Suicide in San Francisco's skid row.
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Clinical research indicates a tendency to compulsive repetitions of traumatic experiences. Such phenomena have not been studied experimentally and so the generality of the tendency has been uncertain. With development of operational definitions and content analysis techniques, it was possible to quantity and examine intrusive and stimulus-repetitive thought in a series of experiments with controlled variations in subject selection, stimuli, demand set, and context. Comparison of data across experiments indicates a tendency toward intrusive and stimulus-repetitive thought that is not restricted to "traumas" or a few predisposed individuals. Intrusive and repetitive thought appears to be a general stress-response tendency seen in a large proportion of persons after even mild to moderately stressful events. It is concluded that the intrusive repetitions observed clinically are extreme forms of this general stress-response tendency.
Six male patients in a maximum-security hospital committed acts of urethral self-mutilation by insertion of a foreign body. The characteristics of the self-mutilators and of this unusual form of self-mutilation are described. The social contagion aspects of the self-mutilation are strongly suggested by the perpetration of urethral insertion for the first time by five patients after direct personal contact with a previous urethral self-mutilator. Techniques used in the management of these patients are described. Self-mutilation evokes strong emotional responses in staff members, and proper patient management also must include attention to the needs and concerns of treatment staff.
BACKGROUND: In functional brain imaging studies, exposure to cues related to cocaine, opiates, and alcohol in dependent individuals is associated with activation of the anterior cingulate gyrus, amygdala, orbitofrontal cortex, and dorsolateral prefrontal cortex. Craving for these substances positively correlates with activity in the orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior insula. The objective of this study was to determine changes in regional cerebral glucose metabolism and correlations between craving and regional metabolism in heavy cigarette smokers exposed to cigarette-related cues. METHODS: Twenty heavy smokers (who smoked > or =20 cigarettes per day) and 20 nonsmoking control subjects underwent 2 fluorine 18-fluorodeoxyglucose positron emission tomography scans 10 days apart in randomized order: one while watching a videotape that presented cigarette-related cues and handling a cigarette, and the other while watching an educational (nature) videotape and handling a neutral object (pen). RESULTS: From the neutral to the cigarette cue scan, heavy smokers had greater increases than nonsmoking controls in relative glucose metabolism in the perigenual anterior cingulate gyrus spanning the midline. Significant positive correlations were found between intensity of craving and metabolism in the orbitofrontal cortex, dorsolateral prefrontal cortex, and anterior insula bilaterally. An unexpected positive association was found between craving and metabolism in the right sensorimotor cortex. CONCLUSIONS: Brain regions associated with arousal, compulsive repetitive behaviors, sensory integration, and episodic memory are activated during exposure to cigarette-related cues and cigarette craving. These regional brain activations and associations with craving are similar to findings with other addictive substances.
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We examined a panel of 21 patients diagnosed with compulsive buying for two DNA sequence polymorphisms found in the gene that encodes the serotonin transport (5-HTT). One polymorphism, found in the promoter region of the 5-HTT gene, involves a 44-base pair (bp) deletion, and the other, found in the second intron, is due to variable numbers of a repeat sequence. We also typed a panel of 38 psychiatrically normal controls for both 5-HH markers. When compared to this control panel, no significant differences were seen for either 5-HTT marker among the compulsive buyers.