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Psychotropic Medications Can Increase Fracture Risk in Older Patients

A study published in the August 2008 issue of the Journal of Clinical Psychopharmacology examined the link between taking selective serotonin reuptake inhibitors (SSRIs),  benzodiazepines, and antipsychotics, and increased risk of fracture in older individuals.  Manitoba-based administrative databases were used to examine psychotropic medication use and fractures in persons aged 50 years and older between 1996 and 200.  A sample of 15,792 patients with osteoporotic fractures (vertebral, wrist, or hip) were compared with 47,289 age, sex, and diagnosis matched controls. The different medications examined included antidepressants, antipsychotics, lithium, and benzodiazepines. The results showed that taking SSRI medication was associated with the highest risk of developing osteoporotic fractures. Other types of antidepressant medication  were also associated with greater fracture risk, although the relationship was weaker. Treatment with lithium was associated with lower fracture risk while treatment with antipsychotic medication was not found to be a significant factor.  The authors conclude SSRIs and benzodiazepines appear to have a dose-specific relationship with fracture risk in the elderly which needs to be taken into consideration when the medication is prescribed for geriatric disorders.

Click here for the abstract.

Doctors Remove Eight-Centimeter Long Nail Following Bizarre Suicide Attempt

Surgeons at a hospital in Meerut, India successfully removed an eight-centimeter-long nail from the skull of a 24-year old patient following an apparent suicide attempt. The patient had reportedly been suffering from post-traumatic stress disorder after witnessing a fire in 2005 that had killed more than 50 people. After seeing the charred bodies he had expressed a desire to die as well. “He had earlier attempted suicide by consuming poison,” said his father, a local resident. On the evening of July 22, he had rammed the rusted nail into his skull using a wooden board lying in the bathroom and then went to bed assuming that he would die in his sleep. The family saw the nail sticking out of his skull on the following morning when he came down to the ground floor.

After being rushed to Lala Lajpat Rai Medical College, doctors operated upon him and removed the nail. Pradeep Bharti, head of the neurosurgery department at the hospital, said: “The nail damaged certain parts of the youth’s brain. The operation was performed successfully. A team of eight medical and paramedical professionals took two and a half hours to take out the nail. The youth is fully conscious and well, but we are keeping him under observation.” Sona Kaushal Bharti, a psychiatrist, said the patient was under treatment of psychologists but did not receive counseling after he went into depression in 2005.

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A Shocking Discovery (Part One)

The 1930s was a turbulent decade for Italian psychiatry due to widespread interest in "physical therapies" for treating asylum inmates. Use of Insulin coma, barbituate narcosis, and lobotomies represented an exciting alternative to the psychoanalytic movement of the time in treating the untreatable. Given the widespread perception that mental patients represented an economic burden on society, Italy's Fascist government (likely inspired by the Erbkrank movement in Nazi Germany), began funding different research projects investigating somatic therapies for mental illness. At the forefront of this research was the medical team led by Ugo Cerletti.

Born in 1877, Ugo Cerletti had studied with the most eminent neurologists of his time before graduating with twin specialties in neurology and neuropsychiatry. By 1935, he had become the Chair of the Department of Mental and Neurological Diseases at Universita Di Roma 'La Sapienza". After visiting Vienna to study insulin coma therapy under Manfred Sakel, Cerletti formed his own research program into chemical convulsion treatments. After observing the use of electrical stunning on hogs being prepared for slaughter however, Cerletti was struck by an inspiration. Since epileptic-type seizures induced by insulin and metrazol were already being used to treat schizophrenics in many countries, could electrically induced convulsions be used as well?

As part of his long-term research project, Cerletti used dogs as test subjects to induce seizures electrically. Although half of the animals died as a result of shock stopping the heart, Cerletti and his research assistant Lucio Bini discovered that electric current could be safely administered if the electrodes were applied to the dog's temples. The dog experiments continued (with the dog catcher's wagon making weekly stops at the clinic) and the bodies were autopsied to examine the effect of electric shock on their brains.

Despite perfecting the technique on dogs, testing the procedure on a human subject was very different. Cerletti was extremely hesitant about taking this next step for obvious reasons. As primary researcher, he would bear full responsibility for any death or serious injury that resulted. Still, his research team (Bini, Ferdinando Accornero and Lamberto Longhi) developed an experimental device that would develop 80 to 100 volts of electricity for a fraction of a second.

And then...

On April 15, 1938, a 39-year old engineer from Milan was arrested while wandering about the railroad station in Rome. The patient (identified only as "S.E") was found to be actively hallucinating and complaining about being "telepathically influenced". Diagnosed with schizophrenia, S.E. became the first test subject for the new treatment (which Cerletti named electroshock). Exactly who provided the informed consent for the use of this experimental procedure on a human patient isn't recorded.

There are different versions of what happened during that first session (the actual date is disputed although it occurred in April, 1938). In addition to Cerletti and his team, there was also medical observers and a male nurse to tend to the patient. S.E. was reportedly very docile as he lay on the examining table while the electrodes were attached to his temples. The first trial was at 80 volts for a tenth of a second and all that happened was that the patient contracted suddenly and then relaxed. His vital signs were carefully monitored with no apparent problems.

After a second trial with the voltage raised to 90 volts with no apparent reaction (although the patient did start singing), the team debated whether to try again. It was at this point when the patient stated in a calm voice, "Careful, the first is pestiferous, the second mortiferous". Although the researchers were puzzled by what he meant, they continued on to the next stage.

On the third trial, with the apparatus turned up to the maximum voltage, S.E. had a classic grand mal epileptic seizure. He became pale, turned blue, and then stopped breathing. The doctors found that his heart was racing and, after forty-eight seconds, S.E. began breathing again on his own (so did the doctors). The patient then sat up calmly and asked what they wanted from him. According to Cerletti's account, S.E. denied any memory of what had just happened. And so ended the first electroshock treatment session.

After ten additional electroshock sessions, S.E. was considered well enough to be discharged from the hospital on June 17, 1938. Cerletti later reported that the patient was "in good condition and well oriented" and could return to his engineering job in Milan. A follow-up assessment a year later found the patient reporting that he was "very well". His wife added her own concerns about her husband's condition, however. She reported that her husband became increasingly paranoid and jealous just a few months after his release. She also mentioned that "sometimes during the night he would speak as though in answer to voices”. While electroshock was no cure for schizophrenia, Cerletti continued to use it with countless other patients and his discovery would soon be adopted around the world.

For better or worse, a new era had begun in psychiatry.

Continue to Part Two.

Are Low Birth Weight Children Prone To Emotional Problems As Adults?

The July 2008 issue of  Pediatrics presents a research study examining adult survivors of premature birth. Prior studies have noted significant personality characteristics associated with preterm birth including elevated neuroticism and cautiousness and lower extraversion. A sample of 71 young adults with extremely low weight at birth (501-1000 g) were compared with a control sample of 83 young adults with normal birth weight on a battery of personality measures, All of the participants were matched for handedness, age, and absence of psychiatric impairments. The results indicated that extremely low birth weight adults reported significantly higher shyness, behavioral inhibition, and socialization (i.e. low risk aversion) than the control adults. They also showed lower sociability and emotional well-being than their normal birth weight counterparts which was consistent with previous studies. The researchers discuss the results and suggest that low birth weight children may be prone to psychiatric and emotional problems in adulthood.

Click here for the abstract.

Release Denied for Dying Manson Family Member

In a unanimous decision by the California Board of Parole, terminally ill Susan Atkins will not be allowed a compassionate release. Atkins, now 60, is serving a life sentence for her role in eight murders stemming from role in the 1969 Manson Family rampage. Charles Manson and his followers committed nine murders at four California locations over a five week period. Atkins, who was known to the other family members as Sadie Mae Glutz, was initially sentenced to death but this was later commuted to life imprisonment. She has been serving her sentence since October 1, 1969 and has been denied parole twelve times.

Despite her diagnosis of terminal brain cancer and having only months to live, the board reported that she did not show significant remorse for her crimes, including the murder of actress Sharon Tate who was 8 1/2 months pregnant at the time. Supporters of Atkins' release argued unsuccessfully that the financial costs of her medical care in prison for the remainder of her life would likely cost the state $1.4 million. Family and friends argued that her good behaviour while incarcerated indicated that she was reformed.

"She has without a doubt paid her debt to society," said her niece, Sharisse Atkins, 17. "You see her as part of the Manson family. I see her as part of our family. I hope you can find it in your heart to do the right thing."

Family members of the Manson victims also attended the hearing and the graphic testimony concerning their pain and loss carried the day.

Click here for more information.

The Cenci Case

Nobody ever really believed that Francesco Cenci's death was an accident.

On September 10, 1598, his body was found with a smashed skull outside the family castle in Petrella Del Santo (near Rome) and authorities were immediately suspicious. It was well known that Francesco Cenci had numerous enemies, not the least of which were his own children. His notorious reputation had gotten him in trouble with the Church on various occasions but his position as a wealthy aristocrat had always kept him safe. Francesco's cruelty towards his five children and his second wife, Lucrezia Petroni, was well known and he had often vowed that he would outlive them all (he may have had a hand in the death of at least one of his sons). Other rumours of dark deeds surrounded him, especially concerning his relationship with his daughter Beatrice.

Born in 1577, any hope that Beatrice might have had of marrying out of the family the way that her older sister did was crushed by Francesco's determination to keep her under his control. It's hard to separate truth from lurid fiction at this point but at least some sources claim that he abused Beatrice sexually. Francesco was furious when she tried to lay a complaint against him and he sent Beatrice and her stepmother into exile away from Rome.

We'll never know exactly when Beatrice, Lucrezia and the surviving Cenci sons, Giacomo and Bernardo, first decided to kill Francesco. The testimony in the case is probably unreliable since most of it was gained through torture (even though it was enough for conviction) but there is little else available. The murder was apparently carried out with the help of Abbe Guerra (a clergyman who was in love with Beatrice). After a poisoning attempt failed, the family eventually smashed Francesco's skull and threw him off a balcony to make it look like an accident. Beatrice and Lucrezia played their parts perfectly and an elaborate funeral was later held.

Pope Clement VIII remained suspicious and arranged for the body to be exhumed so that a medical examination could be made. The disappearance of Abbe Guerra (he had escaped before he could be arrested) and the death of an assassin who had assisted in the murder helped build the case against the family members. I'll spare you the details of the various torture methods that were available at the time but they have been well documented elsewhere. Although Giacomo and Lucrezia eventually confessed, Beatrice was able to resist until she was confronted with the testimony of the others. All of the family members involved in the murder, including 12-year old Bernardo Cenci, were sentenced to death. Pope Clement rejected any plea for mercy and ordered the sentences to be carried out.

On September 10, 1599, the entire family received their final sacraments before being taken to Piazza Castel Sant'Angela in Rome for the execution. Despite a last-minute pardon for Bernardo, he was forced to watch as all the others were executed (he collapsed as Beatrice was led to the scaffold but was revived). Beatrice and Lucrezia were beheaded while Giacomo (whose body bore clear marks of torture) was beheaded, drawn and quartered (the pieces were hung from butcher's blocks). The bodies were kept on display in the Piazza until evening and then released for burial. Beatrice's body was carried in a procession down to the the church of San Pietro in Montorio where she had asked to be buried. It was a day-long spectacle and several of those attending died from heat stroke.

To nobody's surprise, the bulk of the Cenci fortune vanished into the coffers of the Pope's supporters (Bernardo was forced to pay a substantial fine as a condition of his pardon). Aside from Bernardo and Giacomo's children, the Cenci family was largely wiped out but the legends surrounding Beatrice Cenci lived on. According to at least one account, the two executioners who had carried out the death sentences died within a month of her death (one by suicide, the other by murder). She became a figure of legend with stories of her haunting the piazza where she died on each anniversary of her death.

The story of Beatrice Cenci has been appeared in numerous books, plays, an opera and a movie. Percey Bysshe Shelley, Alexander Dumas (pere), Nathaniel Hawthorne and Stendhal wrote extensively about the lurid crime associated with her name. The tragedy has a sadly modern ring to it since domestic violence and parental abuse continue even today. All too often, victims still resort to violence to protect themselves from their abusers, especially when they are given no other options. While some progress has been made, it's still not nearly enough to prevent other domestic tragedies from happening.

Visitors to Rome can still see the haunting portrait of Beatrice (reportedly painted shortly after her death) hanging in Rome's Barberini gallery in addition to her tomb and the Palazzo Cenci where she lived. The executioner's blade that beheaded her is on display in Rome's Criminology Museum. They are fitting reminders about a tragic story and it's brutal ending.

Treatment Compliance in Adolescents Who Attempt Suicide

The June 2008 issue of the Journal of the American Academy of Child and Adolescent Psychiatry presents the results of a two-year follow-up study looking at the benefits of treatment in adolescents who have attempted suicide. A sample of eighty-five adolescents (ages 13-18) who had attempted suicide were recruited along with their families from four psychiatric hospitals and were evaluated for symptoms of emotional problems. Later assessments were conducted every 6 months over the course of a two-year period to determine whether the adolescents had participated in treatment and how well they had complied with the treatment recommendations (whether they had taken prescribed medication or attended treatment sessions), their attitudes toward treatment, and further suicide attempts and ideation. The results showed that adolescents with a disruptive behavior disorder diagnosis were less compliant with individual psychotherapy, as were those with a substance dependence other than alcohol or marijuana. Adolescents who were diagnosed with a mood or anxiety disorder were less compliant with prescribed medication (6 months post-attempt). While parents` perception of treatment as being helpful was predictive of greater treatment compliance, adolescents' attitudes toward treatment did not appear to play a role. Finally, compliance with treatment was not generally found to be a predictor of later suicide attempts. The authors concluded that attempts at increasing treatment compliance in adolescent suicide attempters should vary according to the adolescent`s symptoms as well as parental attitudes toward treatment.

Click here for the abstract.

Hard Work Really Can Kill You

A Japanese labour office has ruled that a 45-year old automotive engineer died from working too many hours. The engineer (the name has been withheld at the request of the family) was Toyota's leading designers and was reportedly under severe pressure to meet a deadline in developing a hybrid version of the Toyota Camry. He was found dead in January, 2006 at his home in central Japan and an autopsy determined that he died of ischemia (restricted blood flow to the heart). In the months leading up to his death, the engineer was required to work more than 80 hours overtime a month (including weekends and evenings) and was also required to make frequent business trips overseas. The labour office's ruling clears the way for his family to collect death benefits from his work insurance.

Although the first case of death from overwork was identified in 1969, the phenomenon known as karoshi (literally "death from overwork" in Japanese) was formally recognized in 1987 when the Japanese Ministry of Labour began collecting statistics. In addition to medical problems caused by overwork, induced stress and depression has often led to mental illness and suicide. Karoshi lawsuits are on the rise as the risks associated with excessive overtime (often unpaid) become better known. In April, 2008, a company was ordered to pay a large settlement after an employee was left in a coma as a result of overwork.

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After The Prophecy

It was in 1954 when Dorothy Martin predicted the end of the world as we know it (and became part of psychological history in the process).

Born in 1900 in Mount Shasta, California, she was a housewife living in the Chicago area when she first came to national attention. Having a longstanding interest in psychic phenomena and theosophy (and was also "cleared" by a dianetics group), she first came in contact with advanced beings from the planet Clarion through her experiments in automatic writing. Through these beings (the most important of whom was her personal mentor, Sananda), she was informed that they had been visiting Earth and monitoring fault lines in the planet's crust. They warned her that a great flood would strike the Chicago area just before dawn on December 24, 1954. The flood would then form an inland sea stretching from the Arctic Ocean to the Gulf of Mexico and a subsequent cataclysm would destroy much of the West Coast from Seattle, Washington down to South America. A flying saucer would come to rescue those who were true believers.

Martin had already become involved with a local flying saucer cult known as "The Seekers" and they responded eagerly to the messages from Sananda and the other Clarions. Their efforts to warn the public of the coming disaster were published in a local newspaper story under the headline: PROPHECY FROM PLANET. CLARION CALL TO CITY: FLEE THAT FLOOD. IT'LL SWAMP US ON DEC. 21, OUTER SPACE TELLS SUBURBANITE (it didn't make the front page for some reason). The two-column story was accompanied by a photograph of Martin with a pencil and pad in her hand and described her experiences in communicating with the "superior beings" who had relayed the warning. It was this newspaper article that first attracted the attention of social psychologist, Leon Festinger.

As later written in the seminal classic When Prophecy Fails (published in 1956), Festinger and his colleagues, Stanley Schacter and Henry W. Riecken, first interviewed Martin in October, 1954 . Given that she was making a prediction about a specific future event which had already become the focus of media attention, the researchers decided to carry out a field study examining apocalytic belief. They also viewed it as an ideal test of Festinger's fledgeling theory of cognitive dissonance.

Mrs Martin and her fellow Seekers (in the book, her name was changed to Marian Keech) strongly believed in her prediction and had already started making arrangements for their departure for Clarion. The three researchers and their fellow cohorts were able to infiltrate the group and provide a fascinating look at what happened before and after December 21. When the Seekers' attempts at "telling the world" were largely ignored, their efforts at proselytizing ended in September when Dorothy Martin was reportedly told by two strange visitors to end all warning efforts and "await further orders". The exact number of Seekers involved in the movement was never made clear but their mailing list ran to hundreds of names.

There was a surprising lack of effort on the part of the Seekers to recruit new members and the researchers had difficulty in infiltrating the movement. Their meetings mainly involved readings of Dorothy Martin's teachings, sharing of mystical experiences, and writing letters urging President Eisenhower to reveal the "secret information" that the U.S. Air Force had collected on flying saucers. Plans to relocate to the mountains were scrapped in favour of waiting for Sananda and the other "Guardians" to transport them from the Seekers' headquarters in Dorothy Martin's house in Chicago.

Then came December 20 when the final group of fifteen to twenty Seekers met in the Martin home to await their salvation. Based on Dorothy Martin's messages from Sananda, the aliens would come at midnight to take them to their new home. To prevent being burned by contact with the alien spacecraft, the Seekers were instructed to remove all metal from their bodies (including zippers and bra straps). The book describes with some detail the suspense as midnight approached and passed and the group became increasingly disappointed. Finally, at 4:45 am, Dorothy Martin received another message stating that the cataclysm had been called off by the "God of Earth". Apparently their group had impressed God with their faith and the human race was spared as a result.

Now came the hard part of telling the world. Dorothy Martin and her supporters were dismayed at the negative reaction that they received from the newspapers and wire services that they contacted. Martin took news of earthquakes in Italy and California as confirmation of her predictions of disaster but there was little else in the weeks that followed. As media interest trickled off, the group slowly dwindled. Dorothy Martin received other messages but they tended to be even more incomprehensible with time.

Responding to complaints from her neighbours, police warned Dorothy Martin that would be arrested and possibly committed to a psychiatric hospital if she persisted with her activities. She went into hiding and eventually joined a dianetics centre in Arizona. The book ends with the group being entirely dispersed although that was not quite the case as we shall see.

Discussing the social psychology surrounding persistence of belief in failed prophecies, Festinger and his colleagues proposed the following five necessary conditions: 1. There must be conviction. 2. There must be commitment to this conviction. i.e, believers have to have taken an important action that is hard to undo (such as quitting a job or selling a house). 3. The conviction must be amenable to unequivocal disconfirmation, i.e, there must be a way of testing the conviction 4. Such unequivocal disconfirmation must occur. 5. Social support must be available subsequent to the disconfirmation (Groups of believers can support one another better than isolated believers).

Despite failures to replicate these findings with other apocalytic groups (and there are more of those around than you might think), When Prophecy Fails represents a fascinating inside look at the mechanics of belief and how it interacts with human behaviour.

Dorothy Martin lived in Peru for several years before returning to Arizona. In 1965, she founded the Association of Sananda and Samat Kumara. Under her new name of "Sister Thedra", she continued to act as a channel for Sananda and was prominent in the UFO contact community until her death in 1992. The association that she founded is still active.

Measuring Pain

An article published in the May 2008 issue of The Lancet features the results of a nationwide survey examining chronic pain in a representative sample of individuals across the USA. Using random-digit dialling, a stratified sample of 10,700 individuals were contacted and recruited for the study involving the collection of pain diary information for one 24-h period. Subjects were asked to rate pain on a 0-6 anchored scale for three randomly selected 15-min intervals. Activities of those individuals who reported substantial pain were also examined. Of the 3982 individuals who were interviewed (response rate 37%), 28.8% of men and 26.6% of women reported feeling some pain at the sampled times. Subjects with lower income or less education were found to spend a higher proportion of time in pain and reported higher average pain than did those with higher income or more education.  The average pain rating increased with age, although a plateau was found between the ages of about 45 years and 75 years, with little difference between men and women. Life and health satisfaction varied inversely with reported pain. The authors report that the telephone diary technique represents a promising method for assessing the prevalence of chronic pain and the factors that can interfere with successful coping.

Click here for the abstract.