Providentia

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.

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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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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.

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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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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.

Are You A Good Wife?

The online version of the American Psychological Association's Monitor presents an interesting look back at a rating scale developed in the 1930s by George W. Crane of Northwestern University. The Marital Rating Scale-Wife's Chart has a straightforward enough purpose: rating wives in terms of their positive and negative characteristics. The test could be completed by either the husband or wife and measured wives in terms of merits or demerits.

Items for which wives could receive demerits included: slow in coming to bed, doesn't like children, wears red nail polish, uses profanity, going to bed with curlers in hair or too much face cream.  Merits for wives included: has meals on time, can play a musical instrument, dresses for breakfast, and neat housekeeper. Adding up the merits and demerits on the test yielded a score that ranged from "very poor" to "very superior".

Crane, who also had his own counseling practice as well as a nationally syndicated newspaper column, developed the test by interviewing 600 husbands to determine the most important positive and negative traits in wives.  No wives were interviewed and it doesn't seem to have occurred to Crane to develop an equivalent test for husbands (the man had his priorities). 

In addition to his syndicated articles on marriage (which were very well received at the time), George Crane also launched the Scientific Marriage Foundation in 1957. As one of the first computer dating services, he was definitely at the forefront for his time although changing attitudes seem to have left him behind otherwise.

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Disaster Mental Health Workers and the Anniversary Effect

A study published in the April 2008 issue of Journal of Traumatic Stress examined anniversary reactions in mental health disaster relief workers following traumatic exposure at the site of the World Trade Center terrorist attacks. Despite relatively low levels of symptom reporting, workers endorsed an increase in both negative mood symptoms and functional impairment at the one-year anniversary of their traumatic exposure (compared to 6 months postexposure). For individuals who met at least some of the criteria for posttraumatic stress disorder (PTSD) immediately following exposure, overall self-reported PTSD symptoms tended to increase from 6 to 12 months. This tendency resulted specifically from an increase in hyperarousal symptoms. Although only a few of the participants had severe PTSD, the results demonstrated that disaster relief workers may experience an increase in symptomatology at the anniversary of their traumatic exposure.

Click here for the abstract.