Suicide prevention in the psychiatric hospital

It is currently impossible to distinguish between patients with depression who will make a suicide attempt and those who will not. Prevention, therefore, must be based on the assumption that any patient with more than mild symptoms of depression is at risk of suicide, and can only be effective if it is applicable to all patients with moderate to severe depression. A treatment strategy that differentiated between regressive and progressive therapeutic measures was developed for patients admitted to a psychiatric hospital. Regressive, as opposed to progressive, treatment meant that the patient was temporarily relieved of virtually all responsibilities for self and others. Progressive measures were strictly avoided for all patients with symptoms of depression, regardless of the primary diagnosis. This strategy was tested on 5,149 inpatients and day patients over a period of 6.25 years and compared with 6,891 patients over the 15.75 years prior to this period. The suicide rate was 97 (per 100,000 admissions) compared with 319 in the previous period. The treatment method appears to be able to reduce the suicide rate. Although this result was achieved with hospital patients, it suggests that a regressive treatment method could be promising if developed for outpatient treatment as well.     

Increased brain serotonin turnover in panic disorder patients in the absence of a panic attack: reduction by a selective serotonin reuptake inhibitor

Since the brain neurotransmitter changes characterising panic disorder remain uncertain, we quantified brain noradrenaline and serotonin turnover in patients with panic disorder, in the absence of a panic attack. Thirty-four untreated patients with panic disorder and 24 matched healthy volunteers were studied. A novel method utilising internal jugular venous sampling, with thermodilution measurement of jugular blood flow, was used to directly quantify brain monoamine turnover, by measuring the overflow of noradrenaline and serotonin metabolites from the brain. Radiographic depiction of brain venous sinuses allowed differential venous sampling from cortical and subcortical regions. The relation of brain serotonin turnover to serotonin transporter genotype and panic disorder severity were evaluated, and the influence of an SSRI drug, citalopram, on serotonin turnover investigated. Brain noradrenaline turnover in panic disorder patients was similar to that in healthy subjects. In contrast, brain serotonin turnover, estimated from jugular venous overflow of the metabolite, 5-hydroxyindole acetic acid, was increased approximately 4-fold in subcortical brain regions and in the cerebral cortex (P < 0.01). Serotonin turnover was highest in patients with the most severe disease, was unrelated to serotonin transporter genotype, and was reduced by citalopram (P < 0.01). Normal brain noradrenaline turnover in panic disorder patients argues against primary importance of the locus coeruleus in this condition. The marked increase in serotonin turnover, in the absence of a panic attack, possibly represents an important underlying neurotransmitter substrate for the disorder, although this point remains uncertain. Support for this interpretation comes from the direct relationship which existed between serotonin turnover and illness severity, and the finding that SSRI administration reduced serotonin turnover. Serotonin transporter genotyping suggested that increased whole brain serotonin turnover most likely derived not from impaired serotonin reuptake, but from increased firing in serotonergic midbrain raphe neurons projecting to both subcortical brain regions and the cerebral cortex.     

Dissociation between the cognitive process and the phenomenological experience of TOT: effect of the anxiolytic drug lorazepam on TOT states

TOT states may be viewed as a temporary and reversible microamnesia. We investigated the effects of lorazepam on TOT states in response to general knowledge questions. The lorazepam participants produced more commission errors and more TOTs following commission errors than the placebo participants (although the rates did not change). The resolution of the TOTs was unimpaired by the drug. Neither feeling-of-knowing accuracy nor recognition were affected by lorazepam. The higher level of incorrect recalls produced by lorazepam participants may be due to the fact that they were more frequently temporarily unable to access a known item. For some of these items, the awareness of the retrieval failure resulted in a commission TOT (phenonemological TOT after a commission error). The resolution of the TOT conflict is discussed in the light of the anxiolytic and anticonflict effects of lorazepam. The data are discussed in terms of contemporary theories of TOTs and the effects that benzodiazepines have on semantic memory.     

Spirituality in Education: Promoting Children's Spiritual Development through Values

This paper reports on research in the Warwick Religions and Education Research Unit (WRERU) at the University of Warwick regarding an educational programme, which is based on what are perceived to be universal values. The programme aims to contribute to the spiritual development of children in schools, which is one of the statutory requirements of mainstream school provision in England and Wales. The Sathya Sai Education in Human Values (SSEHV) offers material which seeks to promote ‘human values’. The paper explores what these values are and why they are perceived to be of a universal nature. The focus on values introduces spiritual dimensions which are examined with reference to the educational contexts in which they are conveyed. The contents of the programme and the development from its inception are described. The paper is based on ethnographic data collected in classrooms and other educational environments where the programme has found application.     

The relationship between contrast sensitivity, gait, and reading speed in Parkinson's disease

Parkinson's disease (PD) results in reduced walking speed and visual difficulties, including difficulty reading (Davidsdottir, Cronin-Golomb, & Lee, 2005). PD is characterized by a reduction in dopamine, which is instrumental in determining a person's contrast sensitivity (CS). This study assessed the relationship between CS, gait (step length and walking speed), and reading speed in 18 non-demented PD volunteers with normal acuity. We found that CS correlated with walking speed (r = .57, p = .01), step length (r = .53, p = .02), and reading speed (r = .54, p = .02). Visual acuity (which has not been tied to dopamine in the same way) correlated with reading speed (r(s) = -.65, p = .004), but not with gait measures. We also assessed the contribution of age, education, and cognitive status (Shipley Institute of Living Scale) to these variables. We conclude that CS and age both play an important role in determining gait in PD, while reading speed is related to both acuity and CS, but not age.     

Surfing for sex: Studying involuntary celibacy using the internet

The Internet offers possibilities for sexuality research that could not have been imagined even a decade ago. Although Internet users are not representative of the general population, they are easily accessible, and the openness with which they discuss sensitive topics has created a tremendous and largely untapped pool of respondents for sex research. Moreover, the web provides access to populations that are largely hidden and difficult to reach using traditional methods. In this article, we explore such issues as sampling, research design, data collection and management, and the ethics of web-based research. In doing so, we review past research, investigate the advantages and disadvantages of using the Internet in sexuality studies, draw examples from our web-based study of involuntary celibacy, and recommend guidelines for future web based inquiries.