Benzodiazepine use and abuse in Canada.

Benzodiazepines are frequently prescribed, yet the extent of their use in Canada has not been described. Such data would be valuable in assessing patient exposure to benzodiazepines and would provide a context to estimate the risk-benefit ratio of these drugs. Analysis of benzodiazepine sales in 1978-87 in Canada, expressed as the defined daily dose (DDD) per 1000 inhabitants per day, showed that the use of these drugs was stable during the first half of the decade, at 33 DDD/1000 inhabitants per day, then steadily increased from 1983 to 1987, reaching 48 DDD/1000 inhabitants per day in 1987. The total use of slowly eliminated benzodiazepines declined, whereas the overall use of rapidly eliminated benzodiazepines increased linearly. In 1978-83 Canada had the second-lowest total benzodiazepine use among several Western countries. The patterns of use and abuse of rapidly eliminated benzodiazepines in 1978-84 showed a close correlation. Our findings indicate that data on drug use can be monitored and linked to clinical data, providing a mechanism for monitoring the relation between use and related illness.     

Child sexual abuse sequelae and body-image surgery

Child sexual abuse is common and damages the body image. Child sexual abuse survivors may request body-image surgery. Seven patients are described in whom child sexual abuse sequelae complicated body-image surgery. Two patients viewed their surgeons as similar to sexual abusers. Yet two patients were clearly, and two possibly, helped by the surgery. Surgeons can detect and manage such patients by (1) having a child sexual abuse therapist on hand for consultation, (2) adding "abuse" to the medical history form, (3) recommending to known or suspected child sexual abuse patients preoperative therapy or a self-help book, (4) obtaining specific permission for any body contact, (5) stating belief in abuse, if revealed, (6) explaining the surgery in unusual detail, (7) recognizing the high-risk child sexual abuse groups, and, (8) declining to operate on the angry child sexual abuse patient.     

Altruism and mental disorders

Data suggest that the theories of kin selection and reciprocal altruism are viable working models to explain altruistic behavior. It remains to be demonstrated if these models can explain the behavior of persons with mentaL disorders for whom altruistic behavior is reported to be reduced. This paper addresses this issue. Part I reviews proximate factors that are thought to influence both altruistic decision making and interindividual variation in altruistic behavior. The focus is on trait signaling by potential beneficiaries and the evaluation of signals and altruistic decision making by potential altruists. In Part II, points developed in Part I are combined with clinical and empirical findings to analyze data on personality disorders and dysthymic disorder. The analysis leads to three causal hypotheses: Reduced altruistic behavior may be an evolved strategy, a consequence of dysfunctional recognition systems or algorithms, and/or a secondary response to an increase in symptoms. Different disorders and features of disorders are explained by each hypothesis.     

Child abuse: The limits of sociobiology

A review of five population based studies indicates that rates of child abuse tend to be highest among young male children from poor families. Children from very large families, children from families with a history of marital disruption, and defective children are also at a high risk of abuse. Perpetrators are more apt to be fathers or stepparents than would be expected on the basis of their representation in families of abused children. Biological mothers are least apt to abuse their children.Although these data are consistent with an evolutionary model of child abuse, many of these findings are also consistent with alternative (especially economic) models for abuse. An attempt is made to develop testable predictions for child abuse that are consistent with evolutionary theory and inconsistent with more conventional models.     

Neurosteroids and neuroactive drugs in mental disorders

Clinical and preclinical studies have suggested that fluctuations in the peripheral and brain concentrations of progesterone and deoxycorticosterone and its metabolites 3alpha,5alpha-tetrahydroprogesterone and 3alpha,5alpha-tetrahydrodeoxycorticosterone, respectively, might play an important role in certain pathological conditions characterized by emotional or affective disturbances, including major depression, anxiety disorders, and schizophrenia. Moreover, it has been shown that administration of drugs having clinical relevance in the treatment of these pathologies influence the secretion of these steroids. It remains to be determined, however, whether such changes in the concentrations of neuroactive steroids are a cause of, a risk factor for, or a consequence of mental disorders. The observation that effective pharmacological treatment of some of these pathologies influences the concentrations of neuroactive steroids suggests that these endogenous compounds might themselves prove to be efficacious in the treatment of mental illness.