Violent behaviour among people with schizophrenia: a framework for investigations of causes, and effective treatment, and prevention

Robust evidence has accumulated showing that individuals who develop schizophrenia are at elevated risk when compared to the general population to engage in violence towards others. This violence impacts negatively on victims as well as perpetrators and poses a significant financial burden to society. It is posited that among violent offenders with schizophrenia there are three distinct types defined by the age of onset of antisocial and violent behaviour. The early starters display a pattern of antisocial behaviour that emerges in childhood or early adolescence, well before illness onset, and that remains stable across the lifespan. The largest group of violent offenders with schizophrenia show no antisocial behaviour prior to the onset of the illness and then repeatedly engage in aggressive behaviour towards others. A small group of individuals who display a chronic course of schizophrenia show no aggressive behaviour for one or two decades after illness onset and then engage in serious violence, often killing, those who care for them. We hypothesize that both the developmental processes and the proximal factors, such as symptoms of psychosis and drug misuse, associated with violent behaviour differ for the three types of offenders with schizophrenia, as do their needs for treatment.     

Why Children with Severe Bacterial Infection Die: A Population–Based Study of Determinants and Consequences of Suboptimal Care with a Special Emphasis on Methodological Issues

Introduction

Suboptimal care is frequent in the management of severe bacterial infection. We aimed to evaluate the consequences of suboptimal care in the early management of severe bacterial infection in children and study the determinants.

Methods

A previously reported population-based confidential enquiry included all children (3 months- 16 years) who died of severe bacterial infection in a French area during a 7-year period. Here, we compared the optimality of the management of these cases to that of pediatric patients who survived a severe bacterial infection during the same period for 6 types of care: seeking medical care by parents, evaluation of sepsis signs and detection of severe disease by a physician, timing and dosage of antibiotic therapy, and timing and dosage of saline bolus. Two independent experts blinded to outcome and final diagnosis evaluated the optimality of these care types. The effect of suboptimal care on survival was analyzed by a logistic regression adjusted on confounding factors identified by a causal diagram. Determinants of suboptimal care were analyzed by multivariate multilevel logistic regression.

Results

Suboptimal care was significantly more frequent during early management of the 21 children who died as compared with the 93 survivors: 24% vs 13% (p = 0.003). The most frequent suboptimal care types were delay to seek medical care (20%), under-evaluation of severity by the physician (20%) and delayed antibiotic therapy (24%). Young age (under 1 year) was independently associated with higher risk of suboptimal care, whereas being under the care of a paediatric emergency specialist or a mobile medical unit as compared with a general practitioner was associated with reduced risk.

Conclusions

Suboptimal care in the early management of severe bacterial infection had a global independent negative effect on survival. Suboptimal care may be avoided by better training of primary care physicians in the specifics of pediatric medicine.     

Postinspiratory neuronal activities during behavioral control, sleep, and wakefulness.

Cells that discharge in early expiration and inhibit other respiratory cells purportedly cause a separate phase of the respiratory cycle that has been named "postinspiration." Our objective was to study these postinspiratory cells in the intact unanesthetized cat during sleep, wakefulness, and behavioral inhibition of inspiration, but we were unable to find cells with strong and consistent activity confined to early expiration. Instead, we found that various cell types were active in early expiration. They included inspiratory-expiratory phase-spanning cells, retrofacial augmenting expiratory cells with bursts in early expiration, retrofacial decrementing expiratory cells, tonic expiratory cells, and cells with variable activity in the early part of expiration. Just as the cell types active during early expiration were heterogeneous so too were their activities during behavioral inhibition of inspiration and during sleep. These results suggest that the state of early expiration is determined by many different cell types rather than a single class of postinspiratory cells.     

Culture,Context, and Maternal Self-Efficacy in Latina Mothers

Youth civic engagement occupies a central space in applied developmental science. However, understanding of the processes and contexts in which early adolescents become civically engaged is still limited. This study draws on a sample of approximately 4,000 students from 11 urban middle schools in Tennessee to address several gaps in the civic engagement literature. First, we use latent class analysis to identify types of civic engagement in early adolescence. Second, we explore associations between types of engagement and youth behavioral and academic outcomes. Third, we focus on urban youth. A latent class analysis using survey items suggests a three-class structure for civic engagement in urban middle schools. One distinction is between students who are engaged and those who are not. Another distinction is that, among the engaged groups, one is engaged both behaviorally and attitudinally (social justice actors), whereas another has strong civic attitudes but infrequent civic behaviors (social justice sympathizers).     

The bodily winds in ancient India revisited

This paper examines the historical development of the doctrine of the five bodily winds ( prā a s) in the early Sanskrit literature of Yoga and Āyurveda. Special attention is paid to the Indian's understanding of the connection between atmospheric wind and bodily breath and the role of wind in the human body. The paper traces the evolution of the Indian concept of breath. Originally, wind and breath were used metaphorically to indicate life. Breath was subsequently classified into five types by early ascetics who used breath-control in their practice of Yoga; and these same five breaths were eventually utilized by the Āyurvedic medical thinkers to establish a sophisticated doctrine of wind and its function in the body.     

Controlled Trial of Treatment for Cerebral Concussion

In a study designed to compare two types of treatment of cerebral concussion, 178 patients were allocated to a routine treatment or to an active treatment group; in the latter a good prognosis was emphasized, the patient was mobilized early and given physiotherapy. In the routine treatment group the average time off work was 32 days compared with 18 days in the active treatment group. Physiotherapy seemed to be particularly valuable in old patients and in those with exaggerated fears about their condition. It is suggested that throughout their illness and follow-up, patients with cerebral concussion should be under the care of one doctor, one who is particularly interested in the subject and that more propaganda is needed     

Comprehensive geriatric assessment for older women with early breast cancer - a systematic review of literature

ABSTRACT: BACKGROUND: The Comprehensive Geriatric Assessment (CGA) is an analytical tool increasingly implemented in clinical practice. Breast cancer is primarily a disease of older people; however, most evidence-based research is aimed at younger patients. METHODS: A systematic review of literature was carried out to assess the use of CGA in older breast cancer patients for clinical decision making. The PubMed, Embase and Cochrane databases were searched. RESULTS: A total of nine useful full text article results were found. Only five of these were exclusively concerned with early breast cancer; thus, studies involving a variety of cancer types, stages and treatments were accepted, as long as they included early breast cancer. The results comprised a series of low sources of evidence. However, all results shared a common theme: the CGA has a use in determining patient suitability for different types of cancer treatment and subsequently maximizing the patient's quality of life. CONCLUSIONS: There is not yet sufficient high level evidence to instate CGA guidelines as a mandatory practice in the management of breast cancer, due to the heterogeneity of available studies. More studies need to be conducted to cement current work on the benefits of the CGA. An area of particular interest is with regard to treatment options, especially surgery and chemotherapy, and identifying patients who may be suitable for these treatments.     

A phylogenetic analysis of the evolution of Austronesian sibling terminologies

Social structure in human societies is underpinned by the variable expression of ideas about relatedness between different types of kin. We express these ideas through language in our kin terminology: to delineate who is kin and who is not, and to attach meanings to the types of kin labels associated with different individuals. Cross-culturally, there is a regular and restricted range of patterned variation in kin terminologies, and to date, our understanding of this diversity has been hampered by inadequate techniques for dealing with the hierarchical relatedness of languages (Galton’s Problem). Here I use maximum-likelihood and Bayesian phylogenetic comparative methods to begin to tease apart the processes underlying the evolution of kin terminologies in the Austronesian language family, focusing on terms for siblings. I infer (1) the probable ancestral states and (2) evolutionary models of change for the semantic distinctions of relative age (older/younger sibling) and relative sex (same-sex/opposite-sex). Analyses show that early Austronesian languages contained the relative-age, but not the relative-sex distinction; the latter was reconstructed firmly only for the ancestor of Eastern Malayo-Polynesian languages. Both distinctions were best characterized by evolutionary models where the gains and losses of the semantic distinctions were equally likely. A multi-state model of change examined how the relative-sex distinction could be elaborated and found that some transitions in kin terms were not possible: jumps from absence to heavily elaborated were very unlikely, as was piece-wise dismantling of elaborate distinctions. Cultural ideas about what types of kin distinctions are important can be embedded in the semantics of language; using a phylogenetic evolutionary framework we can understand how those distinctions in meaning change through time.     

Sex differences in infant rhesus macaque separation-rejection vocalizations and effects of prenatal androgens

Infant and juvenile rhesus macaques exhibit many sexually dimorphic behaviors, including rough and tumble play, mounting, and time spent with nonmother females. This study investigated sex differences in infant rhesus monkey separation-rejection vocalizations (SRVs), and the effects of altering the prenatal hormone environment on these differences. Pregnant females received exogenous androgen (testosterone enanthate), an androgen antagonist (flutamide), or vehicle injections for 30 or 35 days during the second (early) or third (late) trimester of pregnancy. Control females used a greater percentage of coos and arched screams than did control males. In contrast, males used a greater percentage of geckers and noisy screams than did females. Females also had longer SRV bouts, used more calls, and used more types of vocalizations than did males. Mothers were more likely to respond to the SRVs of male infants than to the SRVs of female infants. Prenatal flutamide treatment early in gestation reduced the likelihood that mothers would respond to their male offspring, but prenatal androgen treatment had no effect on response rates of mothers to female offspring. Early, but not late, androgen treatment produced females who vocalized in a male-typical manner. Similarly, early flutamide treatment produced males who displayed more female-typical SRVs. Late flutamide treatments of females produced as much masculinization of SRVs as did early androgen treatment in females. These results demonstrate sex differences in highly emotional vocalizations in infant rhesus macaques and provide evidence that the timing and form of prenatal hormonal exposure influence such vocalizations.     

Sex Differences in Infant Rhesus Macaque Separation–Rejection Vocalizations and Effects of Prenatal Androgens

Infant and juvenile rhesus macaques exhibit many sexually dimorphic behaviors, including rough and tumble play, mounting, and time spent with nonmother females. This study investigated sex differences in infant rhesus monkey separation–rejection vocalizations (SRVs), and the effects of altering the prenatal hormone environment on these differences. Pregnant females received exogenous androgen (testosterone enanthate), an androgen antagonist (flutamide), or vehicle injections for 30 or 35 days during the second (early) or third (late) trimester of pregnancy. Control females used a greater percentage of coos and arched screams than did control males. In contrast, males used a greater percentage of geckers and noisy screams than did females. Females also had longer SRV bouts, used more calls, and used more types of vocalizations than did males. Mothers were more likely to respond to the SRVs of male infants than to the SRVs of female infants. Prenatal flutamide treatment early in gestation reduced the likelihood that mothers would respond to their male offspring, but prenatal androgen treatment had no effect on response rates of mothers to female offspring. Early, but not late, androgen treatment produced females who vocalized in a male-typical manner. Similarly, early flutamide treatment produced males who displayed more female-typical SRVs. Late flutamide treatments of females produced as much masculinization of SRVs as did early androgen treatment in females. These results demonstrate sex differences in highly emotional vocalizations in infant rhesus macaques and provide evidence that the timing and form of prenatal hormonal exposure influence such vocalizations.     

Divorce in the early years of marriage in England and Wales: results from a prospective study using linked records

A representative sample of over 1000 couples who married during 1979 in England and Wales was followed from the date of marriage until mid-1984 to investigate the characteristics of couples who divorce soon after marriage. Results of this 5 year study show that couples who apparently lived together before marriage had a below average chance of early divorce, whereas couples where the addresses of the partners before marriage were very close had a significantly high rate of early breakdown. The chance of early divorce was significantly above average for spouses marrying in their teens and for both husbands and wives who, at their marriage, belonged to social class 5 (work in unskilled manual occupations). Couples who married with a civil ceremony had an above average (and those marrying with a religious ceremony a below average) risk of early divorce, but such differences were found to be negligible on analyzing the results from a matched case-control study in which each "case" marriage (one which did end in early divorce) was matched with a "control" marriage (one which did not end in early divorce). There is substantial evidence that age at marriage and previous marital status of the marriage partners have a decided influence upon the propensity to divorce. 2 conclusions concerning fertility are more likely than the average married couple to have had a pre-maritally conceived child, and 2) that couples who divorce relatively quickly tend on average to have larger family sizes, even if children who were pre-martitally conceived are exluded.     

Genetic and morphologic determinants of pneumothorax in lymphangioleiomyomatosis

Lymphangioleiomyomatosis, a multisystem disease affecting women, is characterized by proliferation of abnormal smooth muscle-like cells in the lungs, leading to cystic destruction of the parenchyma and recurrent pneumothoraces. Clinical characteristics of lymphangioleiomyomatosis patients were analyzed to determine the relationship of pneumothoraces to disease progression. Patients were genotyped for polymorphisms in genes of extracellular matrix proteins collagen, elastin, and matrix metalloproteinase-1 to assess their association with pneumothoraces. Clinical data and polymorphisms in the genes for types I and III collagen, elastin, and matrix metalloproteinase-1 were compared with the prevalence of pneumothorax. Of 227 patients, 57% reported having had at least one pneumothorax. Cyst size on high-resolution computed tomography scans was associated with pneumothorax; patients with a history of pneumothorax were more likely to have larger cysts than patients who had no pneumothoraces. In patients with mild disease, those with a history of pneumothorax had a faster rate of decline in forced expiratory volume in 1 s (FEV(1); P = 0.001, adjusted for age) than those without. Genotype frequencies differed between patients with and without pneumothorax for polymorphisms in the types I and III collagen and matrix metalloproteinase-1 genes. Larger cysts may predispose lymphangioleiomyomatosis patients to pneumothorax, which, in early stages of disease, correlates with a more rapid rate of decline in FEV(1). Polymorphisms in types I and III collagen and matrix metalloproteinase-1 genes may cause differences in lung extracellular matrix that result in greater susceptibility to pneumothorax.     

Who Supports Breastfeeding Mothers?

Breastfeeding is one important form of maternal investment that is influenced by support from kin and non-kin. This paper investigates who provides support for breastfeeding mothers and their children, what type of support they provide, and how support impacts breastfeeding duration. The data were derived from a survey of 594 American mothers and were analyzed using quantitative methods, including Cox regression. Analyses indicate that mothers receive significant support, particularly from spouses and maternal grandmothers. More frequent breastfeeding discussions with La Leche League and maternal grandfathers were associated with longer duration, whereas discussions with physicians were associated with shorter breastfeeding duration. Results indicate that consulting others specifically about breastfeeding may influence breastfeeding decisions. The results are consistent with the idea that social support may influence breastfeeding duration and that some types of support are more influential than others. Furthermore, support persons should be educated about breastfeeding to prevent early weaning.     

Evidence for existence of two types of massive obesity.

The responses of growth hormone, cortisol, and prolactin to symptomatic hypoglycaemia during an intravenous insulin tolerance test were measured in 20 massively obese subjects and six lean volunteers. In 11 subjects, who had been obese since early childhood, an impaired growth-hormone response and an absent prolactin response were found. In the nine other obese subjects, however, the growth-hormone and prolactin responses were not significantly impaired. Seven of these subjects had become obese either as a teenager or during adult life. These findings suggest the existence of two types of human obesity similar to those found in rodent models. In one the disorder of hypothalamic function may be due to a basic, possibly genetic abnormality, while in the other it is acquired.     

Nitric oxide synthases in infants and children with pulmonary hypertension and congenital heart disease

Rationale

Nitric oxide is an important regulator of vascular tone in the pulmonary circulation. Surgical correction of congenital heart disease limits pulmonary hypertension to a brief period.

Objectives

The study has measured expression of endothelial (eNOS), inducible (iNOS), and neuronal nitric oxide synthase (nNOS) in the lungs from biopsies of infants with pulmonary hypertension secondary to cardiac abnormalities (n = 26), compared to a control group who did not have pulmonary or cardiac disease (n = 8).

Methods

eNOS, iNOS and nNOS were identified by immunohistochemistry and quantified in specific cell types.

Measurements and main results

Significant increases of eNOS and iNOS staining were found in pulmonary vascular endothelial cells of patients with congenital heart disease compared to control infants. These changes were confined to endothelial cells and not present in other cell types. Patients who strongly expressed eNOS also had strong expression of iNOS.

Conclusion

Upregulation of eNOS and iNOS occurs at an early stage of pulmonary hypertension, and may be a compensatory mechanism limiting the rise in pulmonary artery pressure.     

Subtypes of Batterers in Treatment: Empirical Support for a Distinction between Type I,Type II and Type III

This study explores the existence of different types of batterers in a sample of 266 men who had been court referred for intimate partner violence. The data collected in the assessment that have been used to perform a hierarchical and a two-step cluster analysis fall into three areas: aggression towards the partner, general aggression and presence of psychopathology and personality traits, more specifically, alcohol use, borderline and antisocial personality traits, psychopathy traits, state anger and trait anger, anger expression and control, anger, hostility, and, finally, impulsivity. The results show a typology consisting of 3 types of batterers on the basis of violence level and psychopathology: low (65%), moderate (27.8%) and high (7.1%). This study provides empirical support for the development of batterer typologies. These typologies will help achieve early detection of different types of batterers, allowing us to tailor interventions on the basis of the needs of each of the types.     

Psychological outcomes of different treatment policies in women with early breast cancer outside a clinical trial.

OBJECTIVES--To assess outside a clinical trial the psychological outcome of different treatment policies in women with early breast cancer who underwent either mastectomy or breast conservation surgery depending on the surgeon''s opinion or the patient''s choice. To determine whether the extent of psychiatric morbidity reported in women who underwent breast conservation surgery was associated with their participation in a randomised clinical trial. DESIGN--Prospective, multicentre study capitalising on individual and motivational differences among patients and the different management policies among surgeons for treating patients with early breast cancer. SETTING--12 District general hospitals, three London teaching hospitals, and four private hospitals. PATIENTS--269 Women under 75 with a probable diagnosis of stage I or II breast cancer who were referred to 22 different surgeons. INTERVENTIONS--Surgery and radiotherapy or adjuvant chemotherapy, or both, depending on the individual surgeon''s stated preferences for managing early breast cancer. MAIN OUTCOME MEASURES--Anxiety and depression as assessed by standard methods two weeks, three months, and 12 months after surgery. RESULTS--Of the 269 women, 31 were treated by surgeons who favoured mastectomy, 120 by surgeons who favoured breast conservation, and 118 by surgeons who offered a choice of treatment. Sixty two of the women treated by surgeons who offered a choice were eligible to choose their surgery, and 43 of these chose breast conserving surgery. The incidences of anxiety, depression, and sexual dysfunction were high in all treatment groups. There were no significant differences in the incidences of anxiety and depression between women who underwent mastectomy and those who underwent lumpectomy. A significant effect of surgeon type on the incidence of depression was observed, with patients treated by surgeons who offered a choice showing less depression than those treated by other surgeons (p = 0.06). There was no significant difference in psychiatric morbidity between women treated by surgeons who offered a choice who were eligible to choose their treatment and those in the same group who were not able to choose. Most of the women (159/244) gave fear of cancer as their primary fear rather than fear of losing a breast. The overall incidences of psychiatric morbidity in women who underwent mastectomy and those who underwent lumpectomy were similar to those found in the Cancer Research Campaign breast conservation study. At 12 months 28% of women who underwent mastectomy in the present study were anxious compared with 26% in the earlier study, and 27% of women in the present study who underwent lumpectomy were anxious compared with 31% in the earlier study. In both the present and earlier study 21% of women who underwent mastectomy were depressed, and 19% of women who underwent lumpectomy in the present study were depressed compared with 27% in the earlier study.) CONCLUSIONS--There is still no evidence that women with early breast cancer who undergo breast conservation surgery have less psychiatric morbidity after treatment than those who undergo mastectomy. Women who surrender autonomy for decision making by agreeing to participate in randomised clinical trials do not experience any different psychological, sexual, or social problems from those women who are treated for breast cancer outside a clinical trial.     

Technic for Photographing Early Cleavage Stages of the Hen's Egg

Altho photographs have been secured of early cleavage stages in the pigeon's egg, no photographs of corresponding stages of development of the hen's egg have been published. Satisfactory photographs of early cleavage stages of the hen's egg have been difficult to obtain in the past because of the indistinctness of the furrows and the lack of contrast between them and the remainder of the blastodisc. The indistinctness of the cleavage furrows in the hen's egg as compared with those of the pigeon's egg was recognized by Patterson (1910) who, after having studied both types of eggs, states (p. 109): “The lack of a furrow is the cause of the indistinctness of the early cells. In this respect, the early cleavages of the hen's egg differ greatly from those of the pigeon's egg, for in the latter their clearness is such as to permit photographing the living cells, while in the former photographs are impossible, except in a few cases”.     

FILIAL CANNIBALISM IN THE CORTEZ DAMSELFISH STEGASTES RECTIFRAENUM

Male cortez damselfish, Stegastes rectifraenum, in a central Gulf of California population, ate a large percentage (28.3%) of the clutches they received. This high rate of filial cannibalism permitted the testing of several predictions concerning the types of clutches that should be preferentially eaten and the mating tactics females should employ to reduce cannibalism rates. Males ate clutches that were smaller than average and that were at early stages of development. Experimentally reduced clutches were consumed at higher rates than controls. When multiple clutches were present, males preferentially ate the younger, smaller clutches. Females were more likely to deposit eggs with males who were caring for other early-stage eggs and to avoid males with late-stage eggs. This pattern was accentuated in females that deposited smaller clutches. These results provide evidence that filial cannibalism represents an adaptive response to clutches that do not provide adequate benefits to warrant the costs of parental care.     

Phenylketonuria and its variants: observations on intellectual functioning.

The age at diagnosis, dietary treatment and intelligence quotient (IQ) of 119 patients with phenylketonuria (PKU) and its variants who were under long-term observation were studied. In 27 of the 79 patients with classic PKU the diagnosis had been made and treatment begun late (after 2 months of age). The mean IQ of these 27 patients was 57.6 when they were in their early 20s (although 2 had normal IQs). In contrast, among the 52 patients with classic PKU who were not treated late the mean IQ was 93.6 for the 27 who were still receiving dietary therapy. The mean IQs were 99.3 and 92.7 at ages 5 (when the diet was discontinued) and 15 years respectively for the 12 who had been treated "adequately". It was 76.0 for the 13 who were "over-treated" (malnourished) in the first 6 months of life. Among the patients with atypical PKU, who were treated early, the mean IQs were 110.0 for the 7 who were still receiving dietary therapy and 102.7 for the 12 who were not. The 21 patients with persistent benign hyperphenylalaninemia, who were not treated, had a mean IQ of 104.2. The most important factor in the ultimate IQ of patients with classic PKU is very early diagnosis (by 2 weeks of age) along with immediate initiation of dietary therapy.