Deliberate self-harm patients who discharge themselves from the general hospital without adequate psychosocial assessment

Deliberate self-harm patients who leave the acute hospital environment before the completion of psychiatric assessment have an increased risk of subsequent self-harm. We considered the available data on 50 premature self-discharges identified prospectively in a general hospital with a well-developed integrated-care pathway for self-harm patients, and compared them to a control group. The self-discharge group was found to be more likely to have attempted self-poisoning without alcohol intoxication or other forms or combinations of self-harm, and an absence of identifiable previous self-harm or prior contact with local specialist psychiatric services. The two groups showed no difference in age, sex, or area of residence based on community mental health team sectors. It is proposed that these findings indicate hypotheses for further studies of why people leave the hospital without adequate assessment, and how service design could be improved in order to help them.     

A comparative study of young and adult deliberate self-harm patients

Research has shown that the prevalence of deliberate self-harm (DSH) is higher in adolescents than in adults, but little is known about other differences. In this study we compare adolescent and adult DSH-patients regarding factors contributing to the suicidal act. In two regions in Norway, 98 persons under 20 years of age and 83 older persons were interviewed following an act of DSH. They were compared regarding intentions involved in the DSH, precipitating circumstances, level of suicidal intent, medical seriousness of the act, depression, hopelessness, and self-esteem. Few differences were found. The adults more often wanted to escape from unbearable thoughts or situations, or to receive care and attention. Adults also reported a slightly higher level of medical seriousness of the DSH act, more psychiatric problems, and substance abuse. The similarities between young and adult DSH-patients are striking. The differences found are most likely related to factors of age itself, such as cognitive immaturity, impulsivity, and lack of experience in enduring problems.     

Suicidal behavior in patients with adjustment disorders

This retrospective study characterizes the suicidal behavior in 119 patients with Axis I adjustment disorders as assessed by psychiatrists at the University of Virginia Hospital. Results indicated that 72 patients (60.5%) had documented suicide attempts in the past, 96% had been suicidal during their admission to the hospital, and 50% had attempted suicide before their hospitalization. The most commonly used method of suicide attempts was overdosing. Of the sample group with suicide attempts in the past, 67% had Axis II diagnoses of borderline personality disorder and antisocial personality disorder. Adjustment disorder diagnosis in patients with the suicide attempts was associated with a high level of suicidality at admission, involuntary hospitalization and substance-abuse disorders. Axis II diagnoses in patients with adjustment disorders constituted risk factors for further suicidal behavior. Additional future prospective studies with reliability checks on diagnosis of adjustment disorders and suicidal behavior are needed.     

Assessment and aftercare for deliberate self-harm patients provided by a general hospital psychiatric service

We report on a sample of 135 deliberate self-harm (DSH) patients who were assessed by a general hospital DSH service, and on those who were offered aftercare by, or telephone open access to, the service. Patients' satisfaction with assessment and treatment, and their outcome were investigated at follow-up 12-20 months later. Four-fifths of patients reported the assessment following DSH to have been helpful and the assessor sympathetic. Thirty-three (24%) of the 135 patients assessed were offered treatment by the DSH service but 13 declined or failed to attend. Of the 20 who engaged in treatment, 17 (94%) were satisfied with their care. Open access to the DSH service by telephone was offered to 53 (39%) patients, nine (22%) of whom reported at follow-up that they had used this facility. A specialist DSH service can effectively assess and treat patients following DSH. It is important that the service is accessible and acceptable to patients.     

Understanding self-harm and suicide websites: a qualitative interview study of young adult website users

Self-harm and suicide websites have been heavily criticized both in the literature and the wider media, despite the fact that very little is known about them. To date, no study has interviewed users of these sites about them. This qualitative study aims to explore the accounts of young adults who engage in self-harming and suicidal behaviors and use websites dedicated to these issues, in order to develop a broader understanding of these websites and to identify potential implications for future research. In-depth interviews were conducted via e-mail with 10 participants, who were recruited directly from self-harm and suicide websites. Using discourse analysis, we identified three main ways in which participants wrote about the sites. They constructed them as sources of empathy and understanding, as communities, and as a way of coping with social and psychological distress. These discourses gave users access to important, socially valued identities, such as being understood, belonging to a community and coping with their problems. If health professionals and researchers hope to understand people who use self-harm and suicide websites, and engage them in their services, they must take a more balanced view and not focus solely on the possible risks associated with using such sites.     

十月革命与中国特色社会主义

今年11月7日是俄国十月革命90周年。二十世纪初发生的这一场史无前例的、被称作开辟人类历史新纪元的社会主义革命,曾经给全世界被压迫人民和被压迫民族带来了莫大的喜悦、鼓舞和希望。二十世纪末,由于苏共垮台、苏联解体,在原苏联地区乃至更大范围内,出现了对十月革命伟大意义的质疑,乃至酿成了世界共产党人队伍中的迷惘。而中国特色社会主义的形成、发展和壮     

Suicide risk in outpatients with specific mood and anxiety disorders

The present study examined the relationships between specific anxiety, mood disorders, levels of hopelessness, and suicide ideation. The sample consisted of 606 outpatients recruited from several psychiatric settings. It was found that dysthymia was significantly associated with hopelessness. Patients presenting major depressive episode with higher anxiety symptoms had significantly increased scores on the hopelessness scale. Major depressive episode and bipolar disorder, but not dysthymia, were significantly associated with higher levels of suicide ideation. Increased levels of anxiety symptoms in patients with dysthymia were associated with increased levels of suicide ideation, while increased depressive symptoms in patients with specific phobia and generalized anxiety disorder were associated with significantly lower levels of suicide ideation. The findings suggest that depressive disorders, but not anxiety disorders, constitute risk for suicide. Moreover, the differentiation between a depressive and an anxiety disorder as the principal diagnosis, as well as the assessment of anxiety-level symptoms in patients with major depressive episode and dysthymia, seems of special relevance when assessing suicide risk.     

U.S. treasury department studies of federal- state-local fiscal relations: the context,the major themes,and the outcome

This article provides an assessment of the condition of the literature on several major issues of Federal-State-local fiscal relations. The assessment is provided in the context of a three-volume report on Federal-State-local fiscal relations recently published by the U.S. Treasury Department. The author was a major participant in the studies who generally views them favorably, but who also raises his real concerns about a number of matters.

This article summarizes and evaluates certain aspects of the economic theory of federalism, the intellectual underpinnings of the report. This article addresses the institutional context in which the report was written, which helped shape its approach, content, and conclusions. The report itself generally lacks detailed recom-mendations.

Three main themes of the report are addressed in detail in this article. These are: (a) issues relevant to programs of general-purpose fiscal assistance, which include the adequacy of any potential improvements that might be made in measures of the fiscal capacity of State and local governments; (b) the role, if any, for tax subsidies to State and local governments through the deductibility of State and local taxes in the computation of individual Federal income taxes, and the exemption from Federal income taxes of interest paid on bonds and notes issued by State and local governments; and (c) the projection of the long-term outlook for the fiscal condition of the State-local sector on a current services basis, compared with projections of the long term outlook for the Federal government.     

Acute carbon monoxide poisoning and alcohol intoxication: a rare condition that is complex to manage

Since the changeover in the gas used in domestic appliances, the prevalence of acute carbon monoxide (CO) poisoning has been dramatically reduced. In suicide attempts with car exhaust fumes lies the most common cause of the disorder. As a consequence, patients are more complex to manage as they often have other associated diagnoses such as substance use disorder, depressive disorder, or long-standing personality disorder. This report details such a case. The medical treatment was based on the carboxyhemoglobin (COHgb) levels at the time of admission. The patient developed permanent cognitive and functional deficits consistent with the observed brain scan changes. The author discusses the importance of an appropriate early diagnosis of the condition, the difficulties associated with it, and the validity of using the carboxyhemoglobin levels as a guide to treatment.     

Lyotard: after and with Marx,within and against capital

This article examines Lyotard's thought by means of a review of his conceptions of Marx and capital. Lyotard is taken to hold ambiguous views on both Marx and capital throughout his career. These ambiguities reflect his development of a post-Marxist standpoint. The ambiguous character of Lyotard's reading of Marx and capital is heightened by the fact that the ways in which they are formulated vary in the course of his career. In criticizing Marx, Lyotard tends to assume an absolutist form of Marxism that abstracts from the variety of ways in which Marx can and has been interpreted. Likewise, Lyotard tends to misrecognize how he retains aspects of Marx's critique of capital, and hence does not explore the critical connections between his own standpoint and that of Marx.     

新官僚利益集团的崛起与俄罗斯特色的资本主义

1997年，当时正红得发紫的俄金融寡头别列佐夫斯基曾经得意洋洋地吹嘘，以他为首的7家私有寡头企业控制了俄罗斯经济。但风水轮流转，10年之后，当别氏等寡头或流亡海外，或被捕入狱，或改头换面之后，俄私有商业寡头的美好时光已经一去不复返了，取而代之的是普京执政后崛起的新的克里姆林宫利益集团。     

Crisis occurrence and resolution in patients with severe and persistent mental illness: the contribution of suicidality

Assertive community treatment appears to have limited impact on the risk of suicide in persons with severe and persistent mental illness (SPMI). This exploratory prospective study attempts to understand this observation by studying the contribution of suicidality to the occurrence of crisis events in patients with SPMI. Specifically, an observer-rated measure of the need for hospitalization, the Crisis Triage Rating Scale, was completed at baseline, crisis occurrence, and resolution to determine how much the level of suicidality contributed to the deemed level of crisis. Second, observer-ratings of suicidal ideation, the Modified Scale for Suicide Ideation, and psychopathology and suicidality, Brief Psychiatric Rating Scale, were measured at baseline, crisis occurrence, and resolution. A self-report measure of distress, the Symptom Distress Scale, was completed at baseline, crisis occurrence, and resolution. Finally, the patients' crisis experiences were recorded qualitatively to compare with quantitative measures of suicidality. Almost 40% of the subjects experienced crisis events and more than a quarter of these events were judged to be severe enough to warrant the need for hospitalization. Our findings suggest that elevation of psychiatric symptoms is a major contributor to the crisis occurrences of individuals with SPMI; although the risk of suicide may have to be conceived as somewhat separate from crisis occurrence.