Characteristics of International Assaultive Psychiatric Patients: Review of Published Findings, 2000–2012

In international reviews of psychiatric inpatient violence, one study of all types of patient violence found hostility, involuntary admission, and longer hospital stays associated with violence. A second study of comparison-group papers of patient assaults found younger males with schizophrenia, past violence, and substance abuse assaultive. The present review of raw assault data studies assessed characteristics of assaultive patients worldwide. It was hypothesized that patients with schizophrenia would present greatest assault risk. There were three analyses: International/no American studies (reviewed earlier), European studies, and merged International/American studies. Results revealed that male and female patients with schizophrenia, affective disorders, personality disorders, and other diagnoses presented greatest worldwide risk. Results partially support earlier findings. Given that individual institutional studies in this review reported significant assailant characteristics, a second finding is the absence of most of these institutional characteristics in this international review. Possible explanations for findings and a detailed methodological review are presented.     

Treatment with mesoridazine and thioridazine in chronic schizophrenia: II. Potential predictors of drug response

There are well recognized differences among effective antipsychotic compounds in their side effect profile. However, attempts to establish indications or “finding the right drug for the right patient” have not been successful. Time and again, putative predictors of response to a given drug disappeared as a result of unsuccessful attempts at replication. ^1–1 Nevertheless, clinical experience, as well as research, strongly suggests that as far as individual patients are concerned, antipsychotic compounds are not alike in their effects, and that these drugs are not interchangeable.⁵ Ayd⁶ has developed a system to assist clinicians in antipsychotic drug selection when a given drug has failed to produce improvement.The search for the right drug for the right patient remains an important task since the cost in human suffering as a result of ineffective antipsychotic therapy is enormous. In research dealing with differential responses among antipsychotics, we believe that false positive results, i.e., identifying supurious invalid predictive relationships, are less harmful than false negatives, i.e., failed attempts to identify true and valid predictors. The clinical consequence in the former case would lead to one drug being favored over other equally effective ones for certain patients on faulty grounds, while, in the latter case, potentially important therapeutic advances may be circumvented.We have looked for predictors of differential response to mesoridazine and thioridazine in our 20-patient comparison study (see Part 1). Based on the modest sample size, our goal was to assess predictor variables for their neuristic, hypothesis-generating value, rather than to establish definitive predictive relationships with changes in psychopathology following drug treatment.     

mAb KUL/05 identifies a denaturation-resistant determinant shared by class II MHC products DR, DQ and DP

mAb KUL/05, a novel murine monoclonal antibody, reacts with molecules displaying the typical tissue distribution and molecular profile of class II MHC antigens. An extensive scrutiny employing serological and immunochemical assays on DR homozygous and DR alpha- mutant cell lines has shown that this reagent displays some additional, interesting features, namely mAb KUL/05 (a) binds in a broadly monomorphic fashion to cells of DR1 through seven specificities, (b) recognizes a determinant shared by a large proportion of DR, DQ and DP beta chains from most haplotypes, in both their monomeric and alpha chain-associated forms, and (c) reacts with frozen, acetone-fixed, as well as conventional, formalin-fixed, paraffin embedded tissues. Thus, mAb KUL/05 is likely to represent a useful adjunct for the study of the expression of class II MHC products in normal and pathological tissue specimens.     

Exposure of nursing personnel to electromagnetic fields in neonatal intensive care

Electromagnetic fields (EMF) are recognised as a source of environmental pollution for workers and people resident in exposed areas. The level of exposure to EMFs of the nurses working in the Siena Neonatal Intensive Care Unit, during two workdays was recorded and peak levels > 10 mG (1 microT) were registered well above an almost permanence exposure at > 2 mg G. The application of existing standard, cautionary criteria and rules would suggest protective or restrictive measures against EMF exposure for these workers.     

A CNV rebound effect.

Fifty normal volunteers were tested in two conditions: (1) a constant-foreperiod reaction time situation consisting of a flash-tone-key press sequence (control trials); (2) a '50%-letters' condition, in which two types of trials occurred randomly--no letters trials, which were identical to control trials, and letters trials, which were similar to control trials but also involved the presentation of four auditory letters within the flash-tone interval as part of a short-term memory task. Compared to control trials, CNV amplitude showed a pattern of reduction in letters trials accompanied by slower reaction times to tone (CNV distraction effect). Compared to control trials, CNV amplitude showed an unexpected supranormal increase in no-letters trials. The CNV rebound effect observed in no-letters trials was interpreted as reflecting a switching of attention from the divided attention set intrinsic to letters trials (listening for letters and preparing for response to tone) to an undivided attention set in no-letters trials (simply preparing for response to tone). The CNV rebound effect, which is diminished in aging individuals and absent in psychosurgery patients, appears to represent a non-invasive technique of possible value in assessing pathophysiology of human brain functioning.     

Differential Expression of Antiapoptotic Genes in Human Endometrial Carcinoma: bcl-XL Succeeds bcl-2 Function in Neoplastic Cells

Objectives.Previous histochemical observations have suggested a possible involvement of the bcl-2 family genes in the acquisition of neoplastic phenotype of the endometrium. Since knowledge of the type and function of genes controlling the transformed cell may result in new diagnostic, prognostic, and therapeutic approaches, we have investigated at the molecular level the biological role of bcl-2 family genes in endometrial neoplastic cells.Methods. To investigate the relationship between the sensitivity to apoptosis and the expression of the bcl-2 family genes, we set up a model system consisting of four human endometrial carcinoma cell lines. This system constitutes an array of two cell pairs presenting, respectively, endometrioid and adenosquamous phenotypes. G2 and G3 gradings are represented within each pair; in addition, each set contains one cell line that is apoptosis-sensitive and one that is resistant. Transfection of bcl-2 and bcl-XL into apoptosis-sensitive cells was used to monitor the biological function of protective genes.Results. A differential pattern of expression of bcl-2 family genes was observed in apoptosis-sensitive versus resistant cells, independent from the histological subtype. Resistant lines exhibited high amounts of Bcl-XL and low amounts of Bcl-2. Bax expression clearly correlates with cellular susceptibility to apoptosis. Transfection of bcl-XL resulted in a dose-dependent enhancement in resistance toward apoptosis. In contrast, the main effect of bcl-2 constitutive overexpression was to drastically abate the proliferative potential of transfected cells.Conclusions. These data demonstrate, at the molecular level, that bcl-XL is selected as an apoptosis-protective gene in place of bcl-2 while bax retains its dominant proapototic role.     

Spiral CT with multiplanar reconstruction in the diagnosis of sternoclavicular osteomyelitis

Objective The purpose of this study was to determine whether contrast-enhanced spiral CT scanning supplemented by multiplanar reconstruction is of value in the evaluation of suspected infection of the sternoclavicular joints.Materials and Methods Seven patients with suspected infection of the sternoclavicular joints were evaluated with spiral CT using narrow collimation (4 mm) and close interscan reconstruction (2–4 mm). All patients were scanned immediately following the injection of 120 ml Omnipaque-300 at a rate of 3 ml/s. Spiral CT scans were of 24 or 32 s duration and done as single-breathhold studies. All images were then filmed at soft tissue and bone settings (window width 2300, window center 270). In selected cases, coronal, sagittal, and/or oblique reconstrution of data was done for review.Results All studies were successfully completed without any interscan or intrascan motion. In six cases, infections of the sternoclavicular joint was found, including five cases of osteomyelitis of the clavicular head. The scans obtained during the phase of high contrast enhancement allowed definition of the extension into the soft tissue and muscle. Bone windows demonstrated subtle cortical and periosteal abnormalities.Conclusion Imaging of the sternoclavicular joints with standard CT can be difficult due to interscan motion and the inability to get good data sets for reconstruction. Spiral CT with 24to 32-s acquisition allows high quality images enabling detection of disease and definition of extent of disease, thus helping to guide patient management.     

EEG correlates of impaired attention performance under secobarbital and chlorpromazine in the monkey

The effects of secobarbital and chlorpromazineupon behavior in a continuous, rapidly presented successive (go-no go) discrimination (attention) task were evaluated in six Macaca mulatta monkeys. Simultaneous monitoring of EEG activity from epidural and subcortical electrodes permitted an evaluation of the nature of altered central nervous system events during erroneous performance (errors of omission) on this task. The computer-assisted analysis of pre-stimulus and post-stimulus EEG frequency activity (baseline crossings) suggests that the best measure of attentive behavior from the pre-stimulus EEG is percentage of beta 2 (25–40 cps) activity. No difference could be observed between drugs or among cerebral placements in this regard. This was determined by comparing measures of EEG frequency, pooled for a given test period, with performance from the same test period. On a trial-by-trial basis, however, the beta 2 measure in the pre-stimulus epoch failed to distinguish correct responses from errors of omission.Separation between correct responses and errors of omission is possible if comparisons are made between the changes in percentage of beta 2 activity in the pre-stimulus vs. post-stimulus epochs. For both drugs, the largest absolute change in beta 2 pre- vs. post-stimulus occurs with correct positive trials and the smallest change with correct negative trials. For secobarbital, no difference could be detected between correct and incorrect positive trials. For chlorpromazine, however, there was significantly less change in beta 2 for incorrect positive than for correct positive trials. The results were interpreted in terms of the hypothesis that secobarbital produces errors by depression of the general level of activation whereas chlorpromazine acts by reducing the sensory input which is necessary for correct discrimination performance.Some of these results were presented to the IXth Meeting of the Collegium Internationale Neuropsychopharmacologicum, Paris, France, July, 1974. Supported by USPHS grant No. MH 12568 from the National Institute of Mental Health. The authors are grateful to Dr. Eva Bakay Pragay for her wise counsel.Research Scientist Awardee K05 14915 of the National Institute of Mental Health.