Suicide and history of childhood trauma among street youth

BackgroundStreet youth represent a marginalized population marked by early mortality and elevated risk for suicide. It is not known to what extent childhood abuse and neglect predispose to suicide in this difficult-to-study population. This study is among the first to examine the relationship between childhood trauma and subsequent attempted suicide during adolescence and young adulthood among street youth.MethodsFrom October 2005 to November 2007, data were collected for the At Risk Youth Study (ARYS), a cohort of 495 street-recruited youth aged 14–26 in Vancouver, Canada. Self-reported attempted suicide in the preceding six months was examined in relation to childhood abuse and neglect, as measured by the Childhood Trauma Questionnaire (CTQ), using logistic regression.ResultsOverall, 46 (9.3%) youth reported a suicide attempt during the preceding six months. Childhood physical and sexual abuse were highly prevalent, with 201 (40.6%) and 131 (26.5%) of youth reporting history of each, respectively. Increasing CTQ score was related to risk for suicide attempt despite adjustment for confounders (adjusted odds ratio [AOR], 1.45 per standard deviation increase in score; 95% confidence interval [CI], 1.08–1.91).LimitationsUse of snowball sampling may not have produced a truly random sample, and reliance on self-report may have resulted in underreporting of risk behaviors among participants. Moreover, use of cross-sectional data limits the degree to which temporality can be concluded from the results of this study alone.ConclusionsThere exists a strong and graded association between childhood trauma and subsequent attempted suicide among street youth, an otherwise ‘hidden’ population. There is a need for effective interventions that not only prevent maltreatment of children but also aid youth at increased risk for suicide given prior history of trauma.     

Current posttraumatic stress disorder and history of trauma in trichotillomania

Though some researchers and clinicians postulate that trauma and posttraumatic stress disorder (PTSD) may be implicated in the etiologic underpinnings of trichotillomania (TTM), very little research to date has examined such postulations. To address this gap in the literature, the current study assessed the prevalence of trauma and PTSD in 42 individuals seeking treatment for TTM. Relations between symptoms of PTSD and TTM also were examined, as were differences in TTM symptoms between those with and without PTSD. Findings revealed that approximately 76% reported a history of at least one traumatic event, and 19% met criteria for PTSD. Furthermore, negative correlations were demonstrated between symptoms of PTSD and characteristics of TTM, and the PTSD group reported less severe TTM characteristics. Findings suggest that the prevalence of PTSD in TTM may be higher than in the general population and that a history of greater number of types of traumas is associated with a longer duration of hair pulling as well as the scalp as the primary pulling site. The authors also speculate that in traumatized individuals, TTM may represent a form of coping vis-à-vis self-soothing or self-harm.     

Benzodiazepine dependence

Benzodiazepines (BDPs) are widely used drugs that are effective in controlling the symptoms of anxiety. Tolerance develops rapidly to some of the effects but not to anxiolytic effect in most patients. Dependence occurs at usual therapeutic doses and in a small proportion of patients is accompanied by an enormous increase in the dose taken. The majority of subjects using very high doses are dependent on other substances concurrently. On discontinuing BDPs patients may suffer from relapse of the original condition, rebound in the severity of the symptoms of the original condition or the onset of new symptoms in an abstinence syndrome. If BDPs are discontinued abruptly there may be severe consequences such as seizures. With tapering of the dose, even if this is rapid and from high dose, high potency BDP, the subject will probably experience considerable discomfort but rarely life-threatening effects. Whilst there is concern that BDPs are used too freely, the conditions treated are accompanied by significant morbidity and mortality. The prevalence of pure BDP dependence is low and it is still a matter of debate as to how often BDPs should be prescribed, for which conditions and for what length of time.     

Maladaptive self-appraisals before trauma exposure predict posttraumatic stress disorder

This study tested the proposal that negative appraisals represent a risk factor for developing posttraumatic stress disorder (PTSD) after trauma. Trainee firefighters (N = 68) were assessed during training (before trauma exposure) for PTSD, history of traumatic events, and tendency to engage in negative appraisals. Firefighters were reassessed 4 years later (N = 52), after commencing firefighter duty (after trauma exposure), for PTSD and depression using the Posttraumatic Stress Disorder Scale (E. B. Foa, L. Cashman, L. Jaycox, & K. Perry, 1997) and the Beck Depression Inventory (Version 2; A. T. Beck, R. A. Steer, & G. K. Brown, 1996). At follow-up, 12% met criteria for PTSD. Pretrauma negative appraisals about oneself accounted for 20% of variance in PTSD severity at follow-up. These data provide the first evidence that preexisting negative appraisals are a risk factor for PTSD.     

Self-reported attachment style,trauma exposure and dissociative symptoms among adolescents

The aim of this study was to analyze whether self-reported attachment style (measuring avoidance and anxiety) among adolescents was associated with dissociative symptoms, in addition to self-reported potentially traumatic experiences. A group consisting of 462 adolescents completed three self-assessment questionnaires: Linkoping Youth Life Experience Scale (LYLES), Experiences in Close Relationships, modified version (ECR) and Dissociation Questionnaire Sweden (Dis-Q-Sweden). Self-reported attachment style had a stronger association with dissociative symptoms than self reported traumas. It was also found that scores on a dissociation questionnaire correlated strongly with scores on self-reported attachment style in adolescence. Discussion concerns reasons why self-reported attachment style is an important factor that may influence dissociative symptoms during adolescence.     

Self-reported attachment style, trauma exposure and dissociative symptoms among adolescents

The aim of this study was to analyze whether self-reported attachment style (measuring avoidance and anxiety) among adolescents was associated with dissociative symptoms, in addition to self-reported potentially traumatic experiences. A group consisting of 462 adolescents completed three self-assessment questionnaires: Linkoping Youth Life Experience Scale (LYLES), Experiences in Close Relationships, modified version (ECR) and Dissociation Questionnaire Sweden (Dis-Q-Sweden). Self-reported attachment style had a stronger association with dissociative symptoms than self reported traumas. It was also found that scores on a dissociation questionnaire correlated strongly with scores on self-reported attachment style in adolescence. Discussion concerns reasons why self-reported attachment style is an important factor that may influence dissociative symptoms during adolescence.     

Radiation exposure in body computed tomography examinations of trauma patients

Multi-slice CT provides an efficient imaging modality for trauma imaging. The purpose of this study was to provide absorbed and effective dose data from CT taking into account the patient size and compare such doses with the standard CT dose quantities based on standard geometry. The CT examination data from abdominal and thoracic scan series were collected from 36 trauma patients. The CTDI(vol), DLP(w) and effective dose were determined, and the influence of patient size was applied as a correction factor to calculated doses. The patient size was estimated from the patient weight as the effective radius based on the analysis from the axial images of abdominal and thoracic regions. The calculated mean CTDI(vol), DLP(w) and effective dose were 15.2 mGy, 431 mGy cm and 6.5 mSv for the thorax scan, and 18.5 mGy, 893 mGy cm and 14.8 mSv for the abdomen scan, respectively. The doses in the thorax and abdomen scans taking the patient size into account were 34% and 9% larger than the standard dose quantities, respectively. The use of patient size in dose estimation is recommended in order to provide realistic data for evaluation of the radiation exposure in CT, especially for paediatric patients and smaller adults.     

Is EMDR an exposure therapy? A review of trauma protocols

This article presents the well established theoretical base and clinical practice of exposure therapy for trauma. Necessary requirements for positive treatment results and contraindicated procedures are reviewed. EMDR is contrasted with these requirements and procedures. By the definitions and clinical practice of exposure therapy, the classification of EMDR poses some problems. As seen from the exposure therapy paradigm, its lack of physiological habituation and use of spontaneous association should result in negligible or negative effects rather than the well researched positive outcomes. Possible reasons for the effectiveness of EMDR are discussed, ranging from the fundamental nature of trauma reactions to the nonexposure mechanisms utilized in information processing models.     

Depression and trauma history in first‐time mothers receiving home visitation

This article examines the prevalence and correlates of depression and trauma history in first‐time mothers receiving home visitation. One hundred twenty‐three mothers in a Healthy Families America (HFA) program completed measures of depression, trauma history, social support, sense of control, and child abuse risk. Number of completed home visits, number of uncompleted home visits, and total telephone contact time were documented for each participant over the first 6 months of enrollment. Nearly 30% of the mothers scored in the clinically significant range on the depression measure. Approximately 70% of the sample had experienced at least one violent trauma. Depression and violent trauma, but not nonviolent trauma, were related to greater child abuse risk and less maternal sense of control and social support. Violent traumas were related to greater interruptions in service delivery as reflected by more uncompleted home visits. After controlling for social support and sense of control, depression was associated with more telephone contact between mothers and home visitors. Mothers receiving home visitation exhibited a heightened incidence of depression and trauma history relative to the population at large. These constructs were related to social support and sense of control, both of which are targets of home visitation. Depression and trauma history may significantly influence the delivery and outcomes obtained from home visitation. © 2002 Wiley Periodicals, Inc.     

Benzodiazepine interactions with GABA receptors

Benzodiazepines (BZs) produce most, if not all, of their pharmacological actions by specifically enhancing the effects of endogenous and exogenous GABA that are mediated by GABAA receptors. This potentiation consists in an increase of the apparent affinity of GABA for increasing chloride conductance without increase in its efficacy and, on the single chloride channel level, seems to be the result of an increased probability of channel opening events. Recent studies indicate that the BZR is a site on the GABA receptor (GABA-R)-chloride channel complex, through which the gain of the signal transducer function of the latter is allosterically modulated. The unique feature of this drug receptor, which is located on a neurotransmitter receptor-gated ion channel, is its specific interaction with three classes of ligands. Agonists, competitive antagonists and inverse agonists at BZR, respectively increase, do not alter and reduce the gain of the GABA-R function. Compounds have been found that cover a whole spectrum of transition between the two extremes (partial agonists, partial inverse agonists) and for which interesting therapeutic applications can be foreseen.     

Benzodiazepine binding to bovine retina

[3H]Diazepam binds to membrane preparations of the retina, suggesting that benzodiazepine receptors exist in this tissue. The binding characteristics are similar to those known to occur in the brain, with affinity constants in the same range. Unlike the finding in the brain, [3H]diazepam binding in the retina is not stimulated by GABA and other GABA agonists. These findings indicate that benzodiazepine receptors may have a more general function and not only be associated with anxiety or emotional behaviour.