Tissue distribution of tramadol and metabolites in an overdose fatality

Tramadol (Ultram) is a centrally acting, synthetic analgesic agent. Although it has some affinity for the opiate receptors, tramadol is believed to exert its analgesic effect by inhibiting the re-uptake of norepinephrine and serotonin. There are several published cases of tramadol's involvement in drug-related deaths and impairment. Reports of deaths involving tramadol alone with associated tissue concentrations are rare. This report documents a case in which tramadol overdose was identified as the cause of death. The following tramadol concentrations were found in various tissues: blood, 20 mg/L; urine, 110.2 mg/L; liver, 68.9 mg/kg; and kidney, 37.5 mg/kg. Tissue distributions of the two primary metabolites, N-desmethyl and O-desmethyl tramadol, are also reported. In each tissue or fluid except urine, the tramadol concentration was greater than either metabolite, consistent with other reports of drug-impaired drivers and postmortem cases. The O-desmethyl metabolite concentration was greater than the N-desmethyl metabolite concentration in all tissues; this is in contrast to other postmortem reports, in which the majority of cases report concentrations of O-desmethyl as less than those of N-desmethyl. This may be useful as an indicator of time lapse between ingestion and death.     

The Attitudes Towards Dating Violence Scales: Development and Initial Validation

This study describes the development and validation of three Attitudes Towards Male Dating Violence (AMDV) Scales and three Attitudes Towards Female Dating Violence (AFDV) Scales. These scales measure attitudes toward use of psychological, physical, and sexual dating violence, respectively, by boys and by girls. Eight hundred twenty-three students from grades 7, 9, and 11 participated in the validation study. All six scales have good internal consistencies. As predicted, students were more accepting of girls' use of violence than of boys' use of violence, and boys were more accepting of violence than were girls. The six scales were positively correlated with traditional attitudes toward gender roles and with each other, providing evidence for their construct validity. Higher scores on the AMDV Scales were related to boys' past use of violence in dating relationships and to their having aggressive friends, supporting their criterion-related validity. Higher scores on the AFDV Scales were associated with girls' past use of dating violence but not with their having aggressive friends, providing partial support for their criterion-related validity. Singly or in combination, the Attitudes Towards Dating Violence Scales can be used to increase our understanding of the development and maintenance of violence-supportive attitudes in adolescents of all ages.     

Risk assessment in offenders with mental disorders: relative efficacy of personal demographic, criminal history, and clinical variables

Following the meta-analysis by Bonta, Law, and Hanson, (1998) this study examined the ability of personal demographic, criminal history, and clinical variables to predict reoffending in offenders in the United Kingdom who had mental disorders. The efficacy of each variable in predicting rate of general reoffending and violent reoffending was investigated. Age on admission, number of days hospitalized, and number of previous offenses were the most effective variables in predicting re-offending, with number of previous offenses being the strongest predictor. Clinical diagnosis was not predictive of reoffending when the variance attributable to these other predictors was controlled for. None of the variables were able to discriminate between general offenders and violent offenders indicating that the same variables predict both types of reoffending. The results showed that reconviction in offenders with mental disorders can be predicted using the same criminogenic variables that are predictive in offenders without mental disorders.     

Developing Principles for Best Practice in Expanded School Mental Health

On the basis of activities of a federally funded national center for school mental health, review of literature on principles for best practice in child and adolescent mental health and school health, and consultation with national experts and family members, a set of 10 principles for best practice in school mental health was developed. A survey was developed enabling 1–6 point Likert ratings (clearly unimportant to clearly important) for each of the 10 principles. With an original sample of 426 people involved in education, school health or mental health, all 10 principles were strongly endorsed, receiving mean ratings ranging between 5.10 and 5.75. On the basis of qualitative feedback from this survey and interactive forums, language for 9 of the 10 principles was revised and a survey reflecting these changes was developed and administered to a validation sample of 86 respondents. As with the original sample, endorsements of the principles were strong, with mean ratings ranging between 5.45 and 5.79. Findings are discussed in relation to advancing interconnected agendas related to quality assessment and improvement and empirically supported practice in school mental health.