Alprazolam-related deaths in Palm Beach County

Alprazolam is a commonly prescribed benzodiazepine. The abuse of benzodiazepines is most frequently seen in conjunction with the abuse of other drugs. Only rare fatalities have been attributed to alprazolam alone. We undertook a retrospective review of cases investigated by the Palm Beach County Medical Examiner's Office in which postmortem toxicologic studies indicated the presence of alprazolam, to further study the pattern of alprazolam abuse. Our review consisted of 178 cases, including 87 in which death was attributed to combined drug toxicity, 2 to alprazolam toxicity alone, 44 to trauma, 12 to natural causes, and 33 to another drug or drugs. Cocaine and methadone were the most common cointoxicants in the cases of combined drug toxicity, while heroin was less frequently detected. There was considerable overlap in the postmortem blood alprazolam concentrations among the groups. The overlapping ranges of concentrations of alprazolam detected indicate that it may be difficult to define a lethal alprazolam range, and that it may not be possible to determine the actual role of alprazolam as a causal factor in cases of combined drug toxicity. This study confirms that alprazolam alone is rarely a cause of death, and that alprazolam abuse usually occurs within a polydrug use pattern. The high incidence of cocaine as a cointoxicant has not been previously reported.     

Death due to Ehlers-Danlos syndrome type IV

Ehlers-Danlos syndrome (EDS) represents a group of collagen connective tissue disorders characterized by joint laxity, easy bruising, and various skin manifestations. Persons with type IV EDS are at risk for gastrointestinal, uterine, and arterial rupture. Mutations in the COL3A1 gene that encodes for type III procollagen underlie the pathologic abnormalities. Forensic pathologists must be aware of this rare, autosomal-dominant connective tissue disorder. Postmortem diagnosis is possible but requires specialized testing (fibroblast culture and subsequent biochemical assays, with or without molecular studies). When the condition is diagnosed or suspected at autopsy, it is important for forensic pathologists to notify family members of this potentially lethal disorder. Three cases of type IV EDS diagnosed by forensic pathologists are presented, followed by a discussion of the disorder.     

Peer Victimization,Social Support,and Psychosocial Adjustment of Sexual Minority Adolescents

The present study examined the link between sexual orientation and adjustment in a community sample of 97 sexual minority (gay male, lesbian, bisexual, and questioning) high school students, taking into account their experiences of peer victimization and social support within peer and family contexts. Adolescents were identified in a large-scale survey study conducted at 5 high schools. They were matched to a comparison sample of their heterosexual peers. Sexual minority adolescents reported more externalizing behaviors and depression symptoms than heterosexual youth. Compared to their heterosexual peers, sexual minority youth reported more sexual harassment, more bullying, less closeness with their mothers, and less companionship with their best friends. There were no significant differences between gay male, lesbian, bisexual, and questioning adolescents. Overall, both victimization and social support mediated the link between sexual orientation and psychosocial symptoms. Among sexual minority youth, the link between social support and externalizing was mediated by experiences of peer victimization. These findings highlight the contextual risk and protective factors associated with non-heterosexual sexual orientation in accounting for the emotional and behavioral problems in this population. Ms. Williams completed her M.A. in Clinical-Developmental Psychology at York University in Toronto, Ontario. She is currently working on her Ph.D. Her research interests include adolescent sexual orientation, adolescent romantic relationships, and dating violence. Dr. Connolly is a Professor of Psychology at York University. She received her Ph.D. from Concordia University and is a Registered Psychologist in the Province of Ontario. Her current research examines adolescent romantic relationships and the peer context. Dr. Pepler is a Professor of Psychology at York University and Psychologist at the Hospital for Sick Children in Toronto. She received her Ph.D. from the University of Waterloo and is a Registered Psychologist in the Province of Ontario. Her current research examines aggression and victimization among adolescents with a concern to the processes related to these problems over the lifespan. Dr. Craig is a Professor of Psychology at Queen's University. She received her Ph.D. from York University and is a Registered Psychologist in the Province of Ontario. Her current research examines bullying, victimization, aggression, juvenile delinquency, peer relations, and the development of intervention programs.     

Sexually abused girls' behavior during an initial counseling session

Three processes of psychotherapy scales, the Vanderbilt Process of Psychotherapy Scale-Revised (VPPS), the Perceptual Process of Psychotherapy Scale (PPPS), and a Rating Form, were utilized to assess sexually abused girls' behavior during an initial counseling session. The variable of interest was the interactional differences between those girls who were treated by male as opposed to female counselors. Videotape recordings provided the medium by which the sessions were assessed. Trained raters observed a continuous portion of videotaped assessment sessions. Results indicated that there was no significant effect for the sex of counselor on the observers' ratings for the VPPS, the PPPS, and the frequency of verbalization as exhibited by the child and counselor. These findings suggest that there is no significant difference in sexually abused girls' interaction with a male or female counselor during an initial counseling session.     

Normal responses to sexually anatomically detailed dolls

The behaviors and verbalizations of normal, preschool age boys and girls during interactions with sexually anatomically detailed (SAD) dolls were examined. A structured, nonsuggestive interview with each child was videotaped, and five behaviors and five verbalizations were coded for each of five phases of the interview. A two-way ANOVA (gender × phase) showed that during those phases when the dolls were undressed, both boys and girls showed more sexual exploratory play, aggressive behavior which was nonsexual, and active avoidance. Across all phases, nonsexual aggression accounted for 31% of the boys' and 22% of the girls' total responses. Behavioral and verbal sexual exploratory play represented 42% of the boys' responses and 50% of the girls' responses. In contrast, sexually aggressive behavior accounted for only 1% and 2% of the boys' and girls' responses, respectively. Girls interacted with the dolls more than did boys. Additionally, girls demonstrated more affection to the dolls than did the boys, and boys displayed more anxiety with the dolls than did girls. Investigators should be cautious as to inferences about preschoolers' interactions with SAD dolls, especially interactions of a sexual or aggressive nature which do not clearly depict fondling or intercourse.     

Crime scene investigation in child-abuse cases

Although child abuse and neglect continue to appear in the medical literature frequently, little regarding scene investigation in such cases has been discussed. Many explanations have been offered for this deficit, the most common one is based on the time delay between infliction of the injury and discovery. At the Armed Forces Institute of Pathology, child-abuse cases submitted for consultation repeatedly show deficits in the scene investigation and its documentation. Since the discovery of child abuse is dependent on either physical evidence of repetitive punitive measures or an injury pattern not in agreement with the alleged circumstances, it behooves the assigned investigator to make every attempt to document the scene(s) as in any other criminal investigation.     

Perceptions of controllability and other stressor event characteristics as determinants of coping among young adolescents and young adults

Young adolescents (N=146, mean age=11.35, 54% female, 81% Anglo) and young adults (N=166, mean age=20.73, 68% female, 82% Anglo) completed questionnaires assessing appraisals of and efforts to cope with three common stressful events, conflicts with mother, a friend, and a failure. For each event, participants rated appraisals of event controllability, including control over event outcomes, event predictability, and perceptions of causal locus (self-culpable, other culpable, and unknown). Additional appraisals rated included event meaningfulness, duration, frequency of occurrence, and stakes/concerns (concerns about one's or another person's well-being). Employment of five coping strategies was rated for each event. Analyses revealed significant correlations among the appraisal and coping variables across the three events. Aggregate variables were computed and significant age differences emerged from analyses of variance. Results of hierarchical multiple regressions suggest that coping is multiply determined. Perceptions of control may be significant predictors for young adolescents, and concerns about other people may be predictive of young adults' responses.Obtained Ph.D. from The Pennsylvania State University in Individual and Family Studies. Major research interest is social and emotional development in children and adolescents.     

Concentrations of ethanol in two segments of the vascular system.

The time courses of capillary and venous blood concentrations of ethanol after oral administration of 0.30 and 0.34 g/kg doses of ethanol to two normal human subjects indicated that, by interpolation, equal capillary and venous concentrations are reached at only one time, and this time varied with the subject. The capillary/venous blood concentration ratios varied markedly as a function of time in both subjects over the entire observation period of 4 h.     

Women's power in heterosexual sex

The ‘male sexual drive’ discourse sees men as sexually insatiable and male sexuality as naturally an uncontrollable drive. Feminist analysis denies its ‘naturalness’ and its constitution as a ‘drive’, seeing it instead in terms of the power conferred on men in patriarchy. However, seeing the penis/male power as monolithic still ends up casting women as victims. Instead this paper looks at actual heterosexual relationships and examines ‘power’ as a more complex process of negotiation. Heterosexual women often fail to recognize that men need relationships; and that women have sources of power in relationships with them; and the paper argues that this occurs through gender-differentiated positions in discourses such as the ‘have/hold’ discourse as well as the ‘male sexual drive’ discourse.