Outbursts Of Anger Research Articles

Relation of Outbursts of Anger and Risk of Acute Myocardial Infarction

The aim of the present study was to explore the association between outbursts of anger and acute myocardial infarction (AMI) risk. Outbursts of anger are associated with an abrupt increase in cardiovascular events; however, it remains unknown whether greater levels of anger intensity are associated with greater levels of AMI risk or whether potentially modifiable factors can mitigate the short-term risk of AMI. We conducted a case-crossover analysis of 3,886 participants from the multicenter Determinants of Myocardial Infarction Onset Study, who were interviewed during the index hospitalization for AMI from 1989 to 1996. We compared the observed number and intensity of anger outbursts in the 2 hours preceding AMI symptom onset with its expected frequency according to each patient's control information, defined as the number of anger outbursts in the previous year. Of the 3,886 participants in the Determinants of Myocardial Infarction Onset Study, 1,484 (38%) reported outbursts of anger in the previous year. The incidence rate of AMI onset was elevated 2.43-fold (95% confidence interval 2.01 to 2.90) within 2 hours of an outburst of anger. The association was consistently stronger with increasing anger intensities (p trend <0.001). In conclusion, the risk of experiencing AMI was more than twofold greater after outbursts of anger compared with at other times, and greater intensities of anger were associated with greater relative risks. Compared with nonusers, regular β-blocker users had a lower susceptibility to heart attacks triggered by anger, suggesting that some drugs might lower the risk from each anger episode.

Abstract P117: Episodes of Anger are Associated with a Higher Risk of Myocardial Infarction and Acute Coronary Syndrome: Systematic Review and Meta-Analysis

Introduction: Short-term psychological stress is associated with an immediate physiologic response. We assessed the hypothesis that brief episodes of anger may trigger the onset of acute myocardial infarction (MI) and other acute coronary syndromes (ACS). Methods: We performed a literature search of the CINAHL, Embase, PubMed and PsycInfo databases from January 1966 through June 2012 using the key words “anger”, “hostility”, “myocardial infarction” and “acute coronary syndrome” without restrictions. We also reviewed the reference lists of retrieved articles and spoke with authors of relevant work to identify unpublished data. We used an inverse-variance-weighted random effects model to perform a meta-analysis of all epidemiological studies that reported relative risks and 95% confidence intervals (CI) for the association between outbursts of anger and nonfatal MI or ACS. Results: The meta-analysis included four independent case-crossover studies of anger and risk of MI or ACS published between 1995 and 2007 and one unpublished report. Combined, there were 4546 MI cases (two studies) and 462 ACS cases (two studies), including 180 that experienced an episode of anger in the two hours prior to disease onset; two studies were restricted to first MI or ACS and two included first and recurrent events. All studies used the Onset Anger Scale to assess anger episodes, but the studies differed in the cutoff used to define exposure. The association between outbursts of anger and disease risk in the following two hours was 3.46 (95%CI 2.08-5.76; p&lt;0.001). The results were similar for studies of first and recurrent events and were similar for studies of MI and ACS. Conclusions: There is a higher risk of MI and ACS shortly after outbursts of anger. Some of the between-study heterogeneity may be due to regional differences in the type of anger expression and the interpretation of the questions. Further research is necessary to evaluate whether the risk is lower among people who are regularly active.

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Taking Disruptive Mood Dysregulation Disorder Out for a Test Drive

Exploring the Impact of Dysfunctional Posttraumatic Survival Responses on Crime Revictimization

This study investigated the association between posttraumatic stress disorder (PTSD) symptoms and repeat victimization across crime types in survivors of traumatic interpersonal violence. An evolutionary psychological perspective was adopted to propose that symptoms of hyperarousal (particularly hypervigilance, exaggerated startle response, and irritability or outbursts of anger) and numbing predict revictimization. These symptoms may act as manifestations of dysfunctional survival responses. Survival responses are adaptive in life-threatening situations but may work counter-productive in the absence of immediate threat. Participants were recruited through the Dutch Victim Compensation Fund (DVCF; N = 233). PTSD symptomatology was assessed between October and December 2007. Revictimization was measured 6 months later. Results were partly in line with expectations. Exaggerated startle response and symptoms of irritability or outbursts of anger but not hypervigilance and numbing were related to revictimization.

Epilepsy and homicide

PurposeWe report the rare case of a patient with intractable epilepsy and escalating aggression, resulting in murder, who had complete resolution of her seizures and explosive behavior following a right temporal lobectomy.Patients and methodsWe searched the available literature from 1880 to 2013 for cases of epilepsy being used as a court defense for murder and collected information regarding the final sentencing outcomes. We selected 15 papers with a total of 50 homicides.ResultsWe describe the case of a 47-year-old woman with drug-resistant right temporal epilepsy who developed increasing emotional lability, outbursts of anger and escalating violent behavior culminating in a violent murder. The patient was imprisoned while awaiting trial. In the interim, she underwent a successful temporal lobectomy with full resolution of seizures, interictal rage and aggressive behaviors. After the surgery, her charges were downgraded and she was transferred to a psychiatric facility.ConclusionThe aggressive behavior associated with epilepsy has been described in the literature for over a century. A link between epilepsy and aggression has been disproportionally emphasized. These patients share some common characteristics: they are usually young men with a long history of epilepsy and lower than average intelligence. The violent act is postictal, sudden-onset, more likely to occur after a cluster of seizures and is usually related with alcohol abuse.

Lula Bell on Geekdom, Freakdom + the Challenges of Bad Hair (review)

Reviewed by: Lula Bell on Geekdom, Freakdom + the Challenges of Bad Hair Karen Coats Payne, C. C. Lula Bell on Geekdom, Freakdom + the Challenges of Bad Hair. Amazon Children’s, 2012. [272p]. Trade ed. ISBN 978-0-7614-6225-5 $16.99 E-book ed. ISBN 978-0-7614-6226-2 $9.99 Reviewed from galleys R Gr. 4–6. With a musician father who’s constantly on the road and a mother who owns her own business, Lula Bell Bonner and her family depend on Grandma Bernice to keep [End Page 211] things together at home—to be there when Lula Bell gets home from school and needs to talk, and to make her award-winning donuts to celebrate events big and small. Right now, things aren’t going so great for Lula Bell at school. She’s somehow made queen bee Kali Keele’s enemy’s list, and no matter what she does, she can’t break into the circle of reasonably popular fifth-grade girls. Alan is always happy to see her and save her a seat at lunch, but he is a geek with impossible hair, so this just makes things worse. Her social problems suddenly seem tiny by comparison, however, when her beloved grandmother passes away. Lula and her mother are undone by grief; the hole Grandma Bernice’s passing has left in their lives seems too big to fill. As Lula Bell works through her loss, she is emboldened to shift the balance of power between her and Kali, and she lashes out at Alan even though he doesn’t deserve it. Lula Bell’s voice is fresh and funny, full of quips and asides that add sparks of energy to her observations about the frustrations of busy parents, embarrassing elders, and social hierarchies. Her winning, upbeat narration secures empathy from the start, and when her grandmother dies readers will be invested in Lula Bell’s grief and recovery, which moves at a realistically patient pace. Lula Bell is flawed enough for most readers to really relate to, so they will forgive her outbursts of anger and aggression as she comes to realize what it means to have and to be a real friend. Karen Coats Reviewer Copyright © 2012 The Board of Trustees of the University of Illinois

Predictive Validity of the MMPI-2 Clinical, PSY-5, and RC Scales for Therapy Disruptive Behavior

Impulsive acts, parasuicidal behavior, and other therapy disruptive incidents occur frequently in the treatment of patients with personality disorders and increase the risk that patients will drop out of treatment. This study examined the predictive validity of the Minnesota Multiphasic Personality Inventory (MMPI)-2 Restructured Clinical (RC) and Psychopathology Five (PSY-5) Scales for therapy disruptive behavior and compared them with the original clinical scales. Using an inventory, the treatment staff recorded the therapy disruptive behavior of 104 patients with personality disorders who were receiving inpatient psychotherapy. Both the RC and the PSY-5 scales predicted several categories of therapy disruptive behavior, and both scales predicted more categories of therapy disruptive behavior than the original clinical scales. Anger outbursts were predicted especially well by a combination of two of the RC scales. The information about the MMPI-2 obtained in this study may be helpful in case formulation when initiating inpatient treatment for patients with personality disorders.

Dissociative Identity Disorder May Be Relieved by the Combined Treatments of Mirtazapine and Risperidone: Case Report of an Adolescent

Back to table of contents Previous article Next article LettersFull AccessDissociative Identity Disorder May Be Relieved by the Combined Treatments of Mirtazapine and Risperidone: Case Report of an AdolescentChen-Han Lai, M.D.Chen-Han LaiSearch for more papers by this author, M.D.Published Online:1 Apr 2012https://doi.org/10.1176/appi.neuropsych.11040083AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: Dissociative identity disorder (DID) is characterized by the existence of two or more personalities that recurrently take control of behavior. Here, we present an adolescent patient with DID, who had improvement of symptoms after the combined treatment of mirtazapine and risperidone.“Miss G” is a 16-year-old adolescent girl with past emotional trauma associated with physical abuse in childhood and recent frustrations in her school and love-life. She visited my clinic, and her mother mentioned that she had said that, for the past 6 months, there were four personalities inside her mind, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. These personalities would provoke her odd behaviors, such as school-refusal; self-harm, such as cutting wrists at superficial depth; verbal aggression; physical aggression; talking to herself; dressing different when her personality changed; initial insomnia; anger outbursts; and mood swings. These odd behaviors have caused impairments in social and academic functioning. No history of substance abuse or medical illness was mentioned. Mild depression (Hamilton Rating Scale for Depression: 13) was also revealed. The scores of the Adolescent Dissociative Experience Scale (A-DES) were 167, with most items rated more than 5 points (at least moderately-severe).With the impression of DID, aggression risk, and deliberate self-harming behavior, we prescribed mirtazapine 30 mg and risperidone 2 mg. After the first week of treatment, her personality switch decreased, and less aggression or self-harm was noted (A-DES scores: 127). Mild sedation and somnolence side effects were mentioned, but without extrapyramidal side effects. Her mother assisted her in receiving the biological treatment and monitored whether she took these medications because of the possibility of poor medication adherence. She mentioned that her original personality could control her mind and behavior longer after the mirtazapine and risperidone treatment. The other three personalities became diminished after medication treatment. The A-DES scores also decreased from 167 to 45, with significant improvement after 1 month of treatment. The symptoms changed mostly in the dimensions of behavioral control, thought control, body self-awareness, personality-switch frequency and duration, and better ability to recall what she did while another personality manipulated her mind and behavior. Her symptoms maintained stationary (A-DES: 41) under mirtazapine and risperidone combined treatment for the next 6 months until the present, with mild body-weight gain, around 1 kg in these 7 months.Emotional trauma is usually associated with mesocortical and mesolimbic dopaminergic system dysfunction, which may alter midbrain defense response, a reaction associated with DID.1 Besides dopamine, the serotoninergic system, such as serotonin-transporter gene polymorphism, might also be associated with childhood emotional trauma or physical abuse.2 Serotonin-transporter short alleles also contribute to emotional sensitivity to stressors in the victims of childhood physical maltreatments.3 The combined treatment might cover the dopamine and serotonin mechanisms and provide the therapeutic effects in this patient.Dept. of Psychiatry Buddhist Tzu-Chi General Hospital, Taipei Branch Taipei, Taiwan Institute of Brain Science National Yang Ming University Taipei City, Taiwane-mail: [email protected]comReferences1 Corrigan FM, Fisher JJ, Nutt DJ: Autonomic dysregulation and the Window of Tolerance model of the effects of complex emotional trauma. J Psychopharmacol 2011; 25:17–25Crossref, Medline, Google Scholar2 Lochner C, Seedat S, Hemmings SM, et al.: Investigating the possible effects of trauma experiences and 5-HTT on the dissociative experiences of patients with OCD using path analysis and multiple regression. Neuropsychobiology 2007; 56:6–13Crossref, Medline, Google Scholar3 Stein MB, Schork NJ, Gelernter J: Gene-by-environment (serotonin transporter and childhood maltreatment) interaction for anxiety sensitivity, an intermediate phenotype for anxiety disorders. Neuropsychopharmacology 2008; 33:312–319Crossref, Medline, Google Scholar FiguresReferencesCited byDetailsCited ByDuloxetine-Induced Liver Injury: A Case ReportCureusAntidepressants- and antipsychotics-induced hepatotoxicity5 January 2021 | Archives of Toxicology, Vol. 95, No. 3 Volume 24Issue 2 Spring 2012Pages E34-E34 Metrics PDF download History Published online 1 April 2012 Published in print 1 April 2012

Worker Reactions to Crisis

In France in 2009-10, several managers announcing redundancies were held hostage by workers. Although the global economic crisis and an attendant rise in unemployment may provide a catalyst for "bossnappings," the real explanations for the phenomenon have to be found partly in the institutional make up of French industrial relations that have resulted in weak, divided unions and weak and conflictual collective bargaining mechanisms. However, such institutional factors cannot provide the whole explanation. Ideas also matter, and these underlying structural weaknesses have been unable to contain radical outbursts of anger when allied to pre-existing concerns over globalization—which appeared to be vindicated by the current economic crisis—, the reactions of the government to crisis, and the incapacity of unions or the state to respond to it.

Fatal child abuse: a study of 13 cases of continuous abuse.

A parent who continuously physically abuses her/his child doesn’t aim to kill the child but commits an accidental filicide in a more violent outburst of anger. Fatal abuse deaths are prevented by recognition of signs of battering in time. Out of 200 examined intra-familial filicides, 23 (12%) were caused by child battering and 13 (7%) by continuous battering. The medical and court records of the victim and the perpetrator were examined. The perpetrator was the biological mother and the victim was male in 69 per cent of the cases. The abused children were either younger than one year or from two-and-a-half to four years old. Risk factors of the victim (being unwanted, premature birth, separation from the parent caused by hospitalization or custodial care, being ill and crying a lot) and the perpetrator (personality disorder, low socioeconomic status, chaotic family conditions, domestic violence, isolation, alcohol abuse) were common. The injuries caused by previous battering were mostly soft tissue injuries in head and limbs and head traumas and the battering lasted for days or even an year. The final assault was more violent and occurred when the parent was more anxious, frustrated or left alone with the child. The perpetrating parent was diagnosed as having a personality disorder (borderline, narcissistic or dependent) and often substance dependence (31%). None of them were psychotic. Authorities and community members should pay attention to the change in child’s behavior and inexplicable injuries or absence from daycare. Furthermore if the parent is immature, alcohol dependent, have a personality disorder and is unable to cope with the demands the small child entails in the parent’s life, the child may be in danger.

More than Anarchy in the UK: ‘Social Unrest’ and its Resurgence in the Madoffized Society

Sudden explosions of street violence and disorder tend to evoke simplistic responses. Echoing Victorian moralising and condemnation of urban street fighting at the end of the nineteenth century, politicians depicted England's August 2011 riots as ‘mindless criminality’. Critical of such rhetoric, we maintain that the recent riots should not be misrecognised through the class politics of the advantaged. Instead, we locate this unrest in a larger historical, social, economic and political context. This context includes the progressive predominance of finance capital in the post-1970s era and related neoliberal policy agendas and ideological forms. We posit that neoliberal transformations in the economy and society have undermined many young people's capacity to lead useful and meaningful lives, and that the potential for hopelessness, resentment, frustration and outbursts of anger has significantly increased as a consequence. We argue that the alienation of young people today cannot be separated from forms of accumulation that depend on massive debt-expansion. Neither can it be separated from the proliferation of related practices and institutional supports that enable this expansion, further accelerating the deterioration of already disaffected young people's prospects and futures. We refer to the enabling elements of this process as ‘Madoffization’ at a time when ponzi finance has made economic collapse and ongoing social unrest inevitable.

Impact of pre-enlistment antisocial behaviour on behavioural outcomes among UK military personnel

Concern has been raised over alleged increases in antisocial behaviour by military personnel returning from the deployment in Iraq and Afghanistan. U.S.-based research has shown that post-deployment violence is related not only to combat experience, but also to pre-enlistment antisocial behaviour (ASB). This study aimed to examine the association between pre-enlistment ASB and later behavioural outcomes, including aggression, in a large randomly selected U.K. military cohort. Baseline data from a cohort study of 10,272 U.K. military personnel in service at the time of the Iraq war in 2003 were analysed. The associations between pre-enlistment ASB and a range of socio-demographic and military variables were examined as potential confounders. Logistic regression analyses were performed to examine the relationship between pre-enlistment ASB and military behavioural outcomes such as severe alcohol use, violence/aggression and risk-taking behaviour, controlling for confounders. 18.1% were defined as having displayed pre-enlistment ASB. Pre-enlistment ASB was significantly associated with factors such as younger age, low educational achievement, male gender, non-officer rank, Army personnel, being a regular, increasing time spent on the deployment and having a combat role. Pre-enlistment ASB was associated with increased risk of negative behavioural outcomes (severe alcohol misuse, outbursts of anger or irritability, fighting or assaultative behaviour and risk-taking behaviour), after controlling for confounders, suggesting that such background information may identify individuals who are more vulnerable to subsequent behavioural disturbance. The results of this study suggest that those already demonstrating ASB prior to joining the military are more likely to continue on this trajectory, thus emphasising the importance of considering pre-enlistment behaviour when exploring the aetiology of aggression in military personnel.

My Very First Narcotics Prescription

Journal of Palliative MedicineVol. 14, No. 10 Personal ReflectionMy Very First Narcotics PrescriptionRichard J. LinRichard J. LinSearch for more papers by this authorPublished Online:17 Oct 2011https://doi.org/10.1089/jpm.2011.0118AboutSectionsView articleView Full TextPDF/EPUB ToolsPermissionsDownload CitationsTrack CitationsAdd to favorites Back To Publication ShareShare onFacebookTwitterLinked InRedditEmail View article"My Very First Narcotics Prescription." , 14(10), pp. 1178–1179FiguresReferencesRelatedDetails Volume 14Issue 10Oct 2011 InformationCopyright 2011, Mary Ann Liebert, Inc.To cite this article:Richard J. Lin.My Very First Narcotics Prescription.Journal of Palliative Medicine.Oct 2011.1178-1179.http://doi.org/10.1089/jpm.2011.0118Published in Volume: 14 Issue 10: October 17, 2011PDF download

Tardive Tourette-Like Syndrome in a Patient Treated With Paliperidone

Tardive Tourette-Like Syndrome in a Patient Treated With Paliperidone

Lamotrigine-Induced Manic Switch

To the Editor: Lamotrigine is currently used for treatment of bipolar depression alone or as an adjunct to other drugs. The exact mechanism of the antidepressant action of lamotrigine is not known. Lamotrigine used as an adjuvant mood stabilizer has been reported to induce mania1 and hypomania2 in case reports. Here we present 2 cases of lamotrigine-induced switch, 1 in which lamotrigine was used as a single agent and another in which it was added in a very small dose as an adjuvant. Case 1. Mr A, a 24-year-old single male university graduate, had a family history of bipolar affective disorder in a grandfather and unspecified psychosis in a maternal uncle. He presented in 2008 with a 2-year history of episodic illness characterized by an episode of mania (DSM-IV criteria) lasting for 6 months treated with olanzapine (10 mg/d) and risperidone (2 mg/d) and an episode of moderate depression with somatic symptoms lasting for 11.5 months characterized by pervasive low mood, anhedonia, loss of interest in pleasurable activities, hopelessness, wish to die, somatic symptoms, and disturbed biofunctions. Results of routine investigations and workup for organicity were within normal limits. He was started on lamotrigine 25 mg at bedtime, and the dose was gradually increased to 200 mg. Two weeks after initiation of the drug, he developed irritability and anger outbursts on a dose of 150 mg. When the dose was increased to 200 mg/d, he developed mania along with mood-congruent psychotic symptoms (his Young Mania Rating Scale3 [YMRS] score was 20). As a result, lamotrigine was tapered and stopped over 2 weeks and lithium was added (300–1,200 mg/d) along with risperidone (2–3 mg/d). His symptoms improved over 2 weeks. He has remained well after discharge from the hospital. Case 2. Mr B, a 23-year-old single man, had a family history of alcohol dependence syndrome in his father and past history of childhood oppositional defiant disorder, cannabis dependence syndrome (currently abstinent), and harmful alcohol use. He presented with an episodic illness since 19 years of age characterized by 1 manic episode (DSM-IV criteria) without psychotic symptoms lasting 3 months treated with risperidone 4 mg/d and clonazepam 1.5 mg/d. He discontinued these medications after 1 year. He had another episode of mania (DSM-IV criteria) lasting for 3 months at 21 years of age and was treated with lithium carbonate 1,600 mg/d, risperidone 8 mg/d, and trihexyphenidyl 4 mg/d. He continued taking lithium, and risperidone was tapered off. He most recently presented in 2008 with pervasive low mood, loss of interest in pleasurable activities, hopelessness, somatic symptoms, and disturbed biofunctions of 3 weeks’ duration. He was diagnosed with bipolar affective disorder, current episode moderate depression with somatic symptoms. Lamotrigine 25 mg/d was added to lithium. A week later, he started to exhibit elated mood, overactivity (goal directed), overfamiliarity with people, grandiose plans of starting a business, increased cigarette smoking, and decreased need for sleep. He was admitted and diagnosed with bipolar affective disorder, current episode mania (lamotrigine induced). Urine cannabis screen was negative. He rated 13 on the YMRS and was started on sodium valproate 1,000 mg/d and tablet clonazepam 3 mg/d along with the lithium carbonate he was receiving. His symptoms improved over a duration of 3 weeks, and he was discharged. He has remained well after discharge on regular medications. In the first case, manic symptoms developed when lamotrigine was gradually hiked to 200 mg/d. The patient was not on any other medications during this time, and lamotrigine was the sole agent that might have induced a manic switch. This is possibly the first such case reported. In the second case, the patient developed a manic switch on the addition of a very small dose of lamotrigine. Lamotrigine may induce a switch through its ability to decrease glutamate release, thereby reducing binding to the N-methyl-D-aspartate receptor complex.4

Overview and Summary: Compassion Fatigue: Caregivers at Risk

Becoming a nurse and caring for others can be very rewarding and fulfilling. However, caring for those in need can also lead to severe stress in all areas of nursing. In 1992 Joinson, a nurse, described the phenomenon of compassion fatigue (CF) as a unique form of burnout that affects people in caregiving professions. Figley (1995) defined it as a secondary traumatic stress reaction resulting from helping or desiring to help a person suffering from traumatic events. Its symptomology is nearly identical to that of post traumatic stress disorder (PTSD), except CF applies to caregivers who were affected by the trauma of others. Caregivers with CF may develop a preoccupation with their patients by re-experiencing their trauma; they can develop signs of persistent arousal and anxiety as a result of this secondary trauma. Examples of this arousal can include difficulty falling or staying asleep, irritability or outbursts of anger, and/or exaggerated startle responses. Most importantly, these caregivers ultimately experience a reduced capacity for, or interest in being empathic toward the suffering of others. Scholars differ in their perspectives of CF especially at it relates to burnout. However, they tend to agree that in general CF has a more sudden and acute onset than burnout, a condition that gradually wears down caregivers who are overwhelmed and unable to effect positive change. Understanding CF can empower nurses to utilize preventive measures that promote self care, improve patient outcomes, and optimize therapeutic relationships. Sabo, in her article, Reflecting on the Concept of reports that nurses working in specialty areas, such as intensive care, are quite vulnerable to work-related stress. She focuses on the theoretical conceptualization of CF, positing that care providers' declining ability to provide empathy in a therapeutic relationship is considered a key factor in compassion fatigue. Sabo explores Figley's (2002a) model of CF noting that the personal characteristics of resilience and hope, as well as the nature of relationships, may add more depth to Figley's model. She emphasizes the need to better understand the roles of empathy and engagement as contributors to CF. In Countering Fatigue: A Requisite Nursing Agenda Boyle, as does Sabo, distinguishes CF from burnout. Whereas CF stems from witnessing another's traumatic events, burnout evolves from dissatisfaction with working conditions. The author admits that both constructs result in outcomes associated with nurses' sense of emotional/physical depletion. Boyle, too, values the need to address resilience in CF research initiatives, especially since nurses are considered first responders who often have little or no formal support to counter the effects of CF. She further indicates that available tools for assessing CF are limited in scope and provide minimal help for nurses who are in dire need of onsite workplace interventions, such as counseling, support groups, and/or de-briefing sessions, to address CF. Lombard and Eyre bring an interesting case-study approach to their discussion of CF in Compassion Fatigue, A Nurse's Primer. They emphasize how CF can negatively affect job satisfaction and care providers' health, resulting in decreased productivity and increased turnover, a significant concern as nurses comprise the largest group of healthcare providers in the country. Lombard and Eyre, too, suggest that imbalanced, empathic, relationshipbased care can contribute to CF. Interventions, including a knowledge of CF symptoms and healthy workplace environments, can help to prevent CF among healthcare providers. Ward-Griffin, St-Amant, and Brown introduce an additional population considered to be at risk for CF in their article, Compassion Fatigue within Double Duty Caregiving: Nurse-Daughters Caring for Elderly Parents. Their qualitative study of nurse-daughters identifies the variable of being an informal family caregiver while at the same time working as an employee in a healthcare setting as another contributor to CF. …

“MALHAMÉ–MALFAMÉ”: LEVANTINE ELITES AND TRANSIMPERIAL NETWORKS ON THE EVE OF THE YOUNG TURK REVOLUTION

AbstractThis article examines the rise and fall of the Malhamé family at the court of Abdülhamit II. The point of departure is the flight and arrest of six Malhamé brothers and the accompanying outbursts of popular anger at them during the Young Turk Revolution of 1908. The analysis locates the historical conditions that made the Malhamé phenomenon possible in the interstices between Levantine society, late Ottoman bureaucracy, and European diplomacy and capitalist expansion. In order to bring into conversation the hitherto unconnected literatures on the Levant and the Ottoman state, the Malhamé story is framed in the analytical concept of transimperialism. This concept shares affinities with wider transnational studies. But it is also grounded in the specific political, economic, and social processes of the Levant—both within the Ottoman Empire and among it and its British, French, German, and Italian imperial rivals at the height of the “Eastern Question.”

Treatment-Disrupting Behaviors during Psychotherapy of Patients With Personality Disorders

Behavioral dyscontrol and violations of treatment contracts are serious clinical problems during psychotherapy, especially in treating patients with personality disorders. However, little is known about predictors of these treatment-interfering phenomena. To identify psychodynamic personality characteristics that can interfere with the psychotherapy process as indicated by treatment-disrupting behaviors. Sociodemographic characteristics, descriptive psychiatric diagnoses, and psycho-dynamic characteristics were assessed in 89 inpatients with personality disorders in psychotherapeutic treatment. Psychodynamic characteristics were assessed with the Develop mental Profile (DP). DP variables were used to predict impulsive acts, anger outbursts, para-suicidal behaviors, and contract violations. Incremental value was established. In this sample, 4 out of 5 patients engaged in treatment-interfering behaviors during the first 3 months of therapy. In general, treatment-disrupting behaviors were not predicted by baseline DSM-IV Axis I or II disorders. In contrast, impulsive behaviors, anger outbursts, and contract violations were significantly predicted by psychodynamic variables, especially the DP levels Fragmentation and Egocentricity. DP variables accounted for an incremental predictive value of 23% for treatment-disrupting behaviors, over and above demographics and descriptive diagnoses. Para-suicidal gestures were not predicted by either DSM-IV diagnoses or psychodynamic variables. Psychodynamic personality variables significantly predicted impulsive behaviors, outbursts of anger, and treatment contract violations during psychotherapeutic treatment. The amount of explained variance and incremental value was substantial. These findings support the relevance of psychodynamic assessment in clinical practice. (Journal of Psychiatric Practice. 2011;17:21-34).

Palliative Care Program For Human Immunodeficiency Virus-Infected Patients: Rebuilding of an Academic Urban Program

palliative care is extremely important for human immunodeficiency virus (HIV)-infected clientele. The impact of HIV infection is significant in the city of New Orleans. As of September 2009, a cumulative total of 29 548 HIV/acquired immunodeficiency syndrome (AIDS) cases and 12 267 HIV-related deaths were reported in Louisiana. retrospective review of charts of patients enrolled in our palliative care program. as of September 2009, there were around 1800 active patients in our HIV outpatient clinic. A total of 5 (22%) patients had multidrug-resistant AIDS infection. Three (13%) referred patients had AIDS dementia. Progressive multifocal leukoencephalopathy (PML) and advanced HIV nephropathy were also reasons for referral (13% and 4% of referred patients, respectively). Around 9% of patients had advanced liver cancer with metastases. In all, 22% of patients had rapidly deteriorating functional status. The rest of the patients (26%) complained of cancer-related nausea and vomiting and progressive and nonresponsive weight loss. In terms of psychosocial assessment, the majority of referred patients had problems in areas such as social functioning, mood swings, unstable moods, problems with controlling temper, outbursts of anger, violence, and disturbing or unreal thoughts and beliefs. palliative care is extremely important in the care of patients with HIV/AIDS. More research is needed to elaborate on best palliative care practices in the care of HIV-infected patients. Interesting to note is that there is significant proportion of patients with mental issues (substance abuse, psychiatric problems, depression, and despair) for which better resources are needed. Integration of services among clinical, mental, and palliative care providers might be needed to better serve this population.

Problem solving skills and childhood traumas in patients who self-injured by punching glass during an anger outburst

Objectives: We aimed to investigate the problem solving skills and its childhood traumas among the patients who failed to control their anger and injured their hands and wrists after punching a window or door glass. Methods: The patients who admitted to emergency service with severe wrist injury including tendon, vessel or nerve cut were included. Twenty-five patients who punching glass constituted study group (23 men, 2 women) and 14 patients who accidentally injured their hands (13 men, 1 woman) included as control group. A few days after wrist operation the patients were informed and asked for study participation. Problem Solving Inventory (PSI) and Childhood Trauma Questionnaire (CTQ) were applied to all patients. Results: The mean age of the study and control groups was 25.9 and 29.7 years, respectively. Ratios of right hand injury in the study and the control groups were 84% and 43%, respectively (p=0.008). The study group showed higher childhood emotional and physical trauma scores than the control group but the difference was not statistically significant (p>0.05). PSI scores were higher in the study group than the controls which means problem solving skills were poorer in the study group (p=0.001). PSI scores, CTQ total score (p<0.001) and sub-scale scores were positively correlated in the study group. Conclusions: Previously experienced emotional and physical traumas interfere with the problem solving skills. These individuals show lower tendency to judge and try alternative ways. Psychoeducation on interpersonal relationships, anger management, and problem solving skills may decrease the future injuries in these patients.