The psychopathology of suicidal tendencies

Suicidality should not, in consideration of the present studies and the experience gained by the author, be considered a disease 'sui generis', but rather a symptom only. The etiopathogenesis of "nonpsychotic" suicidality is discussed with particular reference to the psychopathology thereof. Acts of suicide are most often part of "lasting affective reactions". In a certain number of cases suicidality is the symptom of an emotional disturbance or functional nervous disease resulting from psychic maldevelopment, which is usually characterized by a relatively small number of general symptoms and where conscious acts are impaired by unconscious conflicts.     

Help-seeking tendencies in Asian Americans with suicidal ideation and attempts.

Among rising concerns surrounding heightened suicide in certain subgroups of Asian Americans, it is important to understand the help-seeking rates and pathways among Asian Americans experiencing suicidality. This study examined perceived need for care, help-seeking behavior, and chosen sources of care among Asian Americans compared with Latinos in the National Latino and Asian American Study who reported a history of lifetime suicidal ideation, suicide attempts, or mental disorders without history of suicide. Consistent with existing literature in Caucasians, suicide attempts in Asian Americans and Latinos were related to greater help seeking and perceived need beyond that of mental disorders only. However, Asian Americans with suicide attempts still reported lower perceived need and help-seeking behaviors compared with Latinos. In contrast to both the existing literature and Latinos in this study, Asian Americans with suicidal ideation were no more likely to perceive a need for help or seek help than Asian Americans with a mental disorder without history of suicide and were less likely to seek and perceive a need for help than Latinos with suicidal ideation. These findings point to the idea that Asian Americans who have serious suicidal ideation or attempts may underestimate the importance of their condition and do not receive the level of attention and support needed. Findings also show that Asian Americans with suicidal ideation and attempts prefer seeking help from nonprofessional rather than professional sources of help, other than medical professionals. Clinical implications for outreach, assessment, and management of suicide are discussed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Drug abuse in Japan

OBJECTIVE: Cis-platinum and 13-cis-retinoic acid have received much attention in the treatment of head and neck squamous cell cancer. Even though they have different mechanisms of action, little information is available on their interaction. This paper reviews experimental evidence for retinoic acid-cis-platinum synergy and presents toxicity data from patients with stage IV head and neck squamous cell cancer participating in a phase I trial combining 13-cis-retinoic acid and cis-platinum. METHODS: Patients were given 13-cis-retinoic acid orally daily for 7 days before and daily during high-dose (150 mg/m2 per week for 4 weeks) intraarterial cis-platinum treatment with concurrent radiation. Toxicity was scored with use of the cancer and leukemia group B scale. RESULTS: In the phase I clinical trial, 15 patients were treated to determine a maximum tolerated dosage for 13-cis-retinoic acid of 20 mg/day. Grade 4 hematologic toxicity was dose limiting in 3 of 8 patients treated with 40 mg/day and in 1 patient treated with 60 mg/day. There were no deaths caused by toxicity; 12 of the 15 patients received all four weekly doses and the remaining 3 received three doses. Of 10 patients with fully evaluable data, all achieved a complete response at the primary site and 9 had a complete response in the neck. One patient had persistent neck disease after chemoradiation, and this tumor was removed with neck dissection. CONCLUSIONS: 13-Cis-retinoic acid and cis-platinum are strongly synergistic against head and neck squamous cell cancer in vitro. Pretreatment with retinoic acid results in stronger synergy than concurrent drug exposure alone. Preliminary clinical experience with combined retinoic acid and cis-platinum in a design that parallels the in vitro study indicates that toxicity is acceptable with 13-cis-retinoic acid dosages of 20 mg/day in a high-dose-intensity intraarterial chemoradiation regimen.     

Drug abuse as excessive behaviour.

Presents 4 arguments against the importance of pharmacology in drug abuse: (a) Pharmacology may not have very much to do with drug abuse. (b) Drug taking in itself is, generally speaking, neither harmful nor undesirable. Drug taking need pose a problem only when it is excessive, when it occurs with frequency sufficient to disrupt the effective functioning of an organism. (c) Because it is the excessive nature of the drug-taking behavior that is the problem, it is probably as wise to search for the causes of drug abuse among the causes of all kinds of excessive behavior as it is to focus upon the peculiarly pharmacological aspects of the situation (e.g., alcoholism may have as much in common with overeating as it has with social drinking). (d) A recently discovered experimental procedure known as schedule induction, which is capable of generating vast amounts of apparently unadaptive behavior, may provide a useful model for excessive human behavior generally, and drug abuse in particular. (French abstract) (35 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Childhood sexual and physical abuse and adult self-harm and suicidal behaviour: a literature review

This article reviews the link between childhood sexual and/or physical abuse and adult self-harm, suicidal ideation, and suicidal attempt from 1988 to 1998 in the clinical literature. Despite the methodological and definitional concerns, empirical studies have generally demonstrated more reports of self-harm, suicidal ideation, and suicidal behaviour in clinical and community populations of adults who report sexual and/or physical abuse in childhood than in comparison groups who do not report abuse. Implications for practice include the identification of populations at risk for self-harm or suicide and routine inquiry of abuse histories on admission. Further research into universal definitions of the key terms, standardized measurements of the variables, and longitudinal studies is required.     

Drug use and abuse (2nd ed.).

Review of book, Stephen A. Maisto, Mark Galizio, and Gerard J. Connors. Drug Use and Abuse (2nd ed.) Fort Worth, TX: Harcourt Press, 1995, 500 pp. Reviewed by Mitch Earleywine. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug abuse in Alaska: Myths versus reality.

Presents 10 myths about drug abuse in Alaska and describes what is known about each of the myths. It is concluded that there is much drug use in Alaska and that Alaskans, especially Alaskan natives, are at high risk for human immunodeficiency virus (HIV) infection. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug abuse in Nepal: a rapid assessment study

A rapid assessment of drug abuse in Nepal was conducted at different sites, including eight municipalities in the five development regions of the country. To interview various groups of key informants, such methods as semi-structured interviews, in-depth interviews and focus group discussions were used. A snowball sampling strategy for respondents who were drug abusers and a judgemental sampling strategy for the non-drug-using key informants were applied. About one fifth of the sample was recruited from the treatment centres and the rest from the community. Drug abusers in prison were interviewed, and secondary data from treatment centres and prisons analysed. The study revealed that the sample of drug abusers had a mean age of 23.8 years and was overwhelmingly male. Most respondents lived with their families and were either unemployed or students. About 30 per cent of the sample was married. A large majority of the sample had a family member or a close relative outside the immediate family who smoked or drank alcohol and a friend who smoked, drank or used illicit drugs. Apart from tobacco and alcohol, the major drugs of abuse were cannabis, codeine-containing cough syrup, nitrazepam tablets, buprenor-phine injections and heroin (usually smoked, rarely injected). The commonest sources of drugs were other drug-using friends, cross-border supplies from India or medicine shops. The commonest source of drug money was the family. There has been a clear trend towards the injection of buprenorphine by abusers who smoke heroin or drink codeine cough syrup. The reasons cited for switching to injections were the unavailability and rising cost of non-injectable drugs and the easy availability and relative cheapness of injectables. About a half of the injecting drug users (IDUs) commonly reported sharing injecting equipment inadequately cleaned with water. Over a half of IDUs reported visiting needle-exchange programmes at two of the study sites where such programmes were available. Infection by the human immunodeficiency virus (HIV) appears to be low among IDUs, although systematic surveillance is absent. Two thirds of the sample had experienced sexual intercourse. The last sex partners reported by respondents were commercial sex workers, wives or girl friends. Condom use was low with primary partners and relatively high with sex workers. Treatment facilities, mostly located in the central urban areas of the country, are meagre. An overwhelming majority of drug abusers felt the need to stop abusing drugs. Cost-effective drug treatment and HIV prevention programmes for IDUs are urgently needed in all areas of the country.     

Drug abuse in an obstetric population of a midsized city

Drug abuse during pregnancy has attracted national attention, but most studies are from large cities. This study is concerned with the indigent pregnant patients in a midsized city in the southeastern United States. In a 23-month study, 2,442 patients were delivered of neonates. Using specific criteria, 511 patients were tested for drug abuse. A positive test was identified in 156 (31%), cocaine being the most common agent. During 2 months of random testing, 15 patients (16%) had positive drug screens. Comparison of drug-positive pregnant patients with general obstetric patients identified many adverse obstetric and perinatal outcome data. Drug-positive patients weighed less, were older, were prone to not seek prenatal care, and were more likely to deliver prematurely and have a growth-retarded infant. Drug abuse in this population had significant impact on the health of the patient and her unborn infant.     

Drug abuse treatment readmissions and outcomes. Three-year follow-up of DARP patients

Temporal patterns of drug abuse treatment reentry and other outcome measures were examined over a three-year period based on a national follow-up sample of persons admitted to treatment in the Drug Abuse Reporting Program (DARP) during 1969 to 1972. Follow-up treatment modes included methadone maintenance, residence in a therapeutic community, outpatient drug-free treatment, outpatient detoxification treatment, and a comparison group whose members completed intake only and did not return for treatment in the DARP. Treatment readmission patterns were examined in relation to outcome measures for illicit drug use, alcohol use, employment, and criminality over time. The findings showed there were reliable associations between readmission patterns and posttreatment outcomes, which suggested there were beneficial effects of drug abuse treatment.     

Dissociative tendencies and dissociative disorders.

Although dissociative disorders are relatively rare, dissociative experiences are rather common in everyday life. Dissociative tendencies appear to be modestly related to other dimensions of personality, such as hypnotizability, absorption, fantasy proneness, and some facets of openness to experience. These dispositional variables may constitute diatheses, or risk factors, for dissociative psychopathology, but more complex models relating personality to psychopathology may be more appropriate. The dissociative disorders raise fundamental questions about the nature of self and identity and the role of consciousness and autobiographical memory in the continuity of personality. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Development of self-handicapping tendencies

This study was undertaken to determine when U.S. children begin to self-handicap, that is, to reduce preparation effort before evaluations rather than applying themselves to do their best. The personal variables examined for their impact on practice behavior were gender, grade level, and self-esteem. The situational variables were time of the self-esteem test (before or after the evaluation task) and importance of the evaluation task. The results showed that (a) the 6th-grade boys were more likely than the 6th-grade girls to self-handicap, (b) the 3rd-grade children were not as affected as the 6th-grade children by the self-evaluation implications of performance evaluations, (c) self-handicapping by low-self-esteem and high-self-esteem 6th graders depended on recent experiences, and (d) the self-affirming experience of a self-esteem test reduced the motivation to self-handicap among high-self-esteem 6th-grade boys.     

Dissociative tendencies and facilitated emotional processing.

Dissociation is a process linked to lapses of attention, history of abuse or trauma, compromised emotional memory, and a disintegrated sense of self. It is theorized that dissociation stems from avoiding emotional information, especially negative emotion, to protect a fragile psyche. The present study tested whether or not dissociaters do actually avoid processing emotion by asking groups scoring high or low on the Dissociative Experiences Scale to judge the affective valence of several types of emotional stimuli. Manipulations of valence, modality (pictures or words), task complexity, and personal relevance lead to results suggesting that dissociation is linked to facilitated rather than deficient emotional processing. Our results are consistent with a theory that sensitivity to emotional material may be a contributing factor in subsequent dissociation to avoid further elaboration of upsetting emotion in these individuals. The findings for dissociation further exemplify the influence of individual differences in the link between cognition and emotion. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Drug abuse day treatment: a randomized clinical trial comparing day and residential treatment programs

Clients entering a therapeutic community (TC)-oriented drug treatment program were randomly assigned to day or residential conditions and interviewed at 2 weeks and 6 months after admission. Outcomes included Addiction Severity Index composite scores and summary scores for the Beck Depression Inventory, Symptom Checklist-90-R, and a social support scale. Only clients who remained in treatment for at least 2 weeks were included. The mean age of the sample (N = 261) was 32.9 (SD = 6.7 years) and the mean education level was 12.1 years (SD = 1.9 years); 30% were women. Comparison of outcome scores at 6 months between groups, while controlling for baseline values, indicated greater improvement for residential clients on social problems and psychiatric symptoms. The groups were similar on the 8 remaining outcomes, including measures of alcohol and drug problems. Overall, the level of improvement among day treatment clients was not significantly different from that of residential clients.     

Comparing cultural and individual learning tendencies.

Comments on the article by R. G. Tweed and D. R. Lehman (2001) which stated that a Confucian-Socratic framework provides a structure for analyzing culture-influenced aspects of academic learning. In this article, Tweed and Lehman argued that these ancient exemplars model approaches to learning continue to differentiate students within a modern Canadian postsecondary context. Specifically, it is argued that Chinese cultural influence increases the likelihood that a student will report Confucian learning beliefs and behaviors and that Western cultural influence increases the likelihood that a student will report Socratic learning beliefs and behaviors. The authors of this commentary believe that although Tweed and Lehman presented a thorough and thoughtful review of cultural differences and set the stage for the enhancement of teaching at the postsecondary level, there is disconnect between the framework and external educational theory. The use of a cultural level of analysis vs an individual level of analysis somewhat diluted the potential contribution of their ideas. (PsycINFO Database Record (c) 2010 APA, all rights reserved)