Feasibility of dialectical behavior therapy with suicidal and self-harming adolescents with multi-problems: training, adherence, and retention

We evaluated the feasibility of DBT training, adherence, and retention preparing for a randomized controlled trial of Dialectical Behavior Therapy (DBT) adapted for Norwegian adolescents engaging in self-harming behavior and diagnosed with features of borderline personality disorder. Therapists were intensively trained and evaluated for adherence. Adherence scores, treatment retention, and present and previous self-harm were assessed. Twenty-seven patients were included (mean age 15.7 years), all of them with recent self-harming behaviors and at least 3 features of Borderline Personality Disorder. Therapists were adherent and 21 (78%) patients completed the whole treatment. Three subjects reported self-harm at the end of treatment, and urges to self-harm decreased. At follow up, 7 of 10 subjects reported no self-harm. DBT was found to be well accepted and feasible. Randomized controlled trials are required to test the effectiveness of DBT for adolescents.

MDMA use is associated with increased spatial BOLD fMRI visual cortex activation in human MDMA users

Previous animal studies have demonstrated that 3,4-methylenedioxymethamphetamine (MDMA) exposure causes serotonin axotomy that is greatest in occipital cortex (including primary visual cortex) where serotonergic axons innervate neurons and blood vessels. Human MDMA users have altered serotonergic function and reduced gray matter density in occipital cortex. The fMRI BOLD method is potentially sensitive to both the neuronal and vascular consequences of MDMA-induced serotonin toxicity. To test the hypothesis that MDMA users have altered visual system function, we used the fMRI BOLD technique to assay visual cortical activation after photic stimulation in a group of adult MDMA users. Because MDMA users worldwide are polydrug users and therefore difficult to match to comparison groups in terms of polydrug exposure, we conducted a primary within-group analysis examining the correlation between lifetime episodes of MDMA exposure and measures of visual cortical activation. The within-group correlational analysis in the MDMA user group revealed that the degree of prior MDMA exposure was significantly positively correlated with the number of activated pixels for photic stimulation (r=0.582, p=0.007). A secondary between-group comparison of MDMA users with non-MDMA users found overall greater levels of polydrug exposure in the MDMA user cohort but no significant differences in visual cortical activation measures between the two groups. Additional research is needed to clarify the origin and significance of the current findings.

Epidural metastasis in chemoresistant Wilms' tumor with perilobar nephroblastomatosis

An 8-year-old boy with vertebral and epidural metastases was diagnosed with Wilms' tumor associated with perilobar nephroblastomatosis (NB) based on histologic examination. During combined chemotherapy with vincristine, actinomycin D, doxorubicin, and cyclophosphamide (NWTS-3 J protocol), a rapid increase in tumor size was observed. The treatment was replaced with etoposide and carboplatin (JET regimen). A transient response was sustained for 5 months during this chemotherapy. However, regrowth of the tumor was observed and the patient died 11 months after the initial chemotherapy.

[Health service for physicians. What do physicians want--form and substance?]

In 1991, a special health service for doctors was started in Rogaland county. Three years later this service was evaluated via a questionnaire. Two thirds of 109 doctors were very satisfied, and only one was dissatisfied with this health service. The results show a need for both psychosocial and somatic health examinations for doctors.

Sequelae one year after meningococcal disease

Of 99 consecutive patients with meningococcal disease, 6 died during the acute stage. The 93 survivors were examined one year after hospitalization. 21 (40%) of the adults and 6 (15%) of the children had definite sequelae, and an additional 27% and 11% possible sequelae. 6 adults (12%) and 1 child (2%) had definite neurological sequelae. Electroencephalography (EEG) abnormalities were observed in 7 adults (14%) and 2 children (5%). Epileptogenic activity was present in 3 of these, but none had experienced seizures. 8 adults (19%) and 5 children (14%) had sensorineural hearing loss or impaired vestibular function. Cerebral computerized tomography (CT) scan showed definite and possible abnormalities in 1 (3%) and 6 (18%), respectively, of the 34 patients tested. Neuropsychological tests were performed in 9 patients, 2 of these showed definite impairment. The frequency of neurological abnormalities was higher than in many previous studies, probably reflecting the more comprehensive examinations performed in the present study. However, only 3 patients had serious sequelae. The results suggest that the occurrence of sequelae after meningococcal disease is related to the severity of the acute disease. This may explain the higher rate of sequelae in adults, who have a higher proportion of seriously ill patients. The presence of meningitis is not required for the occurrence of neurological sequelae.

Structural identification of an epitope of antigenic factor 5 in mannans of Candida albicans NIH B-792 (serotype B) and J-1012 (serotype A) as beta-1,2-linked oligomannosyl residues

In previous articles, we reported the presence of phosphate-bound beta-1,2-linked oligomannosyl residues in the mannans of strains of Candida albicans serotypes A and B and Candida stellatoidea. To identify the antigenic factor corresponding to this type of oligomannosyl residue, a relationship between chemical structure and antigenic specificity in the mannans of C. albicans NIH B-792 (serotype B, B-strain) and C. albicans J-1012 (serotype A, J-strain) was investigated by using a combination of two-dimensional 1H nuclear magnetic resonance spectroscopy of H-1, H-2, and H-5 regions in the mannans and an enzyme-linked immunosorbent assay that employed concanavalin A-coated microtiter plates. It was shown in the present 1H nuclear magnetic resonance study that an examination of chemical shifts not only in the H-1 region but also in the H-5 region was useful for the quantitative determination of the phosphate-bound beta-1,2-linked oligomannosyl residues. In the enzyme-linked immunosorbent assay using concanavalin A-coated plates, it was revealed that, of factor sera 1, 4, and 5, only factor serum 5 showed a reactivity proportional to the densities of the beta-1,2-linked oligomannosyl residues of the mannan subfractions of different phosphate contents that had been prepared from the bulk B-strain mannan by DEAE-Sephadex chromatography. The above results indicate that the phosphate-bound beta-1,2-linked oligomannosyl residues, Manp beta 1----(2Manp beta 1----)n2Man (n = 0-5), correspond to antigenic factor 5.

[Health services for physicians in Rogaland. A questionnaire study]

In order to investigate the need for a health service for doctors a questionnaire was mailed to all doctors in Rogaland county. 84% of the respondents were in favour of such a service. It is necessary not only to provide a general medical examination but to focus also on work-related and psychosocial factors.

[Suicide investigation--a psychological autopsy]

The most disastrous complication for a psychiatric team occurs when the patient commits suicide. The reactions of the personnel involved with the patient are similar to the reactions of the bereaved: denial, guilt and shame, aggression and accusation, relief. By psychological autopsy we mean a structured group meeting where all the factors leading up to the suicide are discussed and the reactions of the personnel ventilated. This is different from psychological debriefing, where the primary aim is to ventilate the reactions of the involved personnel without analyzing what went wrong. The article describes how psychological autopsy has been conducted for more than 15 years at the psychiatric ward in the Central Hospital in Stavanger, Norway.

[Tissue polypeptide antigen in serum and tissue in patients with lung cancer]

To evaluate the significance of TPA (tissue polypeptide antigen) as a tumor marker for lung cancer, the present studies were designed to measure serum TPA levels as well as TPA contents in tumor tissues in patients with lung cancer. Average serum TPA levels (203.5 +/- 180.5 U/l, mean +/- SD) in 76 patients with lung cancer (30 squamous cell carcinoma, 38 adenocarcinoma, 8 small cell carcinoma) were significantly higher than those in pneumonia (83.3 +/- 42.7 U/l, n = 13), pulmonary tuberculosis (87.6 +/- 36.3 U/l, n = 16), and normal controls (46.8 +/- 23.7 U/l, n = 28). There was no significant difference in TPA levels according to the histological type of lung cancer. Comparing respective stage cases, statistically significant differences were observed in serum TPA levels between normal controls and stage 1, stage 1 and stage 3, and in stage 3 and stage 4, suggesting a gradual increase in TPA levels accompanying the progress of the lung cancer. In patients with 12 squamous cell carcinoma and 9 adenocarcinoma, the TPA levels in carcinoma tissues and non-tumor invaded lung tissues were 115.2 +/- 187.7 and 148.9 +/- 223.3 U/mg protein, indicating no significant difference in carcinoma and normal tissues. There was definite correlation between serum TPA levels and TPA contents in carcinoma tissues. No significant relationship, however, was observed between serum TPA levels and TPA contents in tissue not invaded by tumor. These results suggest that serum TPA levels reflect the tumor burden in patients with lung cancer. In conclusion, the determination of TPA in blood is useful for the diagnosis of lung cancer.