Predictors of violent behavior among acute psychiatric patients: clinical study.

AIM: Violence risk prediction is a priority issue for clinicians working with mentally disordered offenders. The aim of the present study was to determine violence risk factors in acute psychiatric inpatients. METHODS: The study was conducted in a locked, short-term psychiatric inpatient unit and involved 374 patients consecutively admitted in a 1-year period. Sociodemographic and clinical data were obtained through a review of the medical records and patient interviews. Psychiatric symptoms at admission were assessed using the Brief Psychiatric Rating Scale (BPRS). Psychiatric diagnosis was formulated using the Structured Clinical Interview for DSM-IV. Past aggressive behavior was evaluated by interviewing patients, caregivers or other collateral informants. Aggressive behaviors in the ward were assessed using the Overt Aggression Scale. Patients who perpetrated verbal and against-object aggression or physical aggression in the month before admission were compared to non-aggressive patients, moreover, aggressive behavior during hospitalization and persistence of physical violence after admission were evaluated. RESULTS: Violent behavior in the month before admission was associated with male sex, substance abuse and positive symptoms. The most significant risk factor for physical violence was a past history of physically aggressive behavior. The persistent physical assaultiveness before and during hospitalization was related to higher BPRS total scores and to more severe thought disturbances. Higher levels of hostility-suspiciousness BPRS scores predicted a change for the worse in violent behavior, from verbal to physical. CONCLUSION: A comprehensive evaluation of the history of past aggressive behavior and psychopathological variables has important implications for the prediction of violence in psychiatric settings.

Medical observation, compared with parathyroidectomy, for asymptomatic primary hyperparathyroidism: a prospective, randomized trial.

CONTEXT: The clinical presentation of primary hyperparathyroidism (pHPT) has changed during the last half century, and the diagnosis is now more often made by chance in patients with no specific symptoms. OBJECTIVE: The present study is a randomized, controlled trial that investigates the effects of parathyroidectomy or medical observation in mild asymptomatic pHPT on morbidity and quality of life (QoL). DESIGN/SETTING/PATIENTS: A total of 191 patients (26 men) with asymptomatic pHPT [mean age 64.2 +/- 7.4 (sd) yr] were recruited in the study and randomized to medical observation (serum calcium level 2.69 +/- 0.08 mmol/liter) or surgery (2.70 +/- 0.08 mmol/liter). We here report baseline and 1 (n = 119) and 2 yr data (n = 99) on those who had completed the follow-up visits by the end of the inclusion period. RESULTS: At baseline, the patients had significantly lower QoL (SF-36) and more psychological symptoms, compared with age- and sex-matched healthy subjects. The two groups were similar at baseline, and no clinically significant changes in these parameters were seen during the observation time. Calcium and PTH normalized after surgery. The areal bone mineral density increased in the group randomized to operation, whereas the bone mineral density remained stable in the medical observation group. No change in kidney function (creatinine) or blood pressure was observed longitudinally or between the groups. CONCLUSIONS: Asymptomatic patients with mild pHPT have decreased QoL and more psychological symptoms than normal controls. No benefit of operative treatment, compared with medical observation, was found on these measures so far.

Self-centrality, psychosis and schizotaxia: a conceptual review.

The phenomenon of self-centrality denotes a qualitative modification of the psychotic experience. Transitory experiences of self-reference have regularly been found in subjects in the prodromic phase and at the beginning of psychosis or in the post psychotic phase, and are specifically identified in the semeiotics of Basic Symptoms. However, self-centrality, in addition to being a morphological organizer in the psychotic crisis, also manifests itself in schizotypal personality disorders and in first-degree relatives of schizophrenics (where it is correlated to the degree of schizotypal traits). In these subjects, manifestations of self-centrality of a lesser intensity could be an indication of a latent vulnerability trait, which could modulate personal and psychopathological expressions of the schizotaxic diathesis.

Jealous love and morbid jealousy.

Jealous love and morbid jealousy, although inextricably linked, cannot be considered the same: jealous love (trait jealousy) is the behavioral and cognitive-affective precondition of morbid jealousy (state jealousy). Love is jealous when it is devoured by the desire for the exclusive and total possession of the partner, whose unconditional and continued presence is avidly requested. This type of love, in addition, is permeated by the need to know what the other is thinking, in order to scrutinize every minimal flaw in the faithfulness of the partner even in his or her innermost thoughts and fantasies; in it, jealousy is virtually always present, even in the absence of a triggering event, because captative love, by its very nature, includes the expectation of a conflict which inevitably actually takes place in reality. Finally, jealousy emerges as an emotional event (jealous flash) in response to a more or less significant change in the behavior of the partner, and reveals to the jealous individual a dimension which was previously latent or inexistent. This intense and brief experience, leaves a more or less blurred memory behind, and tends to progressively repeat itself and take root as a feeling.

Presence of an enamel matrix protein derivative on human teeth following periodontal surgery.

An enamel matrix protein derivative (EMD) has been successfully employed to restore fully functional periodontal ligament, cementum, and alveolar bone in patients with severe attachment loss. When applied to denuded root surfaces, EMD is believed to assemble into a matrix that locally stimulates regenerative responses in the surrounding tissues. Since wound healing and induction of regeneration are biological processes typically running from weeks to months after treatment, the EMD matrix must be present on the root surface over a biologically significant time period to be effective. So far, no studies have been done in humans on the persistence of EMD on the treated root surface. The aim of the present study was to investigate the persistence of the EMD-based matrix on periodontally involved human teeth treated surgically with EMD. Sixteen patients with one intrabony defect each around teeth scheduled for extraction due to advanced periodontitis were treated by means of access flap surgery with and without application of EMD. At 1, 2, 3, and 4 weeks postsurgery, the teeth were removed and processed for histology and immunohistochemistry. The slides were stained using a rabbit anti-enamel-matrix-derivative (anti-EMD) antibody and goat-antirabbit secondary antibodies labeled with horseradish peroxidase (HRP). Immunohistochemical evaluation demonstrated the presence of EMD on all test root surfaces during the entire observation period of 4 weeks. No EMD was detected on any of the control roots. The results demonstrate for the first time in humans that EMD is present on treated root surfaces for up to 4 weeks following periodontal surgery.

Quality of care from a patient perspective in population-based cervical cancer screening.

In Stockholm, population-based cervical cancer screening is offered free of charge to all women between 23 and 60 years of age. A survey to assess satisfaction with care using a previously validated questionnaire was conducted with 73 women receiving abnormal Pap smear results through the screening program. Thirty-seven women received results of screening within a feasibility project, in which they had extra contact with a midwife prior to receiving standard information and medical follow-up by a gynaecologist. The other 36 women were a matched sample receiving standard information. The results indicate generally high perceptions of quality of care, with particularly high ratings of perceived gynaecological knowledge and medical information provision. Low perceptions of quality were found regarding several aspects of psychosocial care. Higher levels of self-reported psychological well-being were found among the women who had extra midwifery contact. The results indicate that more attention to psychosocial aspects might optimize the screening program.