Changes in suicidal behavior in child psychiatric inpatients.

This study of 49 preadolescent psychiatric inpatients, aged 6-12 years, evaluated changes from the time of admission to 7 weeks later in ratings of suicidal behavior, assaultive behavior, depression, hopelessness, and global functioning. Standard research instruments were used to measure these variables. There were significant decreases in suicidal behavior, assaultiveness, and depression and a significant increase in global assessment during the 7 weeks of hospitalization. Severity of suicidal behavior and severity of assaultive behavior at admission predicted a subsequent change in level of suicidal behavior. Furthermore, severity of suicidal behavior at admission was the best indicator of a change in severity of suicidal behavior.

Subtypes of suicidal and assaultive behaviors in adolescent psychiatric inpatients: a research note.

Among 129 adolescent psychiatric inpatients, four subgroups of suicidal and/or assaultive behaviors were identified. A suicidal-only subgroup with no evidence of assaultive behavior was characterized by depression, drug abuse and environmental stresses. An assaultive-only subgroup with no evidence of suicidal behavior exhibited aggressive symptoms and violence at home. A subgroup with both suicidal and assaultive behaviors experienced accidents and family violence. A fourth subgroup had neither suicidal nor assaultive behavior. This subgroup showed eating disorders, depression, minimal assaultiveness and few peer friendships.

Inner-city substance abuse patterns: a study of psychiatric inpatients.

Multiple studies have reported about substance abuse in Blacks and Hispanics. However, little is known about substance-abusing psychiatric patients of these ethnic groups. This study reports the prevalence and patterns of substance abuse among 171 consecutive patients (90 Blacks and 81 Hispanics) admitted to the acute psychiatric unit of an inner-city general hospital. The lifetime prevalence was 63%. Within the month prior to admission, 48% had used the following substances: cannabis, 40%; alcohol, 37%; amphetamines, 20%; cocaine, 12%; phencyclidine (PCP), 12%; barbiturates and/or sedative-hypnotics, 10%; opioids, 9%; inhalants, 1%; hallucinogens, 1%. Those who abused alcohol were more likely to abuse barbiturates and/or sedative-hypnotics, and opioids. Logistic regression analysis showed that major depression, ethnicity, and schizophrenia each were significant predictors of particular types of abuse. Patients with major depression were less likely to use PCP, Blacks were more likely than Hispanics to use hallucinogens, and schizophrenics were less likely to use opioids. In all cases in which sex, age, and personality disorder were significant, males, the young adult group, and those with personality disorder were more likely to be abusers. These three variables were all strong predictors of both multiple and extensive substance abuse. Overall, our findings suggest that in the inner-city, a substantial number of young adult psychiatric inpatients are a high risk group for multiple substance abuse. The coexistence of substance abuse and other psychiatric disorders has clinical and treatment implications, and calls attention for changes within the conventional psychiatric milieu.

Quantitative sensory testing demonstrates that subclinical sensory neuropathy is prevalent in patients with cancer.

Vibration threshold (VT) determinations were used to assess the function of the large nerve-fiber sensory system in 171 patients with cancer and 58 healthy subjects. Significant differences in VT indicate dysfunction of this sensory system in the cancer group. Twelve percent of the cancer patients had elevated VT compared with 1.7% of control subjects. Elevated VT was not associated with risk factors for neuropathy such as diabetes, renal disease, poor nutrition, or treatment with chemotherapy. Although VT elevation was associated with alcoholism and increasing age, these variables accounted for only a small proportion of the variance in VT. These data suggest that VT determinations are a useful method for quantifying sensory abnormalities in cancer patients. Sensory abnormalities occur in a significant proportion of patients with cancer and seem to be related directly to the neoplasm, rather than to known risk factors for neuropathy.

A comparison of psychopathology in child psychiatric inpatients, outpatients, and nonpatients. Implications for treatment planning.

A total of 308 preadolescents who were either psychiatric inpatients, psychiatric outpatients, or nonpatients were studied with semistructured interview research instruments that have been described previously. The three groups of children included 106 children consecutively admitted to a voluntary hospital psychiatric inpatient unit, 101 consecutively admitted children to the same voluntary hospital center psychiatric outpatient clinic, and 101 randomly selected nonpatients. The research instruments included a Spectrum of Suicidal Behavior Scale, a Spectrum of Assaultive Behavior Scale, a Precipitating Events Scale, General Psychopathology (recent and past) Scales, a Family Background Scale, a Child's Concept of Death Scale, an Ego-Functioning Scale, and Ego-Defense Scale, and a Medical-Neurological Assessment Scale. The results of the study indicated that the presence of recent depression and recent and past aggression, the use of such ego defenses as projection, displacement, and regression, and the experience of parental separation were significantly different for the three groups of children. Impulse control and reality testing were best in the nonpatients and poorest in the inpatients. The variables that best predicted the need for psychiatric hospitalization were suicidal behavior, recent depression, recent aggression, poor reality testing, and such ego defenses as projection and regression. Implications of these findings are discussed.

Suicidal behavior in child psychiatric inpatients and outpatients and in nonpatients.

One hundred one child psychiatric outpatients were assessed using a standard battery of measures to identify factors associated with suicidal behavior. Data on these outpatients were compared to those for psychiatric inpatients and nonpatients previously studied. The frequency of suicidal behavior among the outpatients (24.8%) was less than for a comparable group of inpatients (78.5%) but more than for a comparable group of nonpatients (12%). Four variables--recent general psychopathology, preoccupation with death, and recent and past depression--were significantly associated with suicidal behavior in the three groups of children.

Antiarrhythmic drug efficacy at electrophysiology testing: predictive effectiveness of procainamide and flecainide.

In an effort to assess the ability of procainamide to predict effectiveness of antiarrhythmic agents at programmed electrical stimulation (PES) testing, we compared the result of procainamide at PES testing with that of all of the other agents studied. One hundred fifty-three patients underwent PES studies because of either sustained or nonsustained ventricular tachycardia (VT). Procainamide prevented VT induction in 79 of 153 patients. Seventy-four of the remaining 153 were inducible for VT on procainamide, with 55 of these being protected by another antiarrhythmic agent (p less than 0.001). If procainamide failed to prevent VT induction, other conventional and experimental agents were equally as likely to be effective in preventing VT induction. Analysis of flecainide acetate as a predictor of efficacy was also evaluated. Fifty-five patients received flecainide and 29 of these were protected at PES testing; 26 of these patients were also protected with another agent. When VT was inducible in patients who received flecainide, 15 of these 26 patients were protected by another agent, either conventional or experimental (p less than 0.01). Thus, if procainamide or flecainide prevented VT induction they accurately predicted effectiveness of other drugs; however, when they did not prevent VT induction, they served as a poor predictor of the possible effectiveness of other drugs. Serial drug testing at PES studies with multiple conventional and experimental drugs increases the likelihood of finding an effective antiarrhythmic agent.

Drinking patterns of inner-city black Americans and Puerto Ricans.

Alcoholic patients--183 Black Americans (62 women) and 132 Puerto Ricans (18 women)--at an inner-city alcoholism treatment program were surveyed using the Drinking History Questionnaire. Significantly more Puerto Rican men than Black men reported drinking distilled spirits, daily drinking, drinking in the morning to relieve a hangover, shakes when sobering up, blackouts when drinking, convulsions after a bout, psychoperceptual withdrawal symptoms and alcohol-related marital difficulties. Puerto Rican women were significantly older at the first time of drunkenness than the other groups. These women tended to drink at home daily and they reported a surprisingly high mean alcohol consumption. Significantly more Black women reported drinking to make friends. The tendency for Blacks to drink with their spouse, and to encourage their spouse to drink, was a major finding. This finding may have clinical implications for treatment and suggests that in lower class Black alcoholics a careful history of the drinking patterns of the spouse or living companion should be taken to determine the proper treatment approach.

Cultural influences and alcoholism: a study of Puerto Ricans.

Some reports in the literature suggest a correlation between acceptance of traditional Latin American family values and alcoholism in Hispanic males. To examine the effects of traditional values on alcoholism, the authors surveyed 151 lower-class Puerto Rican alcoholics (126 males and 25 females), using a scale to measure Hispanic-American family values. The scores of these patients were compared with those of 116 lower-class Puerto Rican nonalcoholics (45 males and 71 females). A path model was constructed with alcoholism as the dependent variable, the Traditional Scale scores as an intervening variable, and demographic variables which may also influence alcoholism (such as sex, age, years of residence in the United States, education, and English ability) as independent variables. Overall, the findings show that traditionalism is a significant predictor of alcoholism, both directly and as an intervening variable in the relation between sex and alcoholism, and education and alcoholism. However, sex and years of residence in the United States were both stronger direct predictors of alcoholism than was traditionalism. These results support the hypothesis that the manifestations of alcoholism in lower-class Puerto Ricans are influenced by cultural attitudes.

Effects of 1,25 dihydroxyvitamin D3 administration on circadian mineral rhythms in humans.

1,25 Dihydroxyvitamin D3 (1,25(OH)2D3) (2.0 micrograms) was given intramuscularly to 6 healthy adult males. Twenty-four circadian patterns of blood-ionized calcium (Ca2+), serum phosphate (Pi), and total calcium (CaT) were assessed pre- and posthormone administration. Correlations of mean mineral rhythms with normative models were significant for each mineral pattern on both study days. Mean Ca2+ and CaT rhythms became weakly correlated after hormone treatment (r = .39). A small but statistically significant increment in the 24 h grand mean Ca2+ concentration was observed on the treatment day compared with the baseline day. However, this increment is less than the year-to-year variability in the grand mean mineral concentrations derived from the same subjects studied under baseline conditions previously. These data indicate that acute parenteral administration of near-physiological (2.0 micrograms) doses of 1,25(OH)2D3 appears to have no major effect on circadian mineral pattern shape or mean mineral concentrations.

Circadian variations in serum zinc (Zn) concentrations: correlation with blood ionized calcium, serum total calcium and phosphate in humans.

Serum zinc (Zn) concentrations were determined in sequentially drawn blood samples from six healthy adult males. Each subject had blood sampling performed every 30 minutes for 24 hours. Mean Zn concentrations at each time point (n = 6, 48 time points) were plotted and fitted by a polynomial regression of the data against time. A "U" shaped curve was derived; we found peak Zn levels at 9:30 AM, a midtrough at 8 PM and a peak-trough difference of 19 micrograms/dl. Correlation with a similarly derived 24-h ionized calcium pattern was strikingly high, r = .923, p less than .001. An intermediate correlation between the Zn and phosphate patterns was observed, r = -.493, p less than .01; and no significant correlation occurred between Zn and total calcium rhythms, r = .167. These data conclusively demonstrate the presence of a circadian rhythm in serum Zn in healthy adult males. Furthermore, the high correlation between the Zn and ionized calcium patterns suggests a common regulator.

Osteocalcin in human serum: a circadian rhythm.

Osteocalcin, the vitamin K-dependent protein synthesized in bone, is found in blood. The level of circulating osteocalcin has recently been used as an indicator of the rate of bone turnover. We measured serum osteocalcin during 24-h periods in 6 normal 20- to 30-yr-old men and 4 women. Blood was sampled via an indwelling venous catheter every 30 or 60 min for 24 h. Circadian rhythmicity in circulating osteocalcin was found in 9 of the 10 individuals studied. Osteocalcin levels fell during the morning, rose in the afternoon and early evening, and reached a peak nocturnally. There were no consistent correlations between osteocalcin concentrations and circulating levels of ionized calcium, total calcium, or inorganic phosphate in the subjects tested. This study illustrates the importance of regulating the time of blood sampling for osteocalcin determinations in clinical investigations of metabolic bone disease.

Circadian rhythms of blood minerals during adolescence.

Sequential blood sampling every 30 min was performed in six adolescent males. Samples were analyzed for serum phosphate [Pi), total calcium (CaT), and blood ionized calcium (Ca++) concentrations. A circadian (24-h) pattern was observed for each mineral: 1) Ca++ concentrations followed a U-shaped curve with a peak at 11 AM and a trough at 3:30 PM; 2) CaT concentrations followed a W-shaped curve with maxima at 11 and 1 AM and troughs at 5 AM and 6 PM; and 3) Pi concentrations followed an M-shaped curve with peaks at 4 PM and 3:30 AM. The overall mineral patterns were similar in shape to those previously described in adult males. In contrast, however, the amplitude of the Pi fluctuations were considerably greater in the adolescents compared with that in adults (3.0 mg/dl versus 1.2 mg/dl). The Ca++ pattern diverged from the CaT pattern during the nocturnal phase to an extent that neither pattern could be predicted from the other. Ultradian rhythms were found in some of the time series mineral data sets; however, no single frequency encompassed all subjects for each circulating mineral.

Suicidal and assaultive behavior in children: classification, measurement, and interrelations.

In 102 children aged 6 to 12 years who were in a municipal psychiatric inpatient or outpatient clinic, the authors identified four groups of suicidal and/or assaultive behaviors. Logistic regression analyses showed that neurosis, intellectualization, and low levels of aggression predicted membership in the nonassaultive-nonsuicidal group; intense aggression, parental suicidal behavior, parental assaultive behavior, and compensation predicted it in the assaultive-suicidal group; depression, a minimum of aggression, and adjustment disorder predicted it in the suicidal-only group; and intense aggression and absence of depression predicted it in the assaultive-only group. Two clearly distinct types of suicidal children were delineated.