Unprovoked Attacks Research Articles

Panic Disorder: Diagnosis and Treatment in Emergency Medicine

Panic disorder is a newly recognized psychiatric illness involving unexpected, unprovoked attacks of anxiety. Patients with panic disorder commonly seek treatment in the ED. It is important for the emergency physician to properly recognize and categorize this disorder to initiate appropriate treatment. Illness description and treatment guidelines of this disorder are discussed in this article. [Zun LS: Panic disorder: Diagnosis and treatment in emergency medicine. Ann Emerg Med July 1997;30:92-96.]

Video Game-Related Seizures: A Report on 10 Patients and a Review of the Literature

To further describe the features, postulated pathophysiology, treatment, and outcome of seizures occurring while playing or watching video games (video game-related seizures (VGRS)). We evaluated retrospectively 10 patients with VGRS seen by us and reviewed 25 reported cases. The 35 patients ranged in age from 1 to 36 years (mean: 13.2); and 26 subjects (74%) were male. Eight individuals (29%) had prior infrequent nonfebrile seizures, 4 (11%) had febrile convulsions, and 2 (6%) had a family history of epilepsy. VGRS consisted of generalized tonic-clonic seizures in 22 of 35 individuals (63%); absences in 2 (6%); simple partial seizures in 6 (19%); complex partial seizures in 4 (11%); and other manifestations in 4. Neurologic examination and computed tomographic and magnetic resonance imaging scans were normal. Electroencephalograms demonstrated generalized or focal, interictal or ictal epileptic patterns in 11 of 21 patients (52%) and photoparoxysmal responses in 17 of 32 (53%). Eleven of 15 individuals (73%) treated with video game (VG) abstinence alone, 3 of 6 who received anticonvulsants but played VGs, and 7 of 12 treated with combined VG abstinence and anticonvulsants had no further seizures. We postulate that a special convulsive susceptibility of selected neurons in striate, peristriate, infratemporal, and posterior parietal cortices to particular visual stimuli plays a major role in VGRS. VG abstinence is the treatment of choice of VGRS. Anticonvulsant medication is suggested only for those individuals who continue to play VGs or suffer from seizures triggered by other, unavoidable visual stimuli, or from unprovoked attacks.

Ethology and pharmacology of hypothalamic aggression in the rat

Stimulation of a restricted area of the rat's hypothalamus elicits unprovoked violent attacks of a species-specific and strain-specific nature. Serotonergic drugs affecting 5HT1 receptors, propranolol, the 5HT re-uptake inhibitor fluvoxamine, and the anxiolytic oxazepam, inhibit hypothalamic attack selectively. However, hypothalamic attack is extremely unsensitive for many drugs that do affect attack provoked by natural stimuli. The pharmacology, the form, the impulsive nature, the absence of preliminaries, the insensitivity for contexts and ultimate aims of aggressive behaviour, suggest that a mechanism with the limited function of damaging adversaries of any kind is activated in the hypothalamus. This hypothalamic attack release mechanism (harm) requires specific sensory input for the expression of specific motor components, such as biting and kicking. The back and dorsal part of the opponent's head are the important attack releasing and directing stimuli. Attacks of this nature are part of the "aggressive" repertoire of the rat in natural settings. "Lateral" or "sideways" postures, specific for intermale fighting cannot be induced by hypothalamic stimulation. Drug, lesion, and stimulation studies suggest that attack and "sideways" postures are under the control of different central mechanisms. These results suggest new ways to describe the patterning of aggressive behaviour. There are interesting ethopharmacological similarities between hypothalamic responses and obsessive compulsive disorders (OCD) in man. It is suggested that further study of the ethopharmacology of hypothalamic responses may shed light on the pathophysiology of impulsive behavioural symptoms which in man seem to be beyond the control of appraisal or context.

A review of Killer Whale interactions with other marine mammals: predation to co‐existence

AbstractKiller Whales are well‐known as predators of other marine mammals, including the large Sperm and baleen whales. Members of all marine mammal families, except the river dolphins and manatees, have been recorded as prey of Killer Whales; attacks have been observed on 20 species of cetaceans, 14 species of pinnipeds, the Sea Otter, and the Dugong. Ecological interactions have not been systematically studied and further work may indicate that the Killer Whale is a more important predator for some populations than previously believed. Not all behavioural interactions between Killer Whales and other marine mammal species result in predation, however. Some involve ‘harassment’ by the Killer Whales, feeding by both species in the same area, porpoises playing around Killer Whales, both species apparently ‘ignoring’ each other, and even apparently unprovoked attacks on Killer Whales by sea lions. These non‐predatory interactions are relatively common. We conclude that interactions between Killer Whales and marine mammals are complex, involving many different factors that we are just beginning to understand.

Dog Bites in Urban Children

As a result of a perceived increase in pit bull injuries, all children who presented to The Children's Hospital of Philadelphia during 1989 for evaluation of dog bite injuries were prospectively studied. Epidemiologic information was collected from parents, either at the time of visit or by phone on the following day. A total of 168 children were enrolled; the mean age was 8 years. Males outnumbered females 1.5:1. Most (61%) injuries occurred in or around the home and involved dogs known to the patient (77%). Types of injuries included abrasions (33%), punctures (29%), and lacerations (38%). Thirteen bites had associated complications; nine developed infection. Twelve (7%) children required admission to the hospital. More than 12 different purebreeds or cross-breeds were identified as perpetrators, including German shepherds (n = 35), pit bulls (n = 33), rottweilers (n = 9), and Dobermans (n = 7). Most (54%) animals were contained (ie, leashed, fenced, in-house) at the time of injury. Fewer (46%) were provoked prior to biting. Significantly more pit bull injuries (94% vs 43%, P less than .001) were the consequence of unprovoked attacks and involved freely roaming animals (67% vs 41%, P less than .01). Children aged 5 or younger were more likely to provoke animals prior to injury than were older children (69% vs 36%, P less than .001). It is recommended that families with young children be the target of pet safety education and that measures be sought that would lead to early identification of a potentially dangerous dog and restrict ownership.

Severe Facial Injuries to Infants due to Unprovoked Attacks by Pet Ferrets

Three infants were attacked by pet ferrets and sustained severe facial injuries. Two of the children had their ears bitten off and required reconstructive surgery. The attacks were unprovoked. Two of the children were asleep in their cribs when they were bitten. Although ferrets are increasingly popular pets, we believe that they are not suitable pets for families with small children. Physicians should be aware that ferrets may unpredictably injure infants and that no effective rabies vaccine for ferrets is yet available.

Severe facial injuries to infants due to unprovoked attacks by pet ferrets

Severe facial injuries to infants due to unprovoked attacks by pet ferrets

Expressions of Aggression

Social learning theory suggests that factors that increase the risk of social reprisal and reprobation should inhibit unprovoked physical attacks. A factorial experiment employing 56 males and 56 females investigated the effects of anonymity to authority figures and potential retaliation from a victim upon aggression displayed by small groups (n = 4) of coacting aggressors. The results disclosed that anticipated negative consequences in the form of counteraggression from the victim combined with surveillance by an authority inhibited the expression of aggression among both males and females. These findings were interpreted in terms of social learning theory, which emphasizes the role of expected negative consequences of behavior violating norms of social propriety.

The Effects of Repeated Aggressive Encounters on Subsequent Aggressive Behavior

Summary The effects of repeated encounters in the laboratory on subsequent aggressive behavior of Ss competing in a reaction-time task were investigated in two studies of male undergraduates. In Study I (n = 20), it was observed that following two sessions in which they competed with aggressive opponents, Ss evidenced a tendency to initiate attacks against an unfamiliar competitor. The results of Study II (n = 30) suggested that the information received by the Ss indicating the aggressive intent of the opponents, rather than the behavioral involvement in the aggressive encounter, was responsible for the observed increase in unprovoked attacks.

Withdrawal From Diazepam

ABSTRACT To the Editor.— Arthur Ecker, MD, commented (237:765, 1977) on our letter (236:2172, 1976) on grand mal convulsions, which we ascribed to abrupt withdrawal from diazepam; he postulated an alternative diagnosis of stress convulsions. The reference he provided to this condition (Arch Neurol 31:155-159, 1974) defined it as epileptic attacks in persons who have not previously had unprovoked epileptic attacks, and who during the period immediately prior to the attack were exposed to stress such as lack of sleep, emotional stress, or somatic or intellectual overexertion. Convulsions owing to alcohol or drug abuse were excluded. Thus, by definition our patient would not receive such a diagnosis if one believes that the exposure to diazepam was drug abuse; conversely, the definition would fit if our assumption was otherwise. It is not crucial for our point, but according to our ability to discriminate, the patient was not under unusual stress. The two