Suicidal behavior and mild traumatic brain injury in major depression

Traumatic brain injury (TBI) is associated with psychiatric illness, suicidal ideation, suicide attempts, and completed suicide. We investigated the relationship between mild TBI and other risk factors for suicidal behavior in major depressive episode. We hypothesized that mild TBI would be associated with suicidal behavior at least partly because of shared risk factors that contribute to the diathesis for suicidal acts. Depressed patients (N = 325) presenting for treatment were evaluated for psychopathology, traumatic history, and suicidal behavior. Data were analyzed using Student t -test, chi-square statistic, or Fisher exact test. A backward stepwise logistic regression model (N = 255) examined the relationship between attempter status and variables that differed in the TBI and non-TBI patients. Forty-four percent of all subjects reported mild TBI. Subjects with TBI were more likely to be male, have a history of substance abuse, have cluster B personality disorder, and be more aggressive and hostile compared with subjects without TBI. They were also more likely to be suicide attempters, although their suicidal behavior was not different from that of suicide attempters without TBI. Attempt status was mostly predicted by aggression and hostility, but not the presence of TBI. Of note, for males, a history of TBI increased the likelihood of being a suicide attempter, whereas the risk was elevated for females regardless of TBI history. Our data suggest that suicidal behavior and TBI share antecedent risk factors: hostility and aggression. Future studies may yield confirmation using a prospective design.

Emotional processing in a non-clinical psychosis-prone sample

Symptoms of psychosis have been proposed to form part of a continuous distribution of experiences in the general population rather than being an all-or-nothing phenomenon. Indeed, schizotypal signs have been reported in subjects from non-clinical samples. Emotional processing has been documented to be deficient in schizophrenia. In the present study, we tested the hypothesis whether putatively psychosis-prone subjects would show abnormalities in emotion processing. Based on the extremes of Launay-Slade Hallucination Scale (LSHS) ratings of 200 undergraduate students, two groups of subjects (total N=40) were selected. All 40 participants filled in the Schizotypal Personality Questionnaire (SPQ). We compared both groups on an alexithymia questionnaire and on four behavioral emotional information processing tasks. Hallucination-proneness was associated with an increased subjective emotional arousal and fantasy-proneness. Although no differences between the high and low group were observed on three behavioral emotion processing tasks, on the affective word-priming task presentation of emotional stimuli was associated with longer reactions times to neutral words in high schizotypal subjects. Also, SPQ scores correlated with several emotion processing tasks. We conclude that these findings lend partial support to the hypothesis of continuity between symptoms characteristic of schizophrenia and psychosis-related phenomena in the normal population.

Predictors of perceived breast cancer risk and the relation between perceived risk and breast cancer screening: a meta-analytic review

BACKGROUND

Perceived risk is a principal variable in theoretical models that attempt to predict the adoption of health-protective behaviors.

METHODS

This meta-analysis synthesizes findings from 42 studies, identified in PubMed and PsycInfo from 1985 onward. Studies examined demographic and psychological variables as predictors of perceived breast cancer risk and the relationship between perceived risk and breast cancer screening. Statistical relationships, weighted for sample size, were transformed to effect sizes and 95% CIs.

RESULTS

Women do not have accurate perceptions of their breast cancer risk (N = 5561, g = 1.10). Overall, they have an optimistic bias about their personal risk (g = 0.99). However, having a positive family history (N = 70660, g = 0.88), recruitment site, and measurement error confounded these results. Perceived risk is weakly influenced by age (N = 38000, g = 0.13) and education (N = 1979, g = 0.16), and is moderately affected by race/culture (N = 2192, g = 0.38) and worry (N = 6090, g = 0.49). There is an association between perceived risk and mammography screening (N = 52766, g = 0.19). It is not clear whether perceived risk influences adherence to breast self-examination. Women who perceived a higher breast cancer risk were more likely to pursue genetic testing or undergo prophylactic mastectomy.

CONCLUSION

Perceived breast cancer risk depends on psychological and cognitive variables and influences adherence to mammography screening guidelines.

Stress, Anpassung und Selbstorganisation: Gleichgewichtsprozesse sichern Gesundheit und Überleben

BACKGROUND

Stress is of growing significance not only in established industrial countries. Preventive medical aspects are becoming important in association with the stress phenomenon.

OBJECTIVE

Discussing the correlation between stress and health (or disease). Does a state of dynamic balance play a role in the context of stress, allostasis, adaptation, and self-organization? What kind of influence do balancing processes have on health and survival?

RESULTS

Stress itself is neither harmful nor healthy. Instead, it represents a fundamental biological principle that is associated with vivacity and that facilitates adaptation, dynamic balance, self-organization, and survival within a constantly changing environment. Stress may also be of significance for biological evolution. A crucial part of the physiological concept is the autoregulatory stress response. Thereby, stress may enhance biological creativity and health, but may also lead to allostatic load and disease. Not only exogenous stressors, but also the subject itself decide upon the individual stress outcome.

CONCLUSIONS

Dynamic balances characterize life and survival. Further, they are crucial for health processes. Stress may facilitate a 'healthy' balance or enhance disease processes likewise. Hence, the subjective inner structure or self-organization of an organism determines--in addition to exogenous factors--individual consequences of stress. Therefore, prevention should strengthen the subject and amplify self-capacity and responsibility. Professional stress-management strategies or integrative/mind-body medical programs may be helpful.

Critical Thinking, Perceived Health Status, and Participation in Health Behaviors

BACKGROUND

Critical thinking has been proposed as crucial for processing conflicting information when people make decisions about participation in health behaviors. The critical thinking of individuals about participation in health behaviors may depend on their perceived health status.

OBJECTIVES

To examine the relations between critical thinking and participation in three categories of health behaviors, and to determine whether these relations are moderated by perceived health status.

METHODS

A cross-sectional, correlational design was used to study a sample of 112 community-dwelling adults who resided in a large, urban Midwest community. The participants were women and men 18 to 90 years of age (mean, 55 +/- 20.47 years) who completed self-report, written questionnaires including the Test of Everyday Reasoning and the Health Practices Instrument.

RESULTS

According to hierarchical multiple regression analyses, the relation between critical thinking and health promotion behaviors and the relation between critical thinking and secondary prevention behaviors were moderated by perceived health status, whereas the relation between critical thinking and health protection behaviors was not.

CONCLUSIONS

The relation between critical thinking and participation in health behaviors depends on perceived health status and category of health behaviors. Researchers can explore the role of other variables (e.g., functional status and perceived susceptibility to disease) to explain why perceived health status moderates the relations between critical thinking and participation in various types of health behaviors differently.

Schizophrenia and eye movement – a new diagnostic and therapeutic concept

In the present article, conclusions are drawn from four papers on the genesis of schizophrenia, published in Medical Hypotheses between 1999 and 2002, knowledge of which is required to understand this paper in greater depth. For these, the author had developed two sight tests in which schizophrenic patients revealed a stronger fusional reactivity of the nasal than of the temporal foveal halves and a disconnection between peripheral and foveal vision. Both phenomena could be explained by a reversed crossing of foveal projections in the chiasma opticum constituting a genetic vulnerability which, in case of additional defects of binocular balance, could result in a foveal convergence stimulus being executed as a divergence movement by one of the eyes. The author has now succeeded in finding a very simple standardized method to discover the described vergence abnormality, the Hook test, part of the ZEISS Near Pola Test, which would therefore be suitable for detecting schizophrenic vulnerability in screening tests so that the outbreak of schizophrenia could be prevented by an early correction of the additional visual defects. The movement impulses resulting from the erraneous vergence are analyzed and explain the phenomenon of the schizophrenic's "mad look". The connection between the somatic component and the patient's psycho-social problems is shown and a detailed description given of non-neuroleptic methods of rectifying both.

Adolescent women underestimate their susceptibility to sexually transmitted infections

OBJECTIVES

Adolescent females are at significant risk for sexually transmitted infections (STI) and may not accurately incorporate indicators of risk into their perceptions of susceptibility. The objectives of the current analyses were to: (1) examine the relation between perceived susceptibility and indicators of risk; and (2) investigate the relation between perceived susceptibility and actual STI diagnosis.

METHODS

Participants were 209 sexually active adolescent females. Indicators of STI risk included STI history, recent symptoms, and sexual risk behaviour (that is, recent unprotected sex and numbers of sexual partners). Chlamydia and gonorrhoea infection were assessed at baseline, 6, and 12 months post-baseline using urine based ligase chain reaction testing.

RESULTS

Most participants perceived little or no chance that they would be diagnosed with an STI in the following year. There was no relation between almost all STI indicators and perceptions of susceptibility. Among those receiving a positive chlamydia or gonorrhoea test (n=49) at baseline or in the year following, almost all (81.3%) had perceived themselves to be at little or no risk.

CONCLUSION

The adolescent females in this sample did not accurately perceive their susceptibility to STI. They must be enabled to more effectively assess and modify their risk.

Pre-morbid characteristics and co-morbidity of methamphetamine users with and without psychosis

BACKGROUND

The long-term use of methamphetamine (MAMP) can result in psychosis but it is not clear why some individuals develop psychotic symptoms, while others use MAMP regularly over long periods and remain unscathed. We set out to characterize MAMP users and to examine the relationship of pre-morbid personality, pre-morbid social function and other psychiatric disorders to MAMP psychosis.

METHOD

Four hundred and forty-five amphetamine users were recruited from a psychiatric hospital and a detention centre in Taipei, and were assessed with the Diagnostic Interview for Genetic Studies (DIGS). Their parents were interviewed with the Premorbid Schizoid and Schizotypal Traits (PSST) and the Premorbid Social Adjustment (PSA) schedules. Pre-morbid characteristics and psychiatric co-morbidity were compared between the MAMP users with a lifetime diagnosis of MAMP psychosis and those without.

RESULTS

The MAMP users with psychosis presented a clinical picture which mimicked the positive symptoms of schizophrenia: 85% had auditory hallucinations; 71% persecutory delusions; 63% delusions of reference. Compared with their non-psychotic counterparts, these MAMP users were younger at first MAMP use, used larger amounts of MAMP, had a significantly higher mean PSST score, and higher rates of major depressive disorder, alcohol dependence and antisocial personality disorder.

CONCLUSIONS

Earlier and larger use of MAMP was associated with increased risk of psychosis. Our data are also compatible with the view that pre-morbid schizoid/schizotypal personality predisposes MAMP users to develop psychosis, and that the greater the personality vulnerability, the longer the psychosis will persist.

Social environments and daily life occurrence of psychotic symptoms--an experience sampling test in a non-clinical population

BACKGROUND

If impairment in social cognition is an important feature of psychosis, characteristics of the social environment may influence the occurrence of psychotic symptoms. The aim of this study was to explore in a non-clinical population whether specific social environments modify the expression of psychotic symptoms in daily life.

METHODS

The Experience Sampling Method was used to collect information on characteristics of the social company and of the daily life psychotic experiences of a sample of 79 students. The level of psychotic symptoms was measured using the Mini International Neuropsychiatric Interview (MINI).

RESULTS

Subjects with MINI psychosis criteria were at increased risk of experiencing unusual perceptions in the presence of non-familiar individuals, and at lower risk of experiencing strange impressions in the presence of family members or friends. Dynamic changes in the social company rather than the social company per se drive variation of psychotic experiences in daily life.

CONCLUSION

The data suggest that the earliest stages of expression of psychosis vulnerability are driven by subtle person-environment interactions in the stream of daily life.

Episodic memory in schizophrenic patients and their relatives

BACKGROUND

Memory dysfunction among healthy relatives of patients with schizophrenia suggests that genetic liability to the disorder can also be manifested as cognitive impairment. This study was designed to further elucidate the nature of the memory dysfunction being transmitted.

METHOD

Memory function was assessed in 62 schizophrenic patients, 98 of their healthy relatives and 66 controls. Material-specific immediate/delayed recall and percentage retention were investigated using the Logical Memory and Visual Reproduction tests of the Wechsler Memory Scale (WMS). A third subtest of the WMS, the Associate Learning and a visual analogue of it, the Abstract Paired Associates, were used to measure verbal and visual learning. Current general intellectual function was assessed using a five-subtest short-form of the Wechsler Adult Intelligence scale-Revised (WAIS-R).

RESULTS

Schizophrenic patients performed significantly worse than controls on nearly all measures. Their relatives also showed significant deficit on the immediate and delayed recall of the Logical Memory, immediate recall of the Visual Reproduction, and the Abstract Paired Associates tests. Logical memory was substantially more impaired than the other measures for both patients and relatives. The deficit in immediate recall of the Logical Memory remained significant even after excluding those relatives with an Axis I diagnosis and schizotypal personality disorder. These findings were despite the relatives having an equivalent level of general intellectual function to that of controls.

CONCLUSION

Familial, presumed genetic, liability to schizophrenia may be expressed as dysfunction in verbal memory.

The magnocellular visual system and schizophrenia: what can the color red tell us?

Previous research has suggested that genetic loading for schizophrenia is related to a dysfunctional magnocellular (M) subcortical visual pathway-responsible for processing movement and location. However, data substantiating this mechanism remains inconclusive. The present study used a novel technique to selectively suppress the M system in order to investigate the impact of genetic loading for schizophrenia on its functioning. A visual backward masking task was administered to 28 healthy first-degree relatives of persons with schizophrenia and 31 healthy controls. The task was administered on both a red and neutral background, as diffuse red light has been shown to selectively suppress the M system in basic vision research. On a location condition of backward masking, controls demonstrated reduced accuracy on the red compared to the neutral background. In contrast, relatives did not display differential performance between the two backgrounds. The differential effect on the two groups appears to be attributable to a difference in activity of the M pathway. Performance in the relatives was consistent with the notion of a hyperactive M pathway.

Sociability and susceptibility to the common cold

There is considerable evidence that social relationships can influence health, but only limited evidence on the health effects of the personality characteristics that are thought to mold people's social lives. We asked whether sociability predicts resistance to infectious disease and whether this relationship is attributable to the quality and quantity of social interactions and relationships. Three hundred thirty-four volunteers completed questionnaires assessing their sociability, social networks, and social supports, and six evening interviews assessing daily interactions. They were subsequently exposed to a virus that causes a common cold and monitored to see who developed verifiable illness. Increased sociability was associated in a linear fashion with a decreased probability of developing a cold. Although sociability was associated with more and higher-quality social interactions, it predicted disease susceptibility independently of these variables. The association between sociability and disease was also independent of baseline immunity (virus-specific antibody), demographics, emotional styles, stress hormones, and health practices.

Peripubertal suicide attempts in offspring of suicide attempters with siblings concordant for suicidal behavior

OBJECTIVE

The authors sought to determine 1) whether the risk for familial transmission of suicidal behavior is greater with increased family loading for suicide attempts, and 2) whether the transmission of suicidal behavior is mediated by impulsive aggression.

METHOD

A reanalysis of a high-risk study compared the offspring of three mood disorder proband groups: suicide attempters with a sibling who also attempted suicide (N=19), suicide attempters whose siblings never made a suicide attempt (N=73), and nonsuicidal probands whose siblings also never engaged in suicidal behavior (N=73). Probands and offspring were assessed with respect to psychopathology, suicide attempt history, impulsive aggression, and exposure to familial adversity.

RESULTS

Offspring of suicide attempters with siblings concordant for suicidal behavior showed a higher risk of suicide attempt than did offspring of nonsuicidal probands and had an earlier age at onset of suicidal behavior than offspring of suicide attempters with siblings discordant for suicidal behavior. Probands from sibling pairs concordant for suicidal behavior and their offspring reported greater lifetime impulsive aggression compared with each of the other two proband/offspring groups. In the offspring, impulsive aggression was the most powerful predictor of early age at first suicide attempt.

CONCLUSIONS

Familial loading for suicide attempts may affect rates of transmission as well as age at onset of suicidal behavior, and its effect may be mediated by the familial transmission of impulsive aggression.

Psychoneuroimmunology and health psychology: an integrative model

The biopsychosocial model describes interactions between psychosocial and biological factors in the etiology and progression of disease. How an individual interprets and responds to the environment determines responses to stress, influences health behaviors, contributes to the neuroendocrine and immune response, and may ultimately affect health outcomes. Health psychology interventions are designed to modulate the stress response and improve health behaviors by teaching individuals more adaptive methods of interpreting life challenges and more effective coping responses. These interactions are discussed in the context of aging.

Depression and anxiety during isolation and radionuclide therapy

The combination of a diagnosis of malignancy and hospitalization, isolation and radioactivity of a radionuclide therapy may have an important effect on the psychological equilibrium of patients and may hamper compliance and acceptability. We performed a psychiatric evaluation in order to study psycho-pathological manifestations and underlying personality related vulnerabilities. During radioisolation, 48 patients (24 male, 24 female; mean age 57.8 years) with a malignant (n=26) or non-malignant (n=22) pathology who needed isolation for radionuclide therapy, completed a series of questionnaires in order to assess anxiety (Spielberger State and Trait Anxiety Inventory; STAI), depression (Beck Depression Inventory; BDI), hopelessness (Beck Hopelessness Scale; BHS), personality characteristics (Temperament and Character Inventory; TCI) and coping strategies (Utrecht's Coping List; UCL). Compared to patients with low state anxiety, patients who experienced a high level of state anxiety showed higher levels of depression (t=-2.10; P=0.04) and hopelessness (t=-4.20; P=<0.001). Their personality was characterized by significantly higher scores on harm avoidance (t=-2.78; P=0.008) and lower scores on self-directedness (t=3.12; P=0.003). Coping strategies were more passive (t=-2.43; P=0.02), avoiding (t=-2.15; P=0.04) and less well aimed (t=2.64; P=0.01). Surprisingly, the nature of disease (malignant versus non-malignant) did not influence these results, nor was there a difference between males and females, age, years of education, having a relationship or not, or the duration of hospitalization. Thus, contrary to what may be expected in isolation with radionuclide therapy, subgroups such as women, elderly, cancer patients or lower educated people do not, a priori, exhibit a higher state anxiety level. Our study shows these levels to be closely related to individual personality traits and coping strategies that are inadequate for the situation. Screening for trait anxiety before admission can be easily done and may guide interventions aimed at increasing patient comfort and acceptability.

[Salutogenesis--a story about the development of an idea]

The medical sociological concept of salutogenesis is introduced and explained. Salutogenesis means essentially: what factors create and maintain relative health; this is in contradiction to the well known questions on pathogenesis. There is special emphasis on the central component: the sense of coherence and the three sub-categories--comprehensibility, manageability and meaningfulness. The importance of the concept salutogenesis for the theory of general medicine and psychotherapy is explored. An eventual application of this concept and attitude in practical medicine is suggested and discussed. The possible importance of the salutogenesis concept and attitude, for coping with continuing and intense professional stress of physicians and other therapists, is outlined.

Developmental neurocircuitry of motivation in adolescence: a critical period of addiction vulnerability

OBJECTIVE

Epidemiological studies indicate that experimentation with addictive drugs and onset of addictive disorders is primarily concentrated in adolescence and young adulthood. The authors describe basic and clinical data supporting adolescent neurodevelopment as a biologically critical period of greater vulnerability for experimentation with substances and acquisition of substance use disorders.

METHOD

The authors reviewed recent literature regarding neurocircuitry underlying motivation, impulsivity, and addiction, with a focus on studies investigating adolescent neurodevelopment.

RESULTS

Adolescent neurodevelopment occurs in brain regions associated with motivation, impulsivity, and addiction. Adolescent impulsivity and/or novelty seeking as a transitional trait behavior can be explained in part by maturational changes in frontal cortical and subcortical monoaminergic systems. These developmental processes may advantageously promote learning drives for adaptation to adult roles but may also confer greater vulnerability to the addictive actions of drugs.

CONCLUSIONS

An exploration of developmental changes in neurocircuitry involved in impulse control has significant implications for understanding adolescent behavior, addiction vulnerability, and the prevention of addiction in adolescence and adulthood.

Experience with breast cancer, pre-screening perceived susceptibility and the psychological impact of screening

This prospective study examined whether the psychological impact of organized mammography screening is influenced by women's pre-existing experience with breast cancer and perceived susceptibility (PS) to the disease. From a target population of 16,886, a random sample of women with a normal screening finding and all women with a false positive or a benign biopsy finding were included (N=1942). Data were collected with postal questionnaires 1-month before screening invitation and 2 and 12 months after screening. Response rate was 63% at baseline; 86, and 80% of the baseline participants responded to the follow-ups. Psychological impact was measured as anxiety (STAI-S), depression (BDI), health-related concerns (IAS), and breast cancer-specific beliefs and concerns. Data was analyzed with repeated measures analyses of variance, with estimates of effect size based on Eta-squared. Women with breast cancer experience had higher risk perception already before screening invitation; after screening they were also more distressed. Women with high PS were more distressed than women with low PS also at pre-invitation. The distress was not alleviated by screening, but instead remained even after normal mammograms. Experience and PS did not influence responses to different screening findings. Of the finding groups, false positives experienced most adverse effects: their risk perception increased and they reported most post-screening breast cancer-specific concerns. Furthermore, they became more frequent in breast self-examination (BSE) despite a simultaneous decrease in BSE self-efficacy. Our findings suggest that women with high PS and women with false positive screening finding may need individualized counseling and follow-up as much as women with a family history of breast cancer. Besides medical risk factors, women's own perceptions of susceptibility should be discussed during the screening process.

Neurobehavioral disinhibition in childhood predicts early age at onset of substance use disorder

OBJECTIVE

This longitudinal study had three aims: 1) determine the extent to which boys at high average risk and low average risk for substance use disorder differ on a construct of neurobehavioral disinhibition, 2) evaluate the capacity of neurobehavioral disinhibition to predict substance use frequency at age 16, and 3) demonstrate the utility of neurobehavioral disinhibition in predicting substance use disorder.

METHOD

The authors derived an index of neurobehavioral disinhibition from measures of affect, behavior, and cognition. The neurobehavioral disinhibition score was used to discriminate youth at high and low average risk for substance use disorder and to predict substance use frequency after 4-6 years and substance use disorder after 7-9 years.

RESULTS

The neurobehavioral disorder score significantly discriminated boys at high average risk from those at low average risk at ages 10-12. Neurobehavioral disinhibition at age 16, in conjunction with substance use frequency and risk status group, predicted substance use disorder at age 19 with 85% accuracy and accounted for 50% of the variance in Drug Use Screening Inventory overall problem density score. Neurobehavioral disinhibition was a stronger predictor of substance use disorder (odds ratio=6.83) than substance consumption frequency (odds ratio=3.19).

CONCLUSIONS

Cross-sectional and longitudinal analyses indicated that neurobehavioral disinhibition is a component of the liability to early age at onset of substance use disorder.

A concept analysis of susceptibility: application of the hybrid model

TOPIC

Choosing to obtain a screening mammogram is often determined by a woman's perceived susceptibility.

PURPOSE

To establish the importance of susceptibility to breast cancer in rural women in southeast Louisiana, using concept analysis as the hybrid model.

SOURCES

Through this analysis, findings from the literature were compared to women's actual perceptions from the field.

CONCLUSIONS

The author concludes that rural women in Louisiana do not view breast cancer as a potential harm, nor is there a belief that they have control over the decision to have a screening mammogram; therefore, rural women do not perceive themselves susceptible.

Resilience in sheltered battered women

While many battered women report physical and psychological distress, others are able to respond to adverse sequelae with less severe outcomes. The findings of this study indicate that resilience assessed by the Resilience Scale was significantly and inversely correlated with three global measures and five subscales of the Symptom Checklist-90R. Further study of battered women's resilience will allow for greater appreciation of their strengths as well as expand understanding of human responses to trauma.

Abnormal expression and functional characteristics of cyclic adenosine monophosphate response element binding protein in postmortem brain of suicide subjects

BACKGROUND

Cyclic adenosine monophosphate response element binding protein (CREB) is a transcription factor that, on phosphorylation by protein kinases, is activated, and in response, regulates the transcription of many neuronally expressed genes. In view of the recent observations that catalytic properties and/or expression of many kinases that mediate their physiological responses through the activation of CREB are altered in the postmortem brain of subjects who commit suicide (hereafter referred to as suicide subjects), we examined the status of CREB in suicidal behavior.

METHODS

These studies were performed in Brodmann area (BA) 9 and hippocampus obtained from 26 suicide subjects and 20 nonpsychiatric healthy control subjects. Messenger RNA levels of CREB and neuron-specific enolase were determined in total RNA by means of quantitative reverse transcriptase-polymerase chain reaction. Protein levels and the functional characteristics of CREB were determined in nuclear fractions by means of Western blot and cyclic adenosine monophosphate response element (CRE)-DNA binding activity, respectively. In the same nuclear fraction, we determined the catalytic activity of cyclic adenosine monophosphate-stimulated protein kinase A by means of enzymatic assay.

RESULTS

We observed a significant reduction in messenger RNA and protein levels of CREB, CRE-DNA binding activity, and basal and cyclic adenosine monophosphate-stimulated protein kinase A activity in BA 9 and hippocampus of suicide subjects, without any change in messenger RNA levels of neuron-specific enolase in BA 9. Except for protein kinase A activity, changes in CREB expression and CRE-DNA binding activity were present in all suicide subjects, irrespective of diagnosis. These changes were unrelated to postmortem intervals, age, sex, or antidepressant treatment.

CONCLUSIONS

Given the significance of CREB in mediating various physiological functions through gene transcription, our results of decreased expression and functional characteristics of CREB in postmortem brain of suicide subjects suggest that CREB may play an important role in suicidal behavior.

Intention to pursue genetic testing for breast cancer among women due for screening mammography

Because few studies have addressed the intention to pursue testing for breast cancer susceptibility among women in the general population, we examined whether women due for routine mammography would want such testing and what factors might impact on their decision to pursue testing. A questionnaire was mailed to women > or =50 years of age who had undergone a screening mammogram 12 to 14 months before the study. Univariate and multivariable analyses were conducted to identify factors associated with intention to pursue genetic testing. Approximately 41% of respondents probably or definitely intended to pursue testing. In univariate analysis, the intention to undergo testing was not significantly associated with age, education, marital status, potential effects on health or life insurance, or physician recommendation. Although significant in univariate analysis, family history of breast cancer and ethnicity were not significant in multivariable analysis. In both univariate and multivariable analysis, factors significantly associated with intention to undergo testing included awareness of genetic testing, cancer worry, and insurance coverage of testing cost. Intention also was associated with the respondent wanting to know whether she possessed the susceptibility gene, even if that knowledge would not impact on options for early detection or treatment. Given the relatively high level of interest in testing among women at average risk of breast cancer, these results may help health care professionals educate and counsel women regarding the appropriate use of genetic testing as well as breast cancer risk factors.

Vulnerability and salutogenesis in health and disease

In this brief overview psychosocial factors which contribute to health and disease are briefly discussed. These opposing factors are mainly investigated in a unidirectional sense and often neutralize each other and thereby explain only little variance. The normally investigated pathological factors would have to be supplemented by salutogenic (health promoting) factors and vice versa. The salutogenic perspective opens up a resource-oriented approach, which can reduce suffering and also health care costs in almost any kind of disease. There is enough empirical evidence, of which only a small part is presented here, to support this claim.

Hand preference, susceptibility to motion sickness, and differential vulnerability to psychiatric admission

Nonright-handers (n = 192) were more common within an inpatient psychiatric population of 792 than in a control nonpatient population of 559. Vulnerability of nonright-handers to admission appears to be associated with an intermediate extent of susceptibility to motion sickness.