Understanding suicidal behaviour in young people referred to specialist CAMHS: a qualitative psychoanalytic clinical research project

A qualitative psychoanalytic clinical research project using a post-Kleinian contemporary approach was undertaken by a team of seven qualified and experienced child psychotherapists working in community Tier 3 Child and Adolescent Mental Health Services (CAMHS). A number of referred young people who deliberately harmed themselves or attempted suicide, who fulfilled the inclusion criteria and consented to participate, were offered an extended individual and family assessment. Grounded Theory analysis of the qualitative data led to the formulation of the Truth Danger Theory. Typical situations in which suicidal behaviour occurred were identified, including intergenerational confusion, neglect, physical and/or sexual abuse within the family, Oedipal conflict, maternal depression and families in which there was a chronically ill sibling. We found that there was a marked disparity between the young person's experience of relationships in the family and the family's own account of their situation, a fractured reality. This can be reflected in an incongruence in the young person's presentation, which may be misleading when assessing risk. The young person feels him/herself to be in a dead end from which there seems to be no escape. Self-harm, for some, contains this impossible dilemma (albeit pathologically) but when it does not, suicide may seem the only option. The Truth Danger Theory provides explanations and predictions for suicidal behaviour and has implications for clinical practice.     

Prenatal dopamine and neonatal behavior and biochemistry

Depressed pregnant women (N=126) were divided into high and low prenatal maternal dopamine (HVA) groups based on a tertile split on their dopamine levels at 20 weeks gestation. The high versus the low dopamine group had lower Center for Epidemiological Studies-Depression Scale (CES-D) scores, higher norepinephrine levels at the 20-week gestational age visit and higher dopamine and serotonin levels at both the 20- and the 32-week gestational age visits. The neonates of the mothers with high versus low prenatal dopamine levels also had higher dopamine and serotonin levels as well as lower cortisol levels. Finally, the neonates in the high dopamine group had better autonomic stability and excitability scores on the Brazelton Neonatal Behavior Assessment Scale. Thus, prenatal maternal dopamine levels appear to be negatively related to prenatal depression scores and positively related to neonatal dopamine and behavioral regulation, although these effects are confounded by elevated serotonin levels.     

结构之后的路（上）——可公度性、可比较性、可交流性

自从P．费耶阿本德和我率先在文献里借用了一个数学术语来描述相继的科学理论之间的关系之后,20年已经过去了。这个术语就是“不可公度性(Incommensurability)”;我们两人都是由于在解释科学理论中所遇到的问题而被引向这个术语的。①我对这个术     

Prenatal predictors of maternal and newborn EEG

Ninety-two mothers were recruited at a prenatal ultrasound clinic at which time they were given the CES-D for depression and the State-Trait Anxiety Inventory, and their urines were assayed for cortisol, norepinephrine, epinephrine, dopamine, and serotonin. At the neonatal period the mothers and neonates were assessed on frontal EEG asymmetry. Correlation analyses revealed the following: (1) the mothers’ frontal asymmetry was negatively related to prenatal depression (CES-D) symptoms, negatively related to prenatal norepinephrine levels and positively related to prenatal serotonin levels; (2) the frontal asymmetry of the newborn was positively correlated with the mothers’ frontal asymmetry and negatively correlated with the mothers’ prenatal depression (CES-D) symptoms and negatively correlated with the mothers’ prenatal state anxiety scores. The neonates’ EEG frontal asymmetry was also, like the mother's, negatively related to prenatal maternal norepinephrine and positively related to prenatal maternal serotonin.