Schizophrenia and other psychotic disorders in a cohort of sexually abused children.

CONTEXT: The evidence for an association between child sexual abuse and subsequently developing psychotic disorders, including the schizophrenias, remains inconclusive. OBJECTIVE: To explore whether child sexual abuse is a risk factor for later psychotic disorders. DESIGN: Case-control study. SETTING: Sample drawn from all notified cases of child sexual abuse over a 30-year period in Victoria, Australia. PARTICIPANTS: A cohort of 2759 individuals ascertained as having been sexually abused when younger than 16 years had their subsequent contacts with mental health services established by data linkage. They were compared with a community-based control group matched on sex and age groupings whose rates of disorder were established using identical methods. MAIN OUTCOME MEASURES: Rates of psychotic and schizophrenic illnesses. RESULTS: Rates were significantly higher among child sexual abuse subjects compared with controls for psychosis in general (2.8% vs 1.4%; odds ratio, 2.1; 95% confidence interval, 1.4-3.1; P < .001) and schizophrenic disorders in particular (1.9% vs 0.7%; odds ratio, 2.6; 95% confidence interval, 1.6-4.4; P < .001). Those exposed to penetrative abuse had even higher rates of psychosis (3.4%) and schizophrenia (2.4%). Abuse without penetration was not associated with significant increases in psychosis or schizophrenia. The risks were highest for those whose abuse involved penetration, occurred after age 12 years, and involved more than 1 perpetrator, the combination producing rates of 8.6% for schizophrenia and 17.2% for psychosis. CONCLUSIONS: Child sexual abuse involving penetration is a risk factor for developing psychotic and schizophrenic syndromes. The risk is greater for adolescents subjected to penetration. Irrespective of whether this statistical association reflects any causal link, it does identify an at-risk population in need of ongoing support and treatment.

Psychopathology in a large cohort of sexually abused children followed up to 43 years.

OBJECTIVE: To determine the rate and risk of clinical and personality disorders diagnosed in childhood and adulthood in those known to have been sexually abused during childhood. METHODS: Forensic medical records of 2,759 sexually abused children assessed between 1964 and 1995 were linked with a public psychiatric database between 12 and 43 years later. Cases were compared to control subjects matched on gender and age groupings drawn from the general population through a random sample of the national electoral database. RESULTS: A lifetime record of contact with public mental health services was found in 23.3% of cases compared to 7.7% of controls. The rate of contact among child sexual abuse victims was 3.65 times higher (95% CI, 3.09-4.32, p<0.001). It was estimated that child sexual abuse accounted for approximately 7.83% of mental health contact. Exposure to sexual abuse increased risks for the majority of outcomes including psychosis, affective, anxiety, substance abuse, and personality disorders. Rates of clinical disorders diagnosed in adulthood and childhood remained significantly higher among child sexual abuse cases. Older age at sexual abuse and those exposed to severe abuse involving penetration or multiple offenders were associated with greater risk for psychopathology. CONCLUSIONS: This study confirms that child sexual abuse is a substantial risk factor for a range of mental disorders in both childhood and adulthood. PRACTICE IMPLICATIONS: Those treating victims of sexual abuse must assess not only disorders commonly associated with trauma, but also low prevalence disorders such as psychosis.

Suicide and fatal drug overdose in child sexual abuse victims: a historical cohort study.

OBJECTIVE: To determine the rate and risk of suicide and accidental fatal drug overdose (ie, overdose deemed not to have been suicide) in individuals who had been medically ascertained as having been sexually abused during childhood. DESIGN: A historical cohort linkage study of suicide and accidental drug-induced death among victims of child sexual abuse (CSA). SETTING AND PATIENTS: Forensic medical records of 2759 victims of CSA who were assessed between 1964 and 1995 were obtained from the Victorian Institute of Forensic Medicine and linked with coronial data representing a follow-up period of up to 44 years. MAIN OUTCOME MEASURES: Rates of suicide and accidental fatal drug overdose recorded in coronial databases between 1991 and 2008, and rates of psychiatric disorders and substance use recorded in public mental health databases. RESULTS: Twenty-one cases of fatal self-harm were recorded. Relative risks for suicide and accidental fatal overdose among CSA victims, compared with age-limited national data for the general population, were 18.09 (95% CI, 10.96-29.85; population-attributable risk, 0.37%), and 49.22 (95% CI, 36.11-67.09; population-attributable risk, 0.01%) respectively. Relative risks were higher for female victims. Similar to the general population, CSA victims who died as a result of self-harm were predominantly aged in their 30s at time of death. Most had contact with the public mental health system and half were recorded as being diagnosed with an anxiety disorder. CONCLUSION: Our data highlight that CSA victims are at increased risk of suicide and accidental fatal drug overdose. CSA is a risk factor that mediates suicide and fatal overdose.

Investigation of RFID tag readability for pharmaceutical products at item level.

BACKGROUND: The applications of radio frequency identification (RFID) technology carry a tremendous potential for pharmaceutical industry. There is a pressing need to analyze the performance of RFID tags attached to various pharmaceutical dosage forms. METHOD: The readability of RFID-tagged pharmaceutical products is, for the first time, systematically investigated by experiments. Factors considered include dosage forms, ion concentration in solution, angle of rotation, and distance between the RFID tag and the interrogator. RESULTS: Compared with empty container, the filling of any representative dosage forms causes deteriorated readability for the tag attached to container. Analysis of variance reveals that the effects of dosage forms, angle of rotation, and their interaction are statistically significant. In addition, an increase in distance (equivalent to higher RF attenuation level) and higher ion concentration in solution beyond a certain level have detrimental effect on tag readability. CONCLUSION: The analysis shows that the RFID tag readability is strongly dependent on the factors that are experimented with. The level of the factors for optimum RFID system performance should be adjusted based on the particular application.

The epidemiology of drug facilitated sexual assault.

The files of the Victorian Institute of Forensic Medicine were reviewed for all cases of alleged drug facilitated sexual assault for the 12 month period concluding in April 2003. Seventy-six cases were identified from a total of 434 (17.5%) cases of adult sexual assault. The median delay from alleged incident to time of examination was 20 h. Alcohol consumption in the hours prior to the assault was reported by 77%. Alcohol was still present in 37% when subsequently examined, with an average blood alcohol concentration of 0.11% at the time of examination. Forty-nine percent reported using prescription medications and 26% reported the use of recreational drugs. Drugs not reportedly consumed by the subject were detected in 15 cases (20%) of the study group or 3% of all adult sexual assault cases. The drugs detected included cannabis (four cases), antidepressants (4), amphetamines (3), benzodiazepines (4) and opiates (3). The study indicates that covert administration of drugs in the setting of adult sexual assault appears uncommon. The true incidence however may be higher (due to non or delayed reporting) or lower (due to inaccurate self reporting of drug consumption) however the frequent findings of high concentrations of alcohol has implications for the health and safety of these individuals.

Sexual assault practice: myths and mistakes.

Stories about sexual activity abound and are often the source of considerable interest and speculation. These anecdotal accounts are rarely subjected to any serious scrutiny and yet may develop folklore proportions. It is concerning that many forensic practitioners are prepared to perpetuate similar myths behind a veneer of scientific practice. Practices such as impotence or virginity testing and the interpretation of penile measurements are lucrative endeavors that remain alive and well. Similarly, court evidence on topics such as the circumstances by which genital injuries were sustained, the relationship between pubertal staging and age or the interpretation of anal findings are often less than objective. These practices are unprofessional. Further, they have the potential to cause significant harm to many individuals and to undermine the standing of the criminal justice system.

Microfabricated cylindrical multielectrodes for neural stimulation.

The effects of spinal cord injuries are likely to be ameliorated with the help of functional electrical stimulation of the spinal cord, a technique that may benefit from a new style of electrode: the cylindrical multielectrode. This paper describes the specifications for, fabrication techniques for, and in vitro evaluation of cylindrical multielectrodes. Four tip shapes were tested to determine which shape required the lowest peak force and would, therefore, be expected to minimize dimpling during implantation. The impedance of the electrode interface was monitored for changes due to insertion as well as repetitive delivery of current pulses. The charge delivery capacity was determined by testing with safe (< or = 0.6 mC/cm2) and damaging levels (> or = 0.8 mC/cm2) of charge density. The results of these tests suggest that this electrode design could be used to stimulate neurons in the ventral horn of the spinal cord.

Impact of child sexual abuse on mental health: prospective study in males and females.

BACKGROUND: The lack of prospective studies and data on male victims leaves major questions regarding associations between child sexual abuse and subsequent psychopathology. AIMS: To examine the association between child sexual abuse in both boys and girls and subsequent treatment for mental disorder using a prospective cohort design. METHOD: Children (n=1612; 1327 female) ascertained as sexually abused at the time had their histories of mental health treatment established by data linkage and compared with the general population of the same age over a specified period. RESULTS: Both male and female victims of abuse had significantly higher rates of psychiatric treatment during the study period than general population controls (12.4% v. 3.6%). Rates were higher for childhood mental disorders, personality disorders, anxiety disorders and major affective disorders, but not for schizophrenia. Male victims were significantly more likely to have had treatment than females (22.8% v.10.2%). CONCLUSIONS: This prospective study demonstrates an association between child sexual abuse validated at the time and a subsequent increase in rates of childhood and adult mental disorders.