Background: Chiari I malformation (CMI) is diagnosed by rigid radiographic criteria along with appropriate clinical symptomatology. The aim of this study was to investigate the dimensions of the posterior cranial fossa in patients without significant tonsillar descent but with symptoms comparable to CMI.

This study evaluates the effects of two group interventions, the Bereavement Group Postvention (BGP) and the Social Group Postvention (SGP), on the bereavement outcomes in widowed survivors of suicide. The goals were to determine if the group interventions would significantly decrease levels of depression, psychological distress, and grief, as well as significantly increase the level of social adjustment among widowed survivors of suicide. Sixty widowed survivors of suicide were randomized to either the BGP or SGP intervention for 1-1/2 hour weekly sessions over an 8-week period. Study participants were recruited through various media and community referrals and initiated telephone contact with the study investigators. Statistically significant changes were found on all measures when the SGP and the BGP were combined for analyses on posttreatment assessments at 3 to 5 days after completion of the group intervention, and 6 months and 12 months after the intervention. Participants experienced a significant reduction in overall depression, psychological distress, and grief, as well as an increase in social adjustment. Further research with tighter controls of confounding variables as well as the inclusion of a no-treatment control group is indicated.

No abstract

Abuse of women by their intimate partner is a staggering national problem. Abused women have a higher number of medically unexplained somatic symptoms, more functional disability, a lower self-rating of general health, and higher health care utilization when compared to nonabused women. The authors' purpose in this study was to examine differences in occurrences of negative life experiences, level of depression, and T-cell function between abused and nonabused women. The sample consisted of abused women (n = 12) and nonabused women (n = 12). Hypotheses tested were (1) abused women will have more negative life experiences than nonabused women, (2) abused women will have higher levels of depression than nonabused women, and (3) abused women will have reduced T-cell function compared to nonabused women. A cross-sectional cohort design was used to compare differences in negative life experiences, levels of depression, and T-cell function. Independent sample t-tests were performed comparing the abused versus nonabused women on the dependent measures. Significant differences were found between the groups for negative life experiences (LES; t = 2.29, p < 0.05), level of depression (BDI; t = 3.48, p < 0.01), and T-cell function (TMR; t = -5.62, p < 0.01). These findings are descriptive and do not establish causal links. However, this is an inquiry into the psychological and biobehavioral responses of women experiencing abuse and their potential health problems. The study shows that abused women reported more negative life experiences, experienced higher levels of depression, and experienced lower T-cell function when compared with nonabused women.

Following sexual assaults, victims are advised to seek health care services with forensic evidence collected and packaged in sexual assault kits (SAKs). This large ( N = 1,874), retrospective study examined rates of SAK submissions by law enforcement to the state crime laboratory for analysis from 2010 to 2013 at four sites in a Western state in the United States with established sexual assault nurse examiner (SANE) programs. Variables of legal and extralegal characteristics in sexual assault cases were explored through generalized estimating equations (GEE) modeling to determine what factors statistically predicted SAK submissions. For submitted SAKs, the length of time between the dates of assault and dates of submission was categorized, and bivariate and multivariate analyses were calculated to discover legal and extralegal characteristics affecting time of submission. The study sites represented 40% of the state's law enforcement agencies and 65% of the state's population. Out of the 1,874 SAKs in the study, only 38.2% were submitted by law enforcement to the state crime laboratory for analysis. When SAK submissions were examined based on time between assaults and submission dates, 22.8% were submitted within a year of the assault and 15.4% were submitted more than a year after the assault following media and community pressure for law enforcement agencies to submit SAKs in storage. Significant variability of SAK submission rates and the time submitted from the assault dates were found between the sites. Site location was found to be the main determinant of whether or not SAKs were submitted. The lack of SAK submissions for analysis results in justice denied for victims and raises public safety concerns. The finding that the location in which the sexual assault occurred was the primary factor on SAK submissions represents an inequity of justice.

No abstract

Animal studies indicate that central cholinergic neurotransmission stimulates CRH secretion, but several human studies suggest that the hypothalamo-pituitaryadrenal cortical (HPA) axis may be activated only by doses of cholinergic agonists that produce noxious side effects and, by inference, a nonspecific stress response. Physostigmine (PHYSO), a reversible cholinesterase inhibitor, was administered to normal women and men at a dose that elevated plasma ACTH cortisol, and arginine vasopressin (AVP) concentrations but produced few or no side effects. Exogenous AVP also was administered alone and following PHYSO, to determine if it would augment the effect of PHYSO on the HPA axis. Fourteen normal women and 14 normal men matched to the women on age and race underwent four test sessions 5 to 7 days apart: PHYSO (8 g/kg IV), AVP (0.08 U/kg IM), PHYSO plus AVP, and saline control. Serial blood samples taken before and after pharmacologic challenge were analyzed for ACTH , cortisol, and AVP. PHYSO and AVP administration produced no side effects in about half the subjects and mild side effects in the other half, with no significant female-male differences overall. There also were no significant female-male differences in ACTH or cortisol responses to AVP. In contrast, the men had significantly greater ACTH There is ample evidence from animal studies that cholinergic neurotransmission stimulates both CRH and arginine vasopressin (AVP) secretion (Gregg 1985;Tuomisto and Männistö 1985;Assenmacher et al. 1987 Received March 20, 1998; revised July 1, 1998; accepted July 10, 1998. N EUROPSYCHOPHARMACOLOGY 1999 -VOL . 20 , NO . 5 Pituitary-Adrenal Responses to Physostigmine and AVP 435 and Grossman 1990;Michels et al. 1991;Okuda et al. 1993;Whitnall 1993;Coiro et al. 1995;Calogero 1995;Ohmori et al. 1995), both of which stimulate ACTH secretion (Rivier et al. 1990;Antoni 1993). Several studies in humans, however, suggest that the hypothalamo-pituitary-adrenal cortical (HPA) axis is activated only by doses of cholinergic agonists that produce noxious side effects, especially nausea (Carroll et al. 1980;Davis et al. 1982;Doerr and Berger 1983;Nurnberger et al. 1983;Lewis et al. 1984;Krieg et al. 1987;Freeman et al. 1990), and, by inference, a nonspecific stress response, nausea being a powerful stimulus to AVP release (Nussey et al. 1988;Koch et al. 1990;Kohl 1992). In the present study, a dose of physostigmine (PHYSO), a reversible cholinesterase inhibitor, was established that discernibly elevated plasma ACTH and cortisol concentrations in normal subjects but produced few or no side effects. The purpose was to develop a pharmacologic cholinergic challenge to the central nervous system as specific as possible, with which to test the cholinergic overactivity hypothesis of major depression (Dilsaver 1986;Janowsky and Overstreet 1995), as reflected by HPA axis hormone responses in patients compared to controls.Under the hypothesis that a low, minimal side-effect producing dose of PHYSO would enhance the secretion...

Pennsylvania's response to adolescent suicide is its Student Assistance Program (SAP). SAP has been funded for 27 years although no statewide outcome studies using case-level data have been conducted. This study used logistic regression to examine drug-/alcohol-related behaviors and suspensions of suicidal students who participated in SAP. Of the 46 services, 10 best predicted (p<.01) that these undesirable outcomes would cease. Although no study subjects died by suicide, 42 of 374,626 referred students did die by suicide. Suicidal students who did not participate had double the rate of suicide of suicidal participants of SAP. Students referred for other reasons also killed themselves. Further work must be done to assess all referred students for suicide risk, examine educational outcomes, monitor substance-related crimes and overdoses, and examine school-related factors postmortem. Evidence from this study can be used by researchers to plan future studies and by Pennsylvania's school nurses when planning services.