Prevalence of victimization, posttraumatic stress disorder and violent behaviour in the seriously mentally ill

AIMS: There is evidence that individuals with a mental illness are more likely to report a history of victimization and to be at an increased risk for future victimization. The aims of the current study are to determine lifetime rates of different types of victimization in a population of psychiatric inpatients and to examine the associations between a history of victimization and measures of adverse outcome and rates of posttraumatic stress disorder (PTSD). METHOD: A total of 130 psychiatric inpatients with a range of psychiatric diagnoses were surveyed. Information collected included history of victimization, aggression and violence levels, suicidal ideation, PTSD symptomatology, rates of hospitalization and pension status. RESULTS: A lifetime history of victimization was reported in 87.7% of patients with 46% having lifetime and 32% current PTSD. Most clinicians did not identify the high rates of comorbid PTSD in these patients. Victimization was associated significantly with receipt of the disability support pension and number of previous psychiatric hospitalizations, both measures of more adverse outcome. CONCLUSION: Victimization may have a negative impact on outcome and may further disadvantage an already vulnerable population. These findings have both clinical and policy implications for the long-term management of people with mental illness.     

Deep brain stimulation for camptocormia in dystonia and Parkinson’s disease

Camptocormia, or “bent spine syndrome”, may occur in various movement disorders such as primary dystonia or idiopathic Parkinson’s disease (PD). Although deep brain stimulation (DBS) is an established treatment in refractory primary dystonia and advanced PD, few data are available on the effect of DBS on camptocormia comparing these two conditions. Seven patients (4 with dystonia, 3 with PD; mean age 60.3 years at surgery, range 39–73 years) with camptocormia were included in the study. Five patients underwent bilateral GPi DBS and two patients underwent bilateral STN DBS guided by CT-stereotactic surgery and microelectrode recording. Pre- and postoperative motor assessment included the BFM in the dystonia patients and the UPDRS in the PD patients. Severity of camptocormia was assessed by the BFM subscore for the trunk at the last available follow-up at a mean of 17.3 months (range 9–36 months). There were no surgical complications. In the four patients with dystonia there was a mean improvement of 53% in the BFM motor score (range 41–79%) and of 63% (range 50–67%) in the BFM subscore for the trunk at the last available follow-up (mean 14.3 months, range 9–18 months). In the three patients with camptocormia in PD who underwent bilateral STN DBS (2 patients) or pallidal DBS (1 patient), the PD symptoms improved markedly (mean improvement in the UPDRS motor subscore stimulation on/medication off 55%, range 49–61%), but there was no or only mild improvement of camptocormia in the two patients who underwent STN DBS, and only moderate improvement in the patient with GPi DBS at the last available follow-up (mean 21 months, range 12–36 months). GPi DBS is an effective treatment for camptocormia in dystonia. The response of camptocormia to chronic STN or GPi DBS in PD is more heterogenous. The latter may be due to a variety of causes and needs further clarification.     

Organelle dynamics and dysfunction: A closer link between peroxisomes and mitochondria

Summary  Mitochondria and peroxisomes are ubiquitous subcellular organelles, which fulfil an indispensable role in the cellular metabolism of higher eukaryotes. Moreover, they are highly dynamic and display large plasticity. There is growing evidence now that both organelles exhibit a closer interrelationship than previously appreciated. This connection includes metabolic cooperations and cross-talk, a novel putative mitochondria-to-peroxisome vesicular trafficking pathway, as well as an overlap in key components of their fission machinery. Thus, peroxisomal alterations in metabolism, biogenesis, dynamics and proliferation can potentially influence mitochondrial functions, and vice versa. In this review, we present the latest progress in the emerging field of peroxisomal and mitochondrial interrelationship with a particular emphasis on organelle dynamics and its implication in diseases. Competing interests: None declared Presented at the Annual Symposium of the SSIEM, Lisbon, Portugal, 2–5 September 2008     

Effect of subthalamic deep brain stimulation on the function of the urinary bladder

Detrusor hyperreflexia is a relevant clinical symptom for patients suffering from Parkinson's disease. In a series of 16 patients, we demonstrated that subthalamic deep brain stimulation has a significant and urodynamically recordable effect leading to a normalization of pathologically increased bladder sensibility.     

Application of image-guided surface coil P-31 MR spectroscopy to human liver, heart, and kidney

Localized phosphorus-31 magnetic resonance (MR) spectroscopy in humans has previously been accomplished with surface coils by means of depth-resolved surface coil spectroscopy or rotating frame experiments, in which the extent of tissue sampled critically depends on surface coil placement. The authors' goal was to modify the surface coil image-selected in vivo spectroscopy (ISIS) experiment to accomplish three-dimensional volume selection through application of selective pulses in the presence of B0 gradients. Advantages of ISIS include the ability to use proton images to define the volume of interest (VOI) and reduced dependence on exact positioning of the surface coil. However, rapid replication of the surface coil ISIS experiment can cause spectral contamination from signals originating outside the VOI. A modified version of the ISIS experiment was developed to alleviate contamination under conditions of rapid replication. Applications of localized P-31 MR spectroscopy for observation of high-energy phosphorus metabolites are presented in human liver, heart, and transplanted and normal kidney.     

High efficacy of integrated preventive measures against zoonotic cutaneous leishmaniasis in northern Afghanistan, as revealed by Quantified Infection Rates

Following an outbreak of more than 200 cases of zoonotic cutaneous leishmaniasis (ZCL) during 2004 and 2005 among International Security Assistance Force (ISAF) troops stationed in the Mazar-e Sharif (MeS) airport area, epidemiological investigations indicated the presence of a local high-density ZCL focus. Based on ZCL's specific transmission modes, density and seasonality, integrated preventive measures were continuously implemented from February 2006 at a German military camp constructed at MeS. Preventive techniques included such synergistic measures as skin repellents and insecticide-impregnated clothing, bednets and curtains, sand fly and rodent monitoring and control, extended habitat sanitation, and health education, all designed to achieve maximum protection against ZCL. Habitat alteration included: (a) erection of a 3.0 m high stone wall around the entire camp area; (b) removal of ≥30 cm of the upper earth layer throughout the site; (c) soil compaction and stone paving to a depth of ≥30 cm plus compaction of the surrounding area to a distance of 100 m outside the camp wall; and (d) regular eradication of vegetation. Aggressive implementation of these measures led to a 166-fold and 546-fold reduction in sand fly numbers and complete eradication of the local rodent reservoir, Rhombomys opimus, inside the camp during 2006 and 2007, respectively. ZCL attack rates decreased significantly (p < 0.0001), from 17.5% (14 cases/80 persons) for the 2005 German assessment teams to 0.087% (1 case/1150 persons) for the 2006 contingent, and 0% (0 cases) (p < 0.0001) for the 2007 contingent, with Quantified Infection Rates (QIRs) of 0.058, 0.0000055, and 0.0, respectively. Using QIR values, the protective factor of the integrated preventive measures was shown to be ≥10,545 times higher in the 2006 and 2007 contingents, compared with the 2005 assessment teams. Results show that the continuously implemented, integrated preventive techniques used in this study gave excellent and long-lasting protection against zoonotic cutaneous leishmaniasis under field conditions.     

Combination protocols of cytokine therapy with interleukin-3 and granulocyte-macrophage colony-stimulating factor in a primate model of radiation-induced marrow aplasia

Single cytokine therapy with granulocyte-macrophage colony-stimulating factor (GM-CSF) or interleukin-3 (IL-3) has been shown to be effective in decreasing the respective periods of neutropenia and thrombocytopenia following radiation- or drug-induced marrow aplasia. The combined administration of IL-3 and GM-CSF in normal primates suggested that a sequential protocol of IL-3 followed by GM-CSF would be more effective than that of GM-CSF alone in producing neutrophils (PMN). We investigated the therapeutic efficacy of two combination protocols, the sequential and coadministration of recombinant human IL- 3 and GM-CSF relative to respective single cytokine therapy, and delayed GM-CSF administration in sublethally irradiated rhesus monkeys. Monkeys irradiated with 450 cGy (mixed fission neutron:gamma radiation) received either IL-3, GM-CSF, human serum albumin (HSA), or IL-3 coadministered with GM-CSF for days 1 through 21 consecutively postexposure, or IL-3 or HSA for days 1 through 7 followed by GM-CSF for days 7 through 21. All cytokines and HSA were injected subcutaneously at a total dose of 25 micrograms/kg/d, divided twice daily. Complete blood counts (CBC) and platelet (PLT) counts were monitored over 60 days postirradiation. The respiratory burst activity of the PMN was assessed flow cytometrically, by measuring hydrogen peroxide (H2O2) production. Coadministration of IL-3 and GM-CSF reduced the average 16-day period of neutropenia and antibiotic support in the control animals to 6 days (P = .006). Similarly, the average 10-day period of severe thrombocytopenia, which necessitated PLT transfusion in the control animals, was reduced to 3 days when IL-3 and GM-CSF were coadministered (P = .004). The sequential administration of IL-3 followed by GM-CSF had no greater effect on PMN production than GM-CSF alone and was less effective than IL-3 alone in reducing thrombocytopenia. PMN function was enhanced in all cytokine-treated animals.     

Demenz und Hypertonie

Due to the demographic situation, dementia is becoming an important public health problem of increasing magnitude. Because of an aging population worldwide, the incidence of dementia is expected to rise exponentially over the coming decades. Attempts to find a causal therapy when manifest dementia is diagnosed have so far failed. At present, available therapies provide only minor and temporary relief. Diagnosis and sufficient control of risk factors for dementia must be the main goals. Epidemiological studies have identified hypertension as a main risk factor for dementia, particularly vascular dementia, as well as for Alzheimer’s disease. Hypertension in midlife is particularly associated with an increased risk of developing cognitive impairment and dementia. These findings provide a therapeutic opportunity to intervene and prevent dementia. Several clinical trials have shown the protective effect of antihypertensive therapy with additional benefits from substances that block the renin–angiotensin system.