patients presenting with hemorrhagic shock were more likely to present adrenal impairment. Variables associated with mortality were Injury Severity Score, Glasgow Coma Scale, Traumatic Coma Data Bank classification different than type II, need of second level measures to control intracranial pressure and plasma ACTH >9 pg/ml. Conclusion  Patients with TBI presenting with or without associated ECT present similar acute HPA response. AI is present in 23.6% of patients. Risk is increased in patients with low plasma ACTH levels and in patients with hemorrhagic shock. Both primary and secondary mechanisms of HPA failure were found. However, AI did not affect outcome.     

Prevalence and Clinical Significance of DSM-5–Attenuated Psychosis Syndrome in Adolescents and Young Adults in the General Population: The Bern Epidemiological At-Risk (BEAR) Study

Objective: Section III of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) lists attenuated psychosis syndrome as a condition for further study. One important question is its prevalence and clinical significance in the general population. Method: Analyses involved 1229 participants (age 16–40 years) from the general population of Canton Bern, Switzerland, enrolled from June 2011 to July 2012. “Symptom,” “onset/worsening,” “frequency,” and “distress/disability” criteria of attenuated psychosis syndrome were assessed using the structured interview for psychosis-risk syndromes. Furthermore, help-seeking, psychosocial functioning, and current nonpsychotic axis I disorders were surveyed. Well-trained psychologists performed assessments using the computer-assisted telephone interviewing technique. Results: The symptom criterion was met by 12.9% of participants, onset/worsening by 1.1%, frequency by 3.8%, and distress/disability by 7.0%. Symptom, frequency, and distress/disability were met by 3.2%. Excluding trait-like attenuated psychotic symptoms (APS) decreased the prevalence to 2.6%, while adding onset/worsening reduced it to 0.3%. APS were associated with functional impairments, current mental disorders, and help-seeking although they were not a reason for help-seeking. These associations were weaker for attenuated psychosis syndrome. Conclusions: At the population level, only 0.3% met current attenuated psychosis syndrome criteria. Particularly, the onset/worsening criterion, originally included to increase the likelihood of progression to psychosis, lowered its prevalence. Because progression is not required for a self-contained syndrome, a revision of the restrictive onset criterion is proposed to avoid the exclusion of 2.3% of persons who experience and are distressed by APS from mental health care. Secondary analyses suggest that a revised syndrome would also possess higher clinical significance than the current syndrome.Key words: attenuated psychosis syndrome, general population, prevalence, distress, disability, functional impairment     

Benton Visual Retention Test Performance in Normal Adults and Acute Stroke Patients: Demographic Considerations,Discriminant Validity,and Test–Retest Reliability

We examined relationships between demographic variables and Benton Visual Retention Test performance in 352 healthy Greek adults, aged 18–84 years. We derived norms for BVRT total number correct and error scores adjusted for variables that contributed significantly to the variance. We also investigated BVRT performance in 28 acute stroke patients M = 6.14 days after insult. Age, education, and IQ, but not gender, were significantly associated with BVRT performance in healthy participants. However, only age contributed significantly to BVRT performance in acute stroke patients. Test–retest reliability was moderate (.782) for number correct and low for number error (.596) scores. Practice effects were noted only for number correct score. The test appears to discriminate adequately between acute stroke patients and matched healthy controls.     

Flexible Visual Processing in Young Adults with Autism: The Effects of Implicit Learning on a Global–Local Task

We utilized a hierarchical figures task to determine the default level of perceptual processing and the flexibility of visual processing in a group of high-functioning young adults with autism (n?=?12) and a typically developing young adults, matched by chronological age and IQ (n?=?12). In one task, participants attended to one level of the figure and ignored the other in order to determine the default level of processing. In the other task, participants attended to both levels and the proportion of trials in which a target would occur at either level was manipulated. Both groups exhibited a global processing bias and showed similar flexibility in performance, suggesting that persons with autism may not be impaired in flexible shifting between task levels.     

Associations of Depressive and Anxiety Disorders with Periodontal Disease Prevalence in Young Adults: Analysis of 1999–2004 National Health and Nutrition Examination Survey (NHANES) Data

Background

Depression and anxiety have been linked to periodontal disease, an emerging risk factor for chronic diseases. However, this literature is mixed, and few studies have concurrently evaluated depression and anxiety.

Purpose

We simultaneously examined the associations of depressive and anxiety disorders with periodontal disease prevalence and explored tobacco use as a mediator.

Methods

Participants were 1,979 young adults from the National Health and Nutrition Examination Survey 1999–2004 who underwent a diagnostic interview and a dental examination.

Results

Adults with panic disorder had a threefold higher odds of having periodontal disease than those without this disorder (OR?=?3.07, 95 % CI 1.17–8.02). This relationship was partially mediated by tobacco use and remained after adjustment for major depressive disorder and generalized anxiety disorder, which were not related to periodontal disease.

Conclusions

Young adults with panic disorder may have greater odds of having periodontal disease, in part, due to increased tobacco use.