Psychiatric features in perpetrators of homicide-unsuccessfulsuicide at Weskoppies Hospital in a 5-year period

Background. In the absence of medical literature reporting on homicide-unsuccessful-suicide (HUS) cases in which the perpetrator is referred for forensic psychiatric observation present an opportunity to explore psychiatric features pertaining to the event.Objective. To identify possible contributing psychiatric features in HUS cases.Method. A retrospective; single-centre; descriptive study was conducted; in which were reviewed clinical records of HUS subjects referred for observation to Weskoppies Hospital from December 2005 to January 2011. Socio-demographic and psychiatric information was obtained. Results. Nine cases were reviewed. The median age of the subjects was 29 years and 7 subjects were male. Five cases involved family members. Cases involving couples demonstrated male subjects and cases involving filicide demonstrated female subjects. Only 1 case involved the use of a firearm. At the time of the incident; 4 of the cases had no psychiatric diagnosis but notable interpersonal difficulties. Psychotic disorders were diagnosed in 3 subjects; a depressive disorder in 1 subject and a depressive and anxiety disorder in 1 subject.Conclusion. Subjects commonly used less lethal methods than shooting. The high rate of psychiatric disorders diagnosed is in keeping with court referrals occurring when a mental illness is suspected. Some cases may require specialised probing before psychosis becomes apparent. Identification of psychosocial stressors and failure of coping mechanisms during periods of strife within an intimate relationship may be a focus of future research in homicide-suicide cases. Separation should possibly be investigated as an independent factor which promotes the interpersonal difficulty associated with homicide-suicide

Physician-hastened death. Advisory guidelines for the San Francisco Bay area from the Bay Area Network of Ethics Committees.

Recent high court opinions and pending Supreme Court rulings on the legality of physician-hastened death necessitate a pragmatic response from the medical profession. Adopting a "harm reduction" perspective on this contentious topic, the Bay Area Network of Ethics Committees developed practice guidelines for responding to a patient request for hastened death. The guidelines will be offered to the local medical community for use by individuals and health care institutions if the practice of physician-hastened death becomes legal. A multidisciplinary consensus process was used in developing the guidelines, which address clinical, ethical, and procedural concerns.

Challenges faced by the HIV health services planning council in Oakland, California, 1991-1994.

This study reports the findings of a case study of the health services planning council established in the Oakland, California, eligible metropolitan area (the Oakland EMA) under Title I of the Ryan White Comprehensive AIDS Resources Emergency Act of 1990 (the CARE Act). We gathered primary data through observation of planning council meetings, examination of documentary evidence, and in-depth interviews with key participants. An important finding of this study was the inconsistency observed between the rational, linear planning model embedded in the CARE Act legislation and the politicized, emergent, and, at times, chaotic planning process actually observed in the Oakland EMA. The primary reasons for this inconsistency included confusion among council members about the planning council's responsibilities and authority, as well as its relationship with the local health department; limitations on administrative support at the local level; reluctance of program administrators at the federal level to provide advice concerning development of the council; allegations of conflict of interest among members of the council; pre-existing societal tensions and divisions; concerns about the representativeness of the council's membership; competition among providers of services for funding; conflicting demands for services by persons affected by HIV disease; disagreements between the council and providers of services over policies and procedures for administering the services contracts; and concerns about the council's involvement in the selection of specific agencies for funding, its lapses in compliance with rules of order, and its failure to accurately record minutes of all of its meetings. Despite the challenges faced by the Oakland planning council, it was able to meet its Title I obligations, which resulted in significant increases in the availability of medical and social services for persons affected by HIV disease. However, dealing with the confusion and conflicts described above consumed a considerable amount of the planning council's time and energy and eventually required a complete reorganization of the council to assure its stability and the legitimacy of the Title I program at the local level. Medical Subject Headings (MeSH): health planning councils; health planning organizations; health care coalitions; organization and administration; organizational innovation; models, organizational.

Quantitative description of sleep stage electrophysiology using digital period analytic techniques.

The purpose of the current study was to assess the overlap in variance of two procedures for the quantification of sleep electrophysiology: conventional stage scoring and computer quantification of tonic activity. Data were collected on 24 nights from eight subjects and were scored according to a modified set of Rechtschaffen and Kales criteria and submitted to a period-analytic computer analysis. Following this, discriminant function analyses were performed on the data for each night to predict the visual stage scores from the computer-generated data. The results indicate a very high degree of predictive accuracy (91.05%) supporting the contention that the computer-quantified data set includes the variance normally captured by stage scoring. The implications of computer quantification of sleep electrophysiology are discussed.

Retained elements of early avoidance training and relearning of forgotten operants.

In a series of 7 experiments we investigated the possibility that juvenile rats show long-term retention for aspects of early avoidance training and that these retained elements serve to reinforce relearning of the forgotten operants. Rats trained in active or passive avoidance at 23-25 days of age demonstrated the typical juvenile forgetting effect relative to adults after a 28-day interval. However, both juveniles and adults demonstrated marked reductions in locomotor activity prior to retraining which were specific to the apparatus and not dependent on the opportunity to perform an operant during initial training. Juvenile animals given a reminder exposure plus footshock 27 days after training, then single daily nonshock trials (Days 28-30), showed decreasing crossover latencies across days if trained in active avoidance and increasing latencies if trained in passive avoidance. This reappearance of task-appropriate crossover latencies was evident in previously trained juveniles only. Finally, young animals' demonstrated change in crossover latency is associated with subsequent superior acquisition performance, and this change depends upon the presentation of the test trials for its appearance. We suggest that the amelioration of "infantile amnesia asociated with the present procedures is a learning process motivated by Pavlovian components of training which are retained well, by juveniles and adults alike, over intervals typical of ontogeny of memory research.

The description of structural and temporal characteristics of tonic electrophysiological activity during sleep.

The structural and temporal characteristics of tonic variation among electrophysiological measures during sleep are examined from the point of view of sleep stage scoring procedures and the digital quantification and statistical analysis of these measures. Sleep stage scoring procedures are nominally scaled and therefore less able to index structural and temporal characteristics than are measures derived from digital methods of quantification having the properties of interval or ratio scales. These arguments are illustrated using principal components analysis to describe the structure of tonic covariation among 36 variables derived from the computer analysis of EEG, EMG, and EOG. Three components resulting from the analysis are tentatively named 'slow-fast', 'hemispheric-shift' and 'eyes-activation'. They appear across variations in experimental manipulations such as night time awakenings and also across differences in age and species. The periodic characteristics of the vectors associated with the three components are specified by means of the Fast Fourier transform in combination with digital low pass and band pass filtering. Cycles are found which are both slower and faster than the paradigmatic 90 min ultradian rhythm. These results indicate that currently available techniques of digital and statistical analysis provide new possibilities for research on the electrophysiology and psychophysiology of sleep.

Conceptual and methodological considerations towards the development of computer-controlled research on the electro-physiology of sleep.

A critical discussion of the visual scoring approach to the measurement of sleep electrophysiology details some theoretical shortcomings of that procedural model. An alternative approach employing high-speed, general purpose digital computers is then presented. It is argued that the measurement potential of computers is barely tapped by using computers to score sleep stages and the advantages of collecting data which are suitable for parametric and multivariate statistical analysis are described. Researchers are urged to include detailed reports on their procedural choices along with a discussion of the methodological implications of these procedures. Examples of computer collected data are presented along with a description of some simple data reduction strategies.

Pregrowth hormone messenger RNA: glucocorticoid induction and identification in rat pituitary cells.

We have investigated whether the large (5- to 15-fold) stimulation of synthesis of growth hormone (somatotropin) observed upon exposure of a strain of rat pituitary (GH3) cells to dexamethasone (a synthetic glucocorticoid) arises from a stimulation of pregrowth hormone mRNA. A good agreement was observed between the stimulation of growth hormone synthesis and the stimulation of cytoplasmic levels of pregrowth hormone mRNA, assayed by translation in wheat germ extracts. Electrophoresis on formamide-acrylamide gels of oligo(dT)-treated membrane fraction RNA revealed a band that was induced by dexamethasone to about the same extent as was translatable pregrowth hormone mRNA. Elution of the band and translation in wheat germ extracts showed directly that it contained pregrowth hormone mRNA. These results suggest that the dexamethasone induction of growth hormone synthesis in GH3 cells arises from an accumulation of pregrowth hormone mRNA in the cytoplasm of the cells. The pregrowth hormone mRNA band observed by gel electrophoresis had an estimated molecular weight of 3.6 X 10(5), suggesting the existence in this molecule of an untranslated region at least 200 nucleotides in length.

Pregrowth hormone: product of the translation in vitro of messenger RNA coding for growth hormone.

Membrane fraction RNA isolated from rat pituitary tumor (GC) cells has been translated in a wheat germ extract. A product was synthesized which was immunologically related to growth hormone, but which migrated more slowly than growth hormone upon sodium dodecyl sulfate-acrylamide gel electrophoresis. The mobility of the cell-free product on gels of this type was unchanged by treatment with either KOH or RNase. The mobilities during paper electrophoresis of the methionine-containing tryptic peptides obtained from the cell-free product were identical to those obtained from growth hormone synthesized and secreted by the GC cells. Molecular weights for growth hormone and the cell-free product of 19,500 and 24,000, respectively, were determined by gel electrophoresis of these proteins together with marker proteins of known molecular weights. No protein with the properties of the cell-free product was detected after a 2 min incubation of the GC cells with [35S]methionine. However, treatment of the GC cells, with a protease inhibitor, L-1-tosylamide-2-phenyl-ethylchloromethyl ketone (TPCK), led to the appearance of a new polypeptide, immunologically related to growth hormone, and with a mobility on gels identical to that of the cell-free product. These results strongly imply that the cell-free product represents a growth hormone precursor (pregrowth hormone) which is rapidly converted to growth hormone in pituitary cells.

Naproxen in rheumatoid arthritis. A controlled trial.

The efficacy of naproxen in treating rheumatoid arthritis patients was evaluated in a double-blind clinical trial using aspirin as the control drug. The study was conducted at seven centers and involved 80 patients. After an unequivocal increase in disease activity during a drug-free period, patients were randomly assigned to either drug and continued in the trial for 16 weeks. Some patients took low maintenance doses of corticosteroids, or gold salts, or both throughout the trial. Both test drugs significantly decreased disease activity as measured by a number of ways. By objective measurements, naproxen was as effective as aspirin, although patients in the naproxen-treated group entered the trial with more severe disease. By some subjective evaluations, naproxen was considered more effective than aspirin. Although patients taking naproxen had less frequent gastrointestinal side effects and fewer symptoms VIIIth nerve toxicity, the differences were not statistically significant. We conclude that naproxen is a useful addition to the physician's armamentarium for the treatment of rheumatoid arthritis.