Risk Of Aggressive Behavior Research Articles

Gastrointestinal stromal tumors (GIST): Evaluation of malignancy and prognosis in 113 cases retrieved from a population based Cancer Registry of Northern Italy

4232 Background: The definition of gastrointestinal stromal tumors (GIST) has evolved over time and its true incidence is still unknown, probably underestimated. We have reviewed 161 cases of soft tissue tumors of the GI diagnosed in the province of Modena between 1988 and 2002 and registered in the Modena Cancer Registry, with the aim of establish the true incidence and the clinical behavior of the disease. Methods: Diagnostic samples were investigated by ICC for CD117 (Dako), PDGFR-A (Santa Cruz) actin, desmin, S100, and CD34. Cases were classified as GIST if resulted KIT+/PDGFR-A- or KIT-/PDGFR-A+.The tumor behavior was assessed on the basis of tumor size and mitotic count, according to the Consensus panel. Results: The diagnosis of GIST was confirmed in 113 cases, 98 KIT+ (87%) and 15 KIT- (13%). The incidence of GIST was of 13 cases per million inhabitants/year. The GIST identified in our population represent 1,1% of all GI cancers diagnosed in the last 15 years. Fifty seven (50%) were men and 56 (50%) women. Median age at diagnosis was 67 years. Sixty four tumors (57%) arose in the stomach. The risk of aggressive behavior was very low, low, intermediate or high in 13%, 12%, 19%, and 55% of cases, respectively. The most frequent symptoms were abdominal pain (37%) and GI bleeding (21%). Twenty one patients (19%) were asymptomatic. Eighty-six patients (76%) underwent radical surgery. After a median follow-up of 46 months (68 months for pts alive) the 5-year survival rate was 53%. At the same interval the survival rate was 75%, 70% and 72% for patients at very low, low and intermediate risk, and 42% for those at high risk (P = 0.0065). The 5-year relapse-free survival rate after radical surgery of primary GIST was 94% for patients at very low, low and intermediate risk, and 43% for patients at high risk (P < 0.0001). Conclusions: GIST represent a rare but well recognizable disease. The risk of aggressive behavior is high in more than 50% of cases. The finding that after radical surgery all relapses but two occurred in patients classified at high risk of aggressive behavior, confirms the clinical usefulness of the Consensus approach. No significant financial relationships to disclose.

Clinicopathologic Study of Gastric Submucosal Tumor: Endosonographic and Immunohistochemical Findings of Gastrointestinal Stromal Tumors (GISTs) in Stomach

Clinicopathologic Study of Gastric Submucosal Tumor: Endosonographic and Immunohistochemical Findings of Gastrointestinal Stromal Tumors (GISTs) in Stomach Bong Min Ko, Su Jin Hong, Kye Won Kwon, Chang Beom Ryu, Joo Young Cho, Joon Seong Lee, Moon Sung Lee, Chan Sup Shim, Boo Sung Kim BACKGROUND/AIM: The gastrointestinal stromal tumors (GIST) constitute the largest catergory of primary non-epithelial neoplasm of the gastrointestinal tract and include most tumors previously designated as leiomyomas/leiomyosarcomas. Clinically and pathologically, GIST represents a spectrum of tumors that include benign and malignant variants. A small proportion of tumors apparently lacking mitotic activity do metastasis. This study was performed to evaluate the need of follow up and treatment of GISTs. METHOD: This study was performed on 38 patients who had gastric submucosal tumor on endoscopy and endosonography (EUS) and confirmed by histologic examinations using immunohistochemistry between January 2001 and October 2003 at our hospital. We evaluated the clinical features, EUS findings (size, layer, echogenicity, cystic change, lobuation, marginal halo, echogenic foci) and immunohistochemical stain (CD117, CD34, SMA, S-100, Ki-67). RESULT: 1) 14 of the 38 patients in gastric submucosal tumors were diagnosed GIST. 2) The age of the patients with GIST ranged from 37 to 86 years old, with an average age of 58.3 years. 3) In GIST, lobulation on EUS findings was correlated with risk of aggressive behavior in GISTs significantly (<0.05). 4) Ki-67 was correlated with risk of aggressive behavior in GISTs significantly (<0.05). 5) GISTs appeared as hypoechoic mass arising from 2nd, 3rd and 4th layer. CONCLUSION: EUS and histologic diagnosis including immunohistochemical stain approach should be performed to differentiate diagnosis when showed gastric SMT. Although GISTs has low malignant potential, regular follow up or resection is needed. *T1650 Endoscopic and Echoendoscopic Evaluation of Gastric Varices Eradication with Cianoacrilate Erika Macedo, Fernanda Thuler, Veruska Di Sena, Gustavo De Paulo, Frank Nakao, Jose Ardengh, Angelo P. Ferrari Jr. Introduction: bleeding from gastric varices rupture is more severe than from esophageal varices. Usual endoscopic techniques (sclerotherapy and banding) are not good choices for gastric varices eradication. Cianoacrilate endoscopic injection has been reported as the best choice for such patients. Aim: to asses the value of echoendoscopy in monitoring gastric varices eradication by cianoacrilate injection. Method: 17 patients with Sarin type GEV2 varices were submitted to endoscopic injection of a cianoacrilate and lipiodol solution (1 ml each). Patients younger than 18 years and/or with severe systemic disease were excluded from the study. All patients were submitted to EUS and endoscopy before and at 3, 6 and 12 months after index treatment. Doppler signal was used during EUS. After each 3-month interval the injection was repeated if there was endoscopic evidence of remaining or recurrent varices. Results: our study group consisted of 10 men and 7 women, mean age 50.6 years (range 22 76, median 51 years). Portal hypertension was secondary to cirrhosis due to schistosomiasis (4), chronic B or C viral hepatitis (3 and 8) and alcohol abuse (2). Endoscopic injection was successfully performed in the U turn position, with no immediate complications. Three patients are still waiting for the first 3-month re-evaluation and two patients died of hepatic insufficiency, unrelated to bleeding. Among the remaining 12 patients, 8 finished the study (1 year follow-up), 4 had their 3and 6month follow-up (2 in each group). In seven patients there was a need for additional injection sessions: a mean of 1.8 sessions/patient (range 1-3). Endoscopic follow up showed complete eradication of variceal novel in every patient. EUS follow up showed absence of variceal flow (negative Doppler signal) in every patient considered eradicated by conventional endoscopy. There were no complications. Conclusion: endoscopic injection of cianoacrilate plus lipiodol is a safe and effective method for gastric varices eradication. EUS evaluation allows detection of variceal flow andmay help in planning additional treatment as well as in monitoring the patient.

Leader and Therapeutic Influences on Prosocial Skill Building in School-Based Groups to Prevent Aggression

Objective: Increasingly, social workers are using standardized skill-building models to provide services to children that are time limited, focused on specific attainable goals, and easily evaluated. Scant attention has been paid to the impact of leader and group factors on the behavioral change of participants in skill-building groups. Method: Multiple regression analysis was used to determine the effects of leader education and experience, therapeutic alliance, and group participation on the prosocial skill development of low-income, elementary-aged children at risk for aggressive behavior. A total of 794 children participated in 106 groups led by 24 graduate/non-graduate-level leaders. Results: Findings indicated that development of prosocial skills decreased aggressive behaviors in the groups. Education level of the leader and group participation contributed to skill development. Experience level implementing the intervention affected aggression level. Conclusions: The findings have important implications for training and supervision of group facilitators, future research on skill-based groups with children, and generalization of skills to school, family, and community settings.

The antecedents of aggressive behavior among men with schizophrenia: a prospective investigation of patients in community treatment.

The association between psychotic symptoms and violence is unclear, due in part to methodological features of investigations that have examined this question, and in part to the fact that the association likely differs by disorder and treatment conditions. Using data from The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons, we examined 128 men with schizophrenia or schizoaffective disorder discharged from general and forensic psychiatric hospitals in Canada, Finland, Germany, and Sweden. The association between symptoms and aggressive behavior was studied during two 6 month periods when the patients lived in the community. Severe positive and negative symptoms of psychosis, depression, and anxiety were measured at the beginning of each of the 6 month periods. In addition, at the beginning of the second 6 month period changes in symptoms in the previous period were indexed. Aggressive behavior was measured in each 6 month period by reports from patients and from collaterals. During the first 6 months post-discharge, after controlling for the presence of antisocial personality disorder or PCL score and past diagnoses of alcohol/drug abuse/dependence, the presence of a severe positive symptom significantly increased the risk of aggressive behavior. During the second 6 month period, after controlling for antisocial personality disorder or PCL score and self-reported alcohol/drug use, the presence of a severe positive symptom, a TCO symptom, and an increase in TCO symptoms significantly increased the risk of aggressive behavior. Neither depot medications nor obligatory community treatment reduced the risk of aggressive behavior after controlling for the presence of a severe positive symptom and/or TCO symptoms. These findings suggest that, among men with schizophrenia being treated in the community, the presence of severe psychotic symptoms and the development of TCO symptoms are antecedents of aggressive behavior.

Delusional misidentifications. Symptoms and neuropsychological models

Delusional misidentifications include the Capgras delusion, Fregoli delusion, the delusion of subjective doubles and other less frequent symptoms. A common denominator of these unspecific psychopathological symptoms is the patients' denial of their identity or the convinction that their identity or the identity of relatives has been altered. These delusional symptoms occur in the context of somatic and mental diseases, most frequently in schizophrenia and dementia. According to neuropsychological and neuroanatomical studies delusional misidentifications are facilitated by lesions of the temporo-limbic system leading to an impairment in the affective recognition and reality control. Patients suffering from delusional misidentifications have a higher risk of aggressive behaviour which emphasises their clinical relevance.

The early risers programme improved academic competence in children at high risk of aggressive behaviour

The early risers programme improved academic competence in children at high risk of aggressive behaviour

The 5-HTTPR polymorphism confers liability to a combined phenotype of psychotic and aggressive behavior in Alzheimer disease.

Psychotic symptoms in subjects with Alzheimer disease (AD+psychosis, AD+P) are a marker for a distinct phenotype characterized by more rapid cognitive and functional decline and a liability to aggressive behaviors. We recently found that AD subjects homozygous for long alleles (l) of an insertion/deletion polymorphism in the promoter region of the serotonin transporter (5-HTTPR) had elevated rates of aggressive behavior. To examine whether the 5-HTTPR ll genotype confers an increased risk of AD+P, and of the combined AD+P/aggressive phenotype. The 5-HTTPR genotype was determined in 332 subjects diagnosed with possible or probable AD. All subjects received structured psychiatric assessments and were categorized with regard to their history of aggressive behaviors and psychotic symptoms. Consistent with other reports, AD+P was associated with a significant increased risk for aggressive behavior. AD+P and aggression were both significantly associated with 5-HTTPR ll genotype and with an increased l allele frequency. Subjects with the combined behavioral phenotype (AD+P and aggressive behavior) had the highest rate of ll genotype and highest l allele frequency. The 5-HTTPR l allele appears to confer risk for the combined AD+P/aggressive phenotype. Confirmation of this association in a similar behaviorally well-characterized independent sample is needed.

Biological markers for suicidal behavior in alcohol dependence

Alcohol-dependent populations have a high lifetime suicide rate (between 7 and 15%, relative risk = 7), and alcoholism is one of the two psychiatric disorders most frequently found in suicidal cases (between 15 and 25%). Biological factors that would detect patients at risk could thus be of value. Carbohydrate-deficient transferrin, monoamine oxydase B, soluble interleukin-2 receptor and cholesterol have been proposed as markers of suicidal risk in alcohol-dependent patients, although nonspecific and with low predictive value. On the other hand, there is large and convergent data stressing the importance of serotonin dysregulation as increasing the risk for aggressive behaviour toward the self, although it is not clear whether serotonin is involved through the altered behavior inhibition system, enhancement of anxiety and depression, or association with specific subtypes of alcohol-dependence, such as early-onset type II alcoholism. Considering the complex but significant impact of alcohol on serotonin metabolism and turnover, it is likely that serotonin mediates a large part of the proneness of ethanol to commit impulsive-aggressive behavior.

Dangerosité criminologique, psychopathologie et co-morbidité psychiatrique

Criminal dangerousness is frequently associated to psychiatric diagnoses. Recent studies using standardised psychiatric instruments confirmed more ancient data. Arrest rate of patients discharged from psychiatric facilities is significantly higher. Jailed detainees have prevalence rate of psychiatric diagnosis three times that of the general population. Schizophrenia, antisocial personality disorder, alcoolism increase the odds-ratio to commit homicide. In community samples (ECA and NCS Studies) most axes I & II disorders increase the prevalent rate of violent behavior by at least several times. Furthermore, the higher the psychiatric comorbidity the higher the risk of aggressive behavior. Finally, there is a correlation between suicidal ideas and attempts and homicidal behavior.

VIOLENCE IN THE EMERGENCY DEPARTMENT

Violence in the emergency department is a frequently encountered problem that is often not promptly or adequately addressed. This article outlines the epidemiology of violence in the emergency department, including patients at greatest risk for aggressive behavior. The necessary steps to identify and approach these patients and recommended methods for sedation and restraint are discussed.

High-risk nonmelanoma skin cancers.

background Some nonmelanoma skin cancers are at high risk to recur after treatment, metastasize, and cause death. objective To provide profiles of nonmelanoma skin cancers that are at high risk of aggressive behavior. methods Review the studies of nonmelanoma skin cancers associated with calculated recurrences after treatment, metastasis, and patient mortality. results Profiles have been developed for nonmelanoma skin cancers considered to be at high risk. conclusions Physician awareness of nonmelanoma skin cancers that can behave aggressively is increased by establishing high-risk profiles for these cancers.

After-School Care for Children: A Resilience-Based Approach

This paper utilizes a resilience perspective and a review of research to identify societal, community, family, and individual factors related to the after-school period that place many children at increased risk for poor developmental and behavioral outcomes. We define and discuss the importance of four key dimensions of children's after-school experiences: safety, developmental appropriateness, cultural relevance, and stability. We recommend that families and practitioners collaborate and include children in the decision making to create after-school care that is individualized. Whenever possible, after-school settings should include opportunities for both enhancing academic achievement and having fun. While emphasizing that all children need appropriate after-school environments, we discuss the importance of assessment and of plan development and monitoring when working with youths at risk for aggressive behavior, impaired relationships with peers and adults, and poor performance in school.

Prevalence and clinical correlates of psychotic symptoms in Alzheimer's disease.

Psychotic symptoms occur commonly in Alzheimer's disease (AD), predict a more rapid rate of cognitive decline and increase the risk of aggressive behaviour. Seventy patients with probable AD, recruited from an old age psychiatry service, were assessed to determine the prevalence and clinical correlates of delusions and hallucinations. Psychiatric symptoms were measured using the Behavioural Pathology in Alzheimer's Disease Rating Scale (BEHAVE-AD), Hamilton Rating Scale for depression (HRSD) and the Depressive Signs Scale (DSS). Thirty-four per cent of the sample experienced delusions and 11% hallucinations in the previous month. Men were more likely than women to have experienced psychotic symptoms. Psychotic and non-psychotic groups did not differ in age, age at illness onset, dementia severity, HRSD or DSS scores. This study confirms the high prevalence of psychotic symptoms in AD patients encountered in clinical practice, and suggests that psychosis and depression represent independent behavioural disturbances in AD.

Cognitions, Behaviors, and Psychological Symptomatology: Relationships and Pathways Among African American and Latino Children

This study examines racial/ethnic differences in the mean levels of children's internal beliefs, fantasies, and attributions about aggressive behavior; interpersonal negotiation strategies; and psychological symptomatology as well as differences in the relationships among these variables. African American (N=436) and Latino (N=387) second- through sixth-graders comprised the sample. African American children reported more aggressive fantasies; Latinos reported more prosocial fantasies and more normative beliefs about aggression. Ethnicity-by-grade interaction revealed that older Latino children and younger African American children had significantly higher mean levels. Path analysis revealed that hostile attributional biases were inversely related to conduct problems among Latinos such that high attributional ratings were associated with fewer reported conduct problems. Implications for research and practice are discussed. INTRODUCTION Most Americans agree that the problem of violence in the United States has reached epidemic proportions. Trends and patterns of violence, particularly among youth under age 18, have placed this issue at the forefront of scientific, public, and policy concern. The implications for preventive interventions for children and youth are especially clear when one realizes that rates of violence among youth less than 18 years of age continued to rise at a time when adult rates were falling (Fox,1996). A multitude of early interventions have been designed to address the problem (see reviews by Tolan & Guerra, 1994; Samples & Aber, in press; Yoshikawa, 1994, 1995), as it has been argued that childhood aggression is the best single predictor of risk for adult aggression (Huesmann, Eron, Lefkowitz, & Walder, 1984; Huesmann, Guerra, Miller, & Zelli, 1992). As these programs and research studies maintain, when developing and implementing preventive interventions, it is important both to identify those populations most at risk and to understand the developmental processes underlying aggression and violent behavior in children's social interactions. Elliott, Heizinga, and Ageton (1985) note that problems of aggression and violence are particularly salient among racial and ethnic minority youth, who are frequently poor, reside in urban centers, and more likely to be the victims of violent acts. Minorities living in disadvantaged urban communities are often cited as having the highest rates of violence, both as victims and perpetrators (Fox, 1996; Hammond & Yung, 1991; Lin, Bussiere, Matthews, & Wilber, 1994). Studies of children's social behavior have begun to make linkages between their social-cognitive processing patterns and patterns of aggression in their social exchanges, suggesting a direct relationship between the ways in which children process social environmental cues and patterns of aggressive behavior among some children (Dodge, Murphy, & Buchsbaum, 1984; Guerra, Huesmann, & Hanish, in press). Unfortunately, racial/ethnic differences in the examination of the relationship between children's cognitions and later aggression have largely been ignored or underinvestigated. Much of the research in this area has been conducted on White samples and has focused less on racial/ethnic or cultural differences within or across non-White samples than on the link between minority group status and poverty (Hawkins, 1993; Guerra, Huesmann, Tolan, Van Acker, & Eron, 1995; Stark, 1990, 1994). This study directly addresses this gap in knowledge. How children process social environmental cues is influenced by their evaluation of the extent to which others' behaviors and intentions are fair and justified (Elliott, Heizinga, & Ageton, 1985). Thus, it would seem that the cognitive processing skills that enable children to appropriately detect and interpret social cues would also reduce their tendencies toward aggression. On the other hand, the absence of effective social information processing skills should increase the risk of aggressive behavior among children. …

Vicarious Emotional Responses of Macho College Males

The vicarious emotional responses of macho and less macho males, as measured by the Hypermasculinity Inventory, were examined among 107 college males, who reported their emotions on arrival for the study and in response to viewing three videotapes of a crying, quiescent, and smiling baby, respectively. Subjects then completed the Hypermasculinity Inventory and the Sexual Experiences Survey. As predicted, macho males responded to the crying baby with more anger and less empathy than did less macho males. The results are discussed in terms of how macho males respond to distressing stimuli by inhibiting “feminine” emotions (e.g., empathy) and by amplifying “masculine” emotions (e.g., anger), thereby increasing the risk of aggressive behavior.

Families Under Economic Pressure

Within a context of increasing economic pressure in rural America, this study assesses family responses to this change and their consequences from the perspective of the household economy in middle-class families. It draws on the findings of largely separate fields of inquiry, including those on income level and loss, unemployment, and economic adjustments. Using survey and observational data on two-parent families in a midwestern rural county, the analysis shows that (a) adverse income change increases economic pressures and hardship adaptations in ways that match the effect of income level and exceed the influence of unstable work, (b) economic pressures and adaptations mediate the negative effects of economic adversity on emotional health and family relationships, (c) father's negativity in the family represents a stronger link between economic conditions and child behavior than does mother's negativity, and (d) economic pressure and father's negativity increase the risk of aggressive behavior and depressed feelings among boys and girls, especially in the absence of maternal support.

Behavioral Manifestations of Chromosomal Abnormalities

Increasing evidence indicates that there are fewer correlations than had been thought to exist between chromosomal abnormality and behavioral dysfunction. It has become clear, for example, that many patients with Turner's or Klinefelter's syndrome are of normal intellect (though Turner's patients may have a specific defect in space perception), and an elevated risk for aggressive behavior in XYY males is moot at best.