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Biomedical subjects

A G Hempel

Publications and source records attributed to A G Hempel.

7 recordsLinked to original sources

Offender and offense characteristics of a nonrandom sample of adolescent mass murderers.

OBJECTIVE: The authors conducted a descriptive, archival study of adolescent (< or =19 years of age) mass murderers-subjects who intentionally killed three or more victims in one event-to identify demographic, clinical, and forensic characteristics. METHOD: A nonrandom sample of convenience of adolescent mass murderers was utilized. RESULTS: Thirty-four subjects, acting alone or in pairs, committed 27 mass murders between 1958 and 1999. The sample consisted of males with a median age of 17. A majority were described as "loners" and abused alcohol or drugs; almost half were bullied by others, preoccupied with violent fantasy, and violent by history. Although 23% had a documented psychiatric history, only 6% were judged to have been psychotic at the time of the mass murder. Depressive symptoms and historical antisocial behaviors were predominant. There was a precipitating event in most cases--usually a perceived failure in love or school--and most subjects made threatening statements regarding the mass murder to third parties. The majority of the sample clustered into three types: the family annihilator, the classroom avenger, and the criminal opportunist. CONCLUSIONS: The adolescent mass murderer is often predatorily rather than affectively violent and typically does not show any sudden or highly emotional warning signs. Although the act of mass murder is virtually impossible to predict because of its extremely low frequency, certain clinical and forensic findings can alert the clinician to the need for further, intensified primary care, including family, school, community, law enforcement, and mental health intervention.

Adolescent↗

Combined homicide-suicide in Galveston County.

Combined homicide-suicides have been classified based on the psychopathology of the perpetrator and the nature of the relationship between perpetrator and victim(s). To further understand the nature of this tragic phenomenon and to test the validity and practicality of a previously suggested classification system, investigators systematically collected data on all combined homicide-suicide events that occurred in Galveston County, Texas over a continuous 18-year period (n = 20). The most common psychopathological finding for perpetrators was high serum alcohol levels that suggested intoxication. Most combined homicide-suicides fell into one of the relational categories and most of these, as predicted, were of the consortial type, possessive subtype. As expected, due to the small sample size, the less common types of combined homicide-suicide were not represented in this sample.

Adolescent↗

A cross-cultural review of sudden mass assault by a single individual in the oriental and occidental cultures.

A nonrandom sample of North American cases of sudden mass assault by a single individual (SMASI, n = 30) is compared with a nonrandom sample of Laotian amok cases (n = 18) and other amok studies. Perpetrators in both studies show evidence of social isolation, loss, depression, anger, pathological narcissism, and paranoia, often to a psychotic degree. The term "innovative perpetrator" is reintroduced and expanded upon. Similarities among samples far outweigh differences, leading the authors to conclude that SMASI and its appearance in different cultures is not a culture-bound syndrome.

Adolescent↗

Offender and offense characteristics of a nonrandom sample of mass murderers.

A nonrandom sample (N = 30) of mass murderers in the United States and Canada during the past 50 years was studied. Data suggest that such individuals are single or divorced males in their fourth decade of life with various Axis I paranoid and/or depressive conditions and Axis II personality traits and disorders, usually Clusters A and B. The mass murder is precipitated by a major loss related to employment or relationship. A warrior mentality suffuses the planning and attack behavior of the subject, and greater deaths and higher casualty rates are significantly more likely if the perpetrator is psychotic at the time of the offense. Alcohol plays a very minor role. A large proportion of subjects will convey their central motivation in a psychological abstract, a phrase or sentence yelled with great emotion at the beginning of the mass murder; but in our study sample, only 20 percent directly threatened their victims before the offense. Death by suicide or at the hands of others is the usual outcome for the mass murderer.

Adolescent↗

Pharmacoeconomic analysis of using Sinemet CR over standard Sinemet in parkinsonian patients with motor fluctuations.

OBJECTIVE: To compare the costs of pharmacotherapy in patients with Parkinson's disease before and after converting from standard Sinemet to extended-release Sinemet CR. DESIGN: Investigators retrospectively reviewed records of patients converting from Sinemet to Sinemet CR for efficacy and total drug costs. Cost-effectiveness was evaluated retrospectively from data collected in prospective Sinemet CR efficacy trials. SETTING: Parkinson's disease clinic at a tertiary care university teaching hospital. PATIENTS: 100 patients with motor fluctuations who had undergone an initial 6-month course of Sinemet therapy, followed by a 6-month course of Sinemet CR. MAIN OUTCOME MEASURES: Total cost was measured as the cost of Sinemet formulations plus the costs of other antiparkinson medications. Differences in pre- and postconversion costs were compared by using the paired, two-tailed Student's t-test. A substudy of 39 patients on the cost-effectiveness of conversion measured the ratio of daily medication costs to the daily hours "on" without chorea. RESULTS: While total daily medication costs after conversion increased by 21%, patients experienced either a comparable or an improved degree of disease control with Sinemet CR. Patients who were also taking selegiline were able to decrease selegiline expense by 20%. The costs of other adjunctive medications did not differ significantly after conversion. The cost-effectiveness analysis revealed an increase in postconversion on time by 2.2 hours (p = 0.0001), accompanied by a $2.85 decrease in total cost per hour on without chorea (p = 0.11). CONCLUSIONS: Although Sinemet CR is more costly, it may be more cost-effective in patients with motor fluctuations. Some patients may be able to reduce adjunctive medications.

Adult↗

Clonidine reverses the behavioral and respiratory effects of continuous naloxone infusion.

Opiate naive rats received 24 hours of continuous subcutaneous infusion of 0.67 mg/kg/hr naloxone via osmotic minipump. As in previous studies, this induced an opiate-abstinence-like syndrome of significantly increased oxygen consumption and behavioral signs (wet-dog shakes, abdominal writhes, etc.). Clonidine, which selectively reduces central noradrenergic activity, has been shown to reverse opiate abstinence syndrome. Subcutaneous injection of 0.033 and 0.01 mg/kg clonidine totally reversed the abstinence-like behaviors and respiratory activity induced by naloxone infusion. This constitutes an additional point of similarity between opiate abstinence syndrome and the "endorphin blockade syndrome" or withdrawal from endogenous opioids resulting from chronic naloxone treatment. It is consistent with the hypothesis that hyperactivity of central noradrenergic mechanisms may contribute to both phenomena.

Animals↗