Suicide: an existentialist reconceptualization

The phenomenon of suicide is one of the primary concerns for mental health professions. The health-care literature is dominated by discussions that focus variously on local and national suicide prevention policies, on the assessment of those individuals judged to be at risk of committing suicide as well as the appropriateness and efficacy of interventions for those who express suicidal ideation and display suicidal behaviours. What appear less frequently in the literature, however, are critical analyses of the concept of suicide and, in particular, critical reflections on the manner in which the concept of suicide has been, and continues to be, understood or 'framed'. In an attempt to respond to this apparent omission, this paper will suggest that the work of Albert Camus, and his philosophical work The Myth of Sisyphus in particular, can be understood as providing a significant reconceptualization and reframing of suicide. In doing so, it will be suggested that Camus's work not only challenges how the concept of suicide has traditionally been situated within the context of mental illness, but can also be understood as challenging the efficacy of the interventions that have been associated with an understanding of suicide within that context.

Common patterns of morbidity and multi-morbidity and their impact on health-related quality of life: evidence from a national survey

Background

There is limited evidence about the impact of specific patterns of multi-morbidity on health-related quality of life (HRQoL) from large samples of adult subjects.

Methods

We used data from the English General Practice Patient Survey 2011–2012. We defined multi-morbidity as the presence of two or more of 12 self-reported conditions or another (unspecified) long-term health problem. We investigated differences in HRQoL (EQ-5D scores) associated with combinations of these conditions after adjusting for age, gender, ethnicity, socio-economic deprivation and the presence of a recent illness or injury. Analyses were based on 831,537 responses from patients aged 18 years or older in 8,254 primary care practices in England.

Results

Of respondents, 23 % reported two or more chronic conditions (ranging from 7 % of those under 45 years of age to 51 % of those 65 years or older). Multi-morbidity was more common among women, White individuals and respondents from socio-economically deprived areas. Neurological problems, mental health problems, arthritis and long-term back problem were associated with the greatest HRQoL deficits. The presence of three or more conditions was commonly associated with greater reduction in quality of life than that implied by the sum of the differences associated with the individual conditions. The decline in quality of life associated with an additional condition in people with two and three physical conditions was less for older people than for younger people. Multi-morbidity was associated with a substantially worse HRQoL in diabetes than in other long-term conditions. With the exception of neurological conditions, the presence of a comorbid mental health problem had a more adverse effect on HRQoL than any single comorbid physical condition.

Conclusion

Patients with multi-morbid diabetes, arthritis, neurological, or long-term mental health problems have significantly lower quality of life than other people. People with long-term health conditions require integrated mental and physical healthcare services.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-014-0820-7) contains supplementary material, which is available to authorized users.

A genome-wide association study of anorexia nervosa

Anorexia nervosa (AN) is a complex and heritable eating disorder characterized by dangerously low body weight. Neither candidate gene studies nor an initial genome-wide association study (GWAS) have yielded significant and replicated results. We performed a GWAS in 2907 cases with AN from 14 countries (15 sites) and 14 860 ancestrally matched controls as part of the Genetic Consortium for AN (GCAN) and the Wellcome Trust Case Control Consortium 3 (WTCCC3). Individual association analyses were conducted in each stratum and meta-analyzed across all 15 discovery data sets. Seventy-six (72 independent) single nucleotide polymorphisms were taken forward for in silico (two data sets) or de novo (13 data sets) replication genotyping in 2677 independent AN cases and 8629 European ancestry controls along with 458 AN cases and 421 controls from Japan. The final global meta-analysis across discovery and replication data sets comprised 5551 AN cases and 21 080 controls. AN subtype analyses (1606 AN restricting; 1445 AN binge-purge) were performed. No findings reached genome-wide significance. Two intronic variants were suggestively associated: rs9839776 (P=3.01 × 10(-7)) in SOX2OT and rs17030795 (P=5.84 × 10(-6)) in PPP3CA. Two additional signals were specific to Europeans: rs1523921 (P=5.76 × 10(-)(6)) between CUL3 and FAM124B and rs1886797 (P=8.05 × 10(-)(6)) near SPATA13. Comparing discovery with replication results, 76% of the effects were in the same direction, an observation highly unlikely to be due to chance (P=4 × 10(-6)), strongly suggesting that true findings exist but our sample, the largest yet reported, was underpowered for their detection. The accrual of large genotyped AN case-control samples should be an immediate priority for the field.

Comparison of broiler performance and carcass yields when fed diets containing genetically modified canola meal from event DP-Ø73496-4, near-isogenic canola meal, or commercial canola meals

Genetically modified (GM) canola (Brassica napus L.) line containing event DP-Ø73496-4 (hereafter referred to as 73496 canola) was produced by the insertion of the glyphosate acetyltransferase (gat4621) gene derived from Bacillus licheniformis. Expression of the GAT4621 protein present in 73496 canola plants confers in planta tolerance to the herbicidal active ingredient glyphosate. The objective of this study was to compare the nutritional performance of broiler chickens fed canola meal from 73496 canola seed with that of broiler chickens fed non-GM canola meal in a 42-d feeding trial. Diets were prepared using meal processed from seed from unsprayed 73496 plants or from plants sprayed with an in-field application of glyphosate herbicide [73496(S)]. For comparison, additional diets were produced with canola meal obtained from the non-GM near-isogenic control or non-GM commercial reference DuPont Pioneer brand varieties 42H72, 42H73, 46A65, and 44A89. Diets were fed to Ross 708 broilers (n = 120/group, 50% male and 50% female) in 3 phases: starter and grower phases containing 10 or 20% canola meal, respectively, and a finisher phase with a common corn-soybean meal diet without any canola meal. No statistically significant differences were observed in growth performance measures or organ and carcass yields between broilers consuming diets produced with canola meal from unsprayed or sprayed 73496 seed and those consuming diets produced with canola meal from control seed. Additionally, all performance, organ, and carcass measures from control, 73496, and 73496(S) canola treatment groups were within tolerance intervals constructed using data from the reference canola groups. It was concluded from these results that meal processed from 73496 canola seed (unsprayed plants or plants sprayed with glyphosate) was nutritionally equivalent to meal processed from non-GM near-isogenic control canola seed.

Beyond the bounds of the dogmatic image of thought: the development of critical, creative thinking in the mental health professions

Reflections upon what it might mean to think, and about what inherited presuppositions or images might influence what thinking is thought to consist of, are not readily considered in the mental health care literature. However, the work of the 20th century French philosopher Gilles Deleuze and, in particular, his account of 'the dogmatic image of thought' can be employed to illustrate how such considerations can be of relevance to the theoretical and practical concerns of mental health professionals. In doing so, Deleuze's work can be understood as seeking to sensitize mental health professionals to the dangers of unreflectively adopting a restrictive notion of what it means to think, as well as an exhortation to develop critical, creative thinking in the mental health professions that moves beyond the bounds of the traditional, dogmatic image of thought. Considerations about what it might mean to think, and about what inherited presuppositions determine what thinking is thought to consist of, are not readily reflected upon in the mental health care literature. However, this paper will propose that such considerations are of relevance to, and possess important implications for, the mental health professions, and it will do so within the context of the work of the 20th century philosopher Gilles Deleuze. In particular, the paper will provide an accessible exposition of what Deleuze refers to as the 'dogmatic image of thought', along with an examination of his suggestion that this traditional image, and its associated presuppositions, not only determine what is considered to be the ostensible 'nature' of thought, but also delineate what the activity of thinking ought to be concerned with. Moreover, it will be argued that Deleuze's exposition and critique of the image of thought can be understood as seeking to sensitize mental health professionals to the dangers of unreflectively perpetuating a restrictive notion of what it means to think, as well as being an exhortation to develop critical, creative thinking in the mental health professions that moves beyond the bounds of that traditional, dogmatic image of thought.

Lipid biomarkers in ooids from different locations and ages: evidence for a common bacterial flora

Ooids are one of the common constituents of ancient carbonate rocks, yet the role that microbial communities may or may not play in their formation remains unresolved. To search for evidence of microbial activity in modern and Holocene ooids, samples collected from intertidal waters, beaches and outcrops in the Bahamas and in Shark Bay in Western Australia were examined for their contents of lipid biomarkers. Modern samples from Cat and Andros islands in the Bahamas and from Carbla Beach in Hamelin Pool, Western Australia, showed abundant and notably similar distributions of hydrocarbons, fatty acids (FAs) and alcohols. A large fraction of these lipids were bound into the carbonate matrix and only released on acid dissolution, which suggests that these lipids were being incorporated continuously during ooid growth. The distributions of hydrocarbons, and their disparate carbon isotopic signatures, were consistent with mixed input from cyanobacteria together with small and variable amounts of vascular plant leaf wax [C27 -C35 ; δ(13) C -25 to -32‰Vienna Pee Dee Belemnite (VPDB)]. The FAs comprised a complex mixture of C12 -C18 normal and branched short-chain compounds with the predominant straight-chain components attributable to bacteria and/or cyanobacteria. Branched FA, especially 10-MeC16 and 10-MeC17 , together with the prevalence of elemental sulfur in the extracts, indicate an origin from sulfate-reducing bacteria. The iso- and anteiso-FA were quite variable in their (13) C contents suggesting that they come from organisms with diverse physiologies. Hydrogen isotopic compositions provide further insight into this issue. FAs in each sample show disparate δD values consistent with inputs from autotrophs and heterotrophs. The most enigmatic lipid assemblage is an homologous series of long-chain (C24 -C32 ) FA with pronounced even carbon number preference. Typically, such long-chain FA are thought to come from land plant leaf wax, but in this case, their (13) C-enriched isotopic signatures compared to co-occurring n-alkanes (e.g., Hamelin Pool TLE FA C24 -C32 ; δ(13) C -20 to -24.2‰ VPDB; TLE n-alkanes δ(13) C -24.1 to -26.2 -‰VPDB) indicate a microbial origin, possibly sulfate-reducing bacteria. Lastly, we identified homohopanoic acid and bishomohopanol as the primary degradation products of bacterial hopanoids. The distributions of lipids isolated from Holocene oolites from the Rice Bay Formation of Cat Island, Bahamas were very similar to the beach ooids described above and, in total, these modern and fossil biomarker data lead us to hypothesize that ooids are colonized by a defined microbial community and that these microbes possibly mediate calcification.

Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis

Mutations in the skeletal muscle ryanodine receptor (RYR1) gene are a common cause of neuromuscular disease, ranging from various congenital myopathies to the malignant hyperthermia (MH) susceptibility trait without associated weakness. We sequenced RYR1 in 39 unrelated families with rhabdomyolysis and/or exertional myalgia, frequent presentations in the neuromuscular clinic that often remain unexplained despite extensive investigations. We identified 9 heterozygous RYR1 mutations/variants in 14 families, 5 of them (p.Lys1393Arg; p.Gly2434Arg; p.Thr4288_Ala4290dup; p.Ala4295Val; and p.Arg4737Gln) previously associated with MH. Index cases presented from 3 to 45 years with rhabdomyolysis, with or without exertional myalgia (n=12), or isolated exertional myalgia (n=2). Rhabdomyolysis was commonly triggered by exercise and heat and, less frequently, viral infections, alcohol and drugs. Most cases were normally strong and had no personal MH history. Inconsistent additional features included heat intolerance, and cold-induced muscle stiffness. Muscle biopsies showed mainly subtle changes. Familial RYR1 mutations were confirmed in relatives with similar or no symptoms. These findings suggest that RYR1 mutations may account for a substantial proportion of patients presenting with unexplained rhabdomyolysis and/or exertional myalgia. Associated clinico-pathological features may be subtle and require a high degree of suspicion. Additional family studies are paramount in order to identify potentially MH susceptible relatives.

Understanding the value of the arts in the education of mental health professionals: Georg Lukács, Samuel Beckett and the aesthetic category of specific particularity

The manner in which the arts can enhance the practical, therapeutic concerns of mental health professionals is becoming well established in the health care literature. What gets discussed less frequently, however, are those aesthetic frameworks that propose to give an account of the possible 'meaning' and 'purpose' of art. In response, this paper will elucidate the aesthetic theory of the Hungarian philosopher Georg Lukács and will suggest that his concept of specific particularity enables an understanding of how art, and literature, poetry and drama in particular, can be employed as an educational resource that can contribute to the development of the 'emotional capabilities' of practitioners. However, insofar as Lukács' works are philosophically complex and challenging, his concept of specific particularity will be discussed within the context of Samuel Beckett's dramatic work Ohio Impromptu. In doing so, it will be suggested that Ohio Impromptu is not only productive for the elucidation of Lukács' aesthetics, but also illustrates how the arts provides practitioners with a valuable educative opportunity to engage with, and critically reflect upon, a multiplicity of affective dimensions, thereby enhancing the practitioner's ability to move towards achieving an empathic understanding of, and 'emotional resonance' with, those receiving mental health care.

Falls from height: injury and mortality

OBJECTIVES

To determine how Injury Severity Score (ISS) and mortality relate to height fallen, and to determine other predictors of mortality including intent and body region injured.

METHODS

A pre-hospital retrospective, observational database study was conducted. Injured or deceased patients following a fall from height (FFH), aged 16 or over, attended to by London Helicopter Emergency Medical Services (HEMS), between Jan 2008 to July 2009 were included in the study. In addition to the database, HEMS mission 'run sheets' provided further information.

RESULTS

117 (91 males and 26 females) patients met the inclusion criteria. The mean age was 37 years (range 16 - 85). 34/117 (29%) died. The mean ISS was 28.6 (median 17) and the mean height fallen 9.9m (3rd floor). In the group that died the mean height was 16.7m (5th floor). Height fallen was found to be a significant predictor of mortality (p < 0.001), as were injuries to the chest and/or head (p < 0.05). In patients with head and chest injuries, a 50% mortality rate was estimated to occur at falls from 10.5m, compared to 22.4m in those without injuries to head or chest. Deliberate falls were more common amongst females than males (chi-squared test, p = 0.001), were associated with greater ISS (Mann Whitney test, p < 0.001) and were more likely to result in death (chi-squared test, p < 0.001).

CONCLUSIONS

Height fallen correlates with ISS and is a significant predictor of death. Chest and/or head injuries significantly increased the likelihood of death following a FFH. This information may enhance triage criteria applied to tasking of emergency response vehicles, and strategies in injury prevention. Other potential predictors of mortality were not found to be significant.