Suicidality prior to presentation in first-episode psychosis

Introduction: Suicide and attempted suicide contribute significantly to the increased mortality and morbidity associated with psychotic illness. The period of highest risk is reportedly in the early years of illness. While the literature concentrates on completed suicide in chronic psychosis, less is understood about attempted suicide in first‐episode psychosis (FEP). Aim: We aimed to examine rates and correlates of suicide attempts in individuals with FEP. Method: Individuals in this study were all those, both in‐ and outpatients, diagnosed with FEP over a 2‐year period, from a defined catchment area. Assessment included Structured Clinical Interview for DSM‐IV, Schedule for Assessment of Positive Symptoms, Schedule for Assessment of Negative Symptoms, Calgary Scale, Beiser Scale and Birchwood Insight Scale. Results: Of 107 patients with FEP, 50 (47%) individuals reported suicidal ideation: 41 (38%) in the month prior to first presentation. Ten individuals (9%) made a suicide attempt. The only factor significantly associated with previous suicide attempt was higher insight scores at first presentation (P = 0.04). Conclusion: Individuals with a history of suicide attempt tend to have higher insight into having a mental illness at first presentation.     

Arthritis symptoms, the work environment, and the future: measuring perceived job strain among employed persons with arthritis

OBJECTIVE: To develop a measure of job strain related to differing aspects of working with arthritis and to examine the demographic, illness, work context, and psychosocial variables associated with it. METHODS: Study participants were 292 employed individuals with osteoarthritis or inflammatory arthritis. Participants were from wave 3 of a 4-wave longitudinal study examining coping and adaptation efforts used to remain employed. Participants completed an interview-administered structured questionnaire, including a Chronic Illness Job Strain Scale (CIJSS) and questions on demographic (e.g., age, sex), illness and disability (e.g., disease type, pain, activity limitations), work context (e.g., job type, job control), and psychosocial variables (e.g., arthritis-work spillover, coworker/managerial support, job perceptions). Principal component analysis and multiple linear regression were used to analyze the data. RESULTS: A single factor solution emerged for the CIJSS. The scale had an internal reliability of 0.95. Greater job strain was reported for future uncertainty, balancing multiple roles, and difficulties accepting the disease than for current workplace conditions. Participants with inflammatory arthritis, more frequent severe pain, greater workplace activity limitations, fewer hours of work, less coworker support, and greater arthritis-work spillover reported greater job strain. CONCLUSION: The findings underscore the diverse areas that contribute to perceptions of job strain and suggest that existing models of job strain do not adequately capture the stress experienced by individuals working with chronic illnesses or the factors associated with job strain. Measures similar to the CIJSS can enhance the tools researchers and clinicians have available to examine the impact of arthritis in individuals' lives.     

Chemotherapy for metastatic breast cancer

Cytotoxic chemotherapy is a mainstay of treatment for advanced breast cancer. Treatment of metastatic (also called stage IV, advanced, or recurrent) breast cancer is not considered curative. Rather, the goals of treatment with chemotherapy are to prolong survival, alleviate or prevent tumor-related symptoms or complications, and improve quality of life. While the purpose of chemotherapy is to prevent or alleviate symptoms, chemotherapy paradoxically carries considerable toxicities that cause substantial symptoms in patients, notoriously including fatigue, nausea, vomiting, diarrhea, hair loss, mucositis, neutropenia, and neuropathy. Balancing the benefits and the side effects of chemotherapy is further complicated by the natural history of advanced breast cancer, which can be quite prolonged and typically involves multiple lines of chemotherapy, especially in patients whose tumors respond to treatment.     

Pharmacokinetics of high-dose diluted lidocaine in local anesthesia for facelift procedures

The maximal recommended local anesthetic dose of lidocaine is 7 mg/kg; higher doses are used in tumescent liposuction. The objective of this study was to characterize the pharmacokinetics of high-dose diluted lidocaine administered together with epinephrine for local anesthesia in facelift procedures. This was a prospective study of six female patients undergoing elective facelift surgery. The local anesthetic solution consisted of 0.33% lidocaine, 0.07% sodium bicarbonate, and 1:600,000 epinephrine in normal saline. Plasma lidocaine levels were determined in the course of 24 hours and were subjected to pharmacokinetic analysis. Patients' age was 58.5 +/- 8 years and weight 68.5 +/- 18.7 kg. Mean lidocaine dose was 21.6 +/- 3.6 mg/kg (range, 17.5-26.3 mg/kg) infiltrated subcutaneously over 20 minutes or less. No lidocaine-related adverse effects were recorded. Major bleeding was not observed. Postoperative analgesia was required only at 11.8 +/- 4.6 hours after surgery. Pharmacokinetic analysis was peak concentration 1.41 +/- 0.4 microg/mL, time to reach peak concentration 9.3 +/- 1.6 hours, terminal half-life 6.2 +/- 1.5 hours, area under the curve from time zero to last data point 1379.8 +/- 470 microg/min/mL, and area under the curve from time zero to infinity 1530.6 +/- 471.6 microg/min/mL. Plasma lidocaine concentrations formed almost a plateau between 2 and 12 hours (ie, at approximately 1.2 microg/mL) after infiltration. It is concluded that local anesthesia with diluted lidocaine at a dose 3.1 times higher than the currently recommended dose (7 mg/kg) administered with epinephrine yielded a peak plasma lidocaine level that was 72% below the level considered safe (5 microg/mL).     

Resolution of a phytobezoar with Aldoph's Meat Tenderizer

A 58-year-old man went to his physician with complaints of midepigastric pain, flatulence, belching, and shortness of breath. During a physical examination, the patient was in no acute distress. The patient underwent an ultrasound examination, which revealed cholelithiasis, a laparoscopic cholecystectomy, which revealed chronic gallbladder disease, and esophagogastroduodenoscopy, which revealed gastritis, a hiatal hernia, and a phytobezoar. To treat the bezoar, the patient was given Adolph's Meat Tenderizer 1 teaspoonful in 8 oz of water before each meal for 7 days. This product contains papain, a proteolytic enzyme, that is thought to cleave protein linkages within bezoars. The patient's symptoms resolved with no adverse events reported, and follow-up endoscopy revealed resolution of the phytobezoar. Although a few other agents are used to treat phytobezoars, little clinical data exist on their safety and effectiveness. Adolph's Meat Tenderizer appears to be a safe and effective treatment for patients with a phytobezoar.     

Practical insights into chronic management of hepatic Wilson’s disease

Wilson’s disease (WD) is a rare inherited disorder of human copper metabolism, with an estimated prevalence of 1:30000-1:50000 and a broad spectrum of hepatic and neuropsychiatric manifestations. In healthy individuals, the bile is the main route of elimination of copper. In WD patients, copper accumulates in the liver, it is released into the bloodstream, and is excreted in urine. Copper can also be accumulated in the brain, kidneys, heart, and osseous matter and causes damage due to direct toxicity or oxidative stress. Hepatic WD is commonly but not exclusively diagnosed in childhood or young adulthood. Adherent, non-cirrhotic WD patients seem to have a normal life expectancy. Nevertheless, chronic management of patients with Wilson’s disease is challenging, as available biochemical tests have many limitations and do not allow a clear identification of non-compliance, overtreatment, or treatment goals. To provide optimal care, clinicians should have a complete understanding of these limitations and counterbalance them with a thorough clinical assessment. The aim of this review is to provide clinicians with practical tools and suggestions which may answer doubts that can arise during chronic management of patients with hepatic WD. In particular, it summarises current knowledge on Wilson’s disease clinical and biochemical monitoring and treatment. It also analyses available evidence on pregnancy and the role of low-copper diet in WD. Future research should focus on trying to provide new copper metabolism tests which could help to guide treatment adjustments.     

Applying experience sampling methods to partner violence research: safety and feasibility in a 90-day study of community women

An experience sampling method (ESM) rarely has been applied in studies of intimate partner violence (IPV) despite the benefits to be gained. Because ESM approaches and women who experience IPV present unique challenges for data collection, an empirical question exists: Is it safe and feasible to apply ESM to community women who currently are experiencing IPV? A 90-day, design-driven feasibility study examined daily telephone data collection, daily paper diaries, and monthly retrospective semistructured interview methods among a community sample of 123 women currently experiencing IPV to study within-person relationships between IPV and substance use. Findings suggest that ESM is a promising method for collecting data among this population and can elucidate daily dynamics of victimization as well as associated behaviors and experiences. Lessons learned from the application of ESM to this population are also discussed.