Suicide experiment

Table 7- Killing of B-precursor cells by specific lethal radioactive antigens (suicide experiment). From Hasten et al. (1971)...

Disulfiram works by irreversibly blocking the enzyme aldehyde dehydrogenase, a step in the metabolism of alcohol, resulting in increased blood levels of the toxic metabolite acetaldehyde. As levels of acetaldehyde increase, the patient experiences decreased blood pressure, increased heart rate, chest pain, palpitations, dizziness, flushing, sweating, weakness, nausea and vomiting, headache, shortness of breath, blurred vision, and syncope. These effects are commonly referred to as the disulfiram-ethanol reaction. Their severity increases with the amount of alcohol that is consumed, and they may warrant emergency treatment. Disulfiram is contraindicated in patients who have cardiovascular or cerebrovascular disease, because the hypotensive effects of the disulfiram-alcohol reaction could be fatal in such patients or in combination with antihypertensive medications. Disulfiram is relatively contraindicated in patients with diabetes, hypothyroidism, epilepsy, liver disease, and kidney disease as well as impulsively suicidal patients. 

Experiences hearing others call his name, and interpreting the car lights coming down his street as meaning people are out to get him. He denies suicidal or homicidal thoughts. 

The course of MDD varies markedly from patient to patient. It is not uncommon for a patient to experience only a single major depressive episode, but most patients with MDD will experience multiple episodes. Some patients experience isolated episodes separated by many years, others have clusters of episodes, and still others will suffer more frequent episodes as they age. The number of prior episodes predicts the likelihood of developing subsequent episodes such that by the time a patient experiences a third major depressive episode, there is about a 90% chance that he or she will have a fourth one. MDD is associated with a high mortality rate because about 15% of patients ultimately will commit suicide.3... 

Now there are a number of problems with relapse-prevention studies. One is the fact that many people who are taken off antidepressants experience withdrawal symptoms, which in severe cases can last for months. Some of these withdrawal symptoms - sadness, suicidal thoughts, crying spells, trouble concentrating, irritability, anxiety, agitation and insomnia, for example - are also symptoms of depression.12 These withdrawal symptoms could lead both patients and researchers to think that the patient has relapsed. 

The basic strategy in using taxometric procedures is to presume a taxon— for example, depression. Next, we are required to conjecture the presumed taxon s indicators—sadness, anhedonia, and suicidality. Presume and conjecture based on what Clinical experience, intuition, past theory and research. .. it really does not matter. The presuming and conjecturing take place in what Popper (1959) called the context of discovery, where ideas, theories, and hypotheses are developed from any source. The empirical evaluation of these ideas, however, takes place in Popper s context of justification when the question is a taxometric one, the context of justification involves taxometric analyses. 

In the earlier scheme, I represents a product formed by metabolism of the inhibitor by the enzyme. This product may be released into bulk solvent, or may interact (often covalently) with a suitably reactive component of the enzyme within the active site. This irreversibly inactivated enzyme complex is shown as El". There are two kinetic constants that can be obtained from relatively straightforward experiments with a suicide inhibitor. The Ki value is an equilibrium constant for the initial reversible step, and all the rate constants from the above scheme contribute to its value. The rate of irreversible inactivation of enzyme at a saturating concentration of the suicide inhibitor is given by fcinact. to which only k2> h, and k contribute (Silverman, 1995). At infinitely high concentrations of the inhibitor, the half-Ufe for inactivation is equal to ln2/ l inact ... 

Quite withdrawn and ruminative at times, he would suddenly come to life and enter into the ongoing discussion. During one interchange, he revealed he had once made a suicide attempt, which he had not mentioned during the pre-drug interview. His description of such experiences lacked much emotion. 

The course of AN is highly variable. Some patients with anorexia experience a single episode of the disorder with full recovery. Others have recurrent exacerbations of AN interspersed with periods of remission during which they return to a normal weight. Finally, some AN patients experience a chronic, deteriorating course that results in frequent hospitalizations for medical stabilization. Of the chronic AN patients who are admitted to academic center hospitals for medical care, 10% ultimately die from AN due to starvation, suicide, or electrolyte imbalance. 

The full spectrum of depressive symptoms including depressed mood, anhedonia, lack of energy, and even suicidal thoughts may strike as many as 25% of patients who experience a TBL Depression in these patients not only exacts a tremendous psychosocial toll but also interferes with their participation in physical and occupational rehabilitation. As a result, long-term functional recovery from TBl can be sorely compromised by depression. Potential treatments for post-TBl depression include conventional antidepressants and stimulants (see Table 12.1). 

Suicide risk Patients with major depressive disorder, both adult and pediatric, may experience worsening of their depression and/or the emergence of suicidal ideation and behavior (suicidality), whether or not they are taking antidepressant medications, and this risk may persist until significant remission occurs. 

The account I heard most often in my interviews mirrors my own experience. It is one of ambivalence toward medications, of reluctance to rely on them, of movement from one drug or dose to another, and of uncertainty about the treatment s efficacy. It also hints at the process through which a clear majority of patients move—from initial resistance to a grudging acceptance of their need for medication. Eventually, those who follow this archetypal career capitulate to the idea that they will probably have to take medication for the rest of their lives. The first narrative, then, is one of partial success. We will hear it from Rachel, a twenty-nine-year-old accountant, whose depression was severe enough to have included a suicide attempt at age eighteen. 

Serious psychiatric adverse experiences (aggressive reactions, agitation, delusions, emotional lability, mania, neurosis, paranoia, psychosis, suicide) have been... 

Diagnosing depression is not a simple matter. Everyone experiences sadness once in a while, and in certain situations, such as the loss of a loved one, it is expected. The American Psychiatric Association, a group of professional psychiatrists, publishes the Diagnostic and Statistic Manual of Mental Disorders, a manual that outlines the criteria for diagnosing psychiatric disorders. This widely followed manual is periodically updated, and it is currently in its fourth edition. DSM-IV, as it is often abbreviated, defines a major depressive episode to be when the patient shows a depressed mood or the absence of pleasure for a certain period of time, as well as exhibiting some other symptoms such as loss of sleep, appetite, or recurrent thoughts of suicide. Depression is one of the most common disorders, with millions of cases diagnosed every year in the United States alone. 

Tricyclic antidepressants are still prescribed today, but some patients experience side effects such as dry mouth, blurry vision, constipation, and other uncomfortable conditions. Other antidepressants have since been found that induce fewer side effects. One of the most popular is fluoxetine, which is marketed under the trade name Prozac. This drug, along with Zoloft and other antidepressants, are known to inhibit reuptake proteins specifically for serotonin. As a result, these drugs are called selective serotonin reuptake inhibitors, or SSRIs. Although some concerns have appeared because of a possible risk of suicide in young patients who take Prozac, these drugs are commonly prescribed and have proved highly effective in millions of patients. 

In patients receiving antidepressants for acute major depression, the initial therapeutic response is often delayed by several weeks. Patients with severe anxiety or insomnia may benefit from the concurrent, time-limited use of a benzodiazepine or short-acting hypnotic (Chapter 3). A patient may initially experience a return of energy and motivation while still having feelings of hopelessness and excessive guilt. Such patients may be at an increased risk for suicide because a return of energy in an extremely dysphoric individual may provide the impetus and means for an act of self-destruction. 

Isacsson, G., Boethius, G., Bergman, U. Low kvel of antidepressant prescription for people who later commit suicide 15 years of experience from a population-based drug database in Sweden. Acta Psychiatr. Scand. 85, 444-448, 1992. 

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