[Cyberstalking]

The term cyberstalking appears in the media with increasing frequency. So far epidemiological studies are sparse. Since researchers have used different definitions and study samples for cyberstalking, widely varying prevalence rates have been published. We report here a case of cyberstalking and discuss available empirical data. Cyberstalking may cause psychological distress similar to that of real world stalking. The need for a scientific definition of cyberstalking and for future studies is presented. Since it is likely that psychiatrists will encounter victims of cyberstalking they should have knowledge of this phenomenon.

[Are journalists more frequently victims of stalking? Results of first empirical examinations]

The lifetime prevalence of stalking is about 12% in the general population. The risk to become a stalking victim is increased for psychiatrists and psychologists. However, there are no studies with regard to other professions. The present study analyses the lifetime prevalence of stalking victimization for journalists, because some professional tasks may also put members of this professional group at a higher risk to become a stalking victim. 493 journalists answered an internet questionnaire. 12% of the journalists reported stalking victimization due to private or other non-professional reasons. This is nearly exactly the same lifetime prevalence that was found in a German community sample. However, 2.2% of the journalists reported stalking victimization that was related to their professional work. This is the first empirical study on this issue. Due to methodological problems no other studies have been published on this topic so far. The reported data of this study have to be interpreted cautiously, because the data are not based on a representative sample. However, comparisons with community-based epidemiological studies render our data a valid basis for starting a discussion of a so far neglected research issue. Our preliminary data suggest that journalists may be at higher risk to become a stalking victim because of their professional activities. Since stalking may cause severe psychological distress in the victims and, in some cases, puts them in severe risk of aggressive violence, preventive strategies should be considered.

[Ill due to amalgam? 10 rules for managing the symptomatic patient]

Over the past two decades, mercury released by amalgam fillings has been held responsible for a number of mental and somatic health complaints. However, a systematic relation between increased mercury levels and the severity of the reported symptoms has never been demonstrated in any of the present well-controlled multidisciplinary studies. These studies, however, have found a high prevalence of mental disorders, especially somatization syndromes, among patients with self-diagnosed "amalgam illness". Additionally, our own studies indicate that amalgam anxiety is often merely one aspect of a general environmental anxiety. Overall, the present findings suggest a psychological etiology for amalgam-related complaints. Our psychosomatic model of "amalgam illness" integrates external factors, individual predispositions and specific processes of perception, awareness, evaluation and attribution. Practical management strategies for primary care physicians can be derived from this model.

Adverse health effects related to mercury exposure from dental amalgam fillings: toxicological or psychological causes?

BACKGROUND

Possible adverse health effects due to mercury released by amalgam fillings have been discussed in several studies of patients who attribute various symptoms to the effects of amalgam fillings. No systematic relation of specific symptoms to increased mercury levels could be established in any of these studies. Thus, a psychosomatic aetiology of the complaints should be considered and psychological factors contributing to their aetiology should be identified.

METHODS

A screening questionnaire was used to identify subjects who were convinced that their health had already been affected seriously by their amalgam fillings (N = 40). These amalgam sensitive subjects were compared to amalgam non-sensitive subjects (N = 43). All participants were subjected to dental, general health, toxicological and psychological examinations.

RESULTS

The two groups did not differ with respect to the number of amalgam fillings, amalgam surfaces or mercury levels assessed in blood, urine or saliva. However, amalgam sensitive subjects had significantly higher symptom scores both in a screening instrument for medically unexplained somatic symptoms (SOMS) and in the SCL-90-R Somatization scale. Additionally, more subjects from this group (50% versus 4.7%) had severe somatization syndromes. With respect to psychological risk factors, amalgam sensitive subjects had a self-concept of being weak and unable to tolerate stress, more cognitions of environmental threat, and increased habitual anxiety. These psychological factors were significantly correlated with the number and intensity of the reported somatic symptoms.

CONCLUSIONS

While our results do not support an organic explanation of the reported symptoms, they are well in accord with the notion of a psychological aetiology of the reported symptoms and complaints. The findings suggest that self-diagnosed 'amalgam illness' is a label for a general tendency toward somatization.

Exposure-response analysis of risk of respiratory disease associated with occupational exposure to chrysotile asbestos

OBJECTIVES

To evaluate alternative models and estimate risk of mortality from lung cancer and asbestosis after occupational exposure to chrysotile asbestos.

METHODS

Data were used from a recent update of a cohort mortality study of workers in a South Carolina textile factory. Alternative exposure-response models were evaluated with Poisson regression. A model designed to evaluate evidence of a threshold response was also fitted. Lifetime risks of lung cancer and asbestosis were estimated with an actuarial approach that accounts for competing causes of death.

RESULTS

A highly significant exposure-response relation was found for both lung cancer and asbestosis. The exposure-response relation for lung cancer seemed to be linear on a multiplicative scale, which is consistent with previous analyses of lung cancer and exposure to asbestos. In contrast, the exposure-response relation for asbestosis seemed to be nonlinear on a multiplicative scale in this analysis. There was no significant evidence for a threshold in models of either the lung cancer or asbestosis. The excess lifetime risk for white men exposed for 45 years at the recently revised OSHA standard of 0.1 fibre/ml was predicted to be about 5/1000 for lung cancer, and 2/1000 for asbestosis.

CONCLUSIONS

This study confirms the findings from previous investigations of a strong exposure-response relation between exposure to chrysotile asbestos and mortality from lung cancer, and asbestosis. The risk estimates for lung cancer derived from this analysis are higher than those derived from other populations exposed to chrysotile asbestos. Possible reasons for this discrepancy are discussed.

Premorbid adjustment as predictor of outcome in schizophrenia: results of a prospective study

The present prospective follow-up study of 163 schizophrenic patients admitted to hospital for the first time examined the relationship between premorbid adjustment and different measures of the 3-year course and outcome. The same instruments had been used in all phases of the study. The Premorbid Adjustment Scale was used to assess premorbid social functioning. Outcome measures were positive symptoms, negative symptoms, social disability and number of rehospitalizations. The results of the multiple regression analyses showed that premorbid adjustment was the strongest overall predictor of outcome. Premorbid adjustment was significantly associated with negative symptoms and social disability over the 3-year course of illness. In a further step, we examined the relationship between good, moderate and poor premorbid adjustment and the course of positive symptoms, negative symptoms and social disability within the first 3 years after index admission. The most important finding was that premorbid functioning showed a stronger correlation with the course of negative symptoms and social disability than with the course of positive symptoms. Poor premorbid social functioning implies a poor social course of the illness. Female subjects showed better premorbid functioning than male subjects. Good premorbid adjustment was strongly associated with an acute onset of the illness, and poor premorbid adjustment with an insidious onset.

The Prognostic Scale by Strauss and Carpenter and its validity

The Prognostic Scale by Strauss and Carpenter (1974) is thoroughly analysed and its predictive value is compared with other predictors, such as symptomatology, premorbid adjustment and social disability. A sample of 138 first-hospitalized schizophrenic patients serve as database. The total days of stationary treatment, the number of rehospitalizations, a complex criterion regarding the course of illness and the extent of social impairment were selected as outcome criteria. The period of time allowing for predictions was 36 months after index episode. A factor analysis yields results indicating that the Prognostic Scale can be divided into two subscales, namely the "social functioning in the previous twelve months" and the "extent of handicap by psychiatric symptoms". With respect to prognostic aspects it is the first subscale which proves to be especially valuable.

Stability trends and longitudinal correlations of negative and positive syndromes within a three-year follow-up of initially hospitalized schizophrenics

Our study investigates whether the distinction between positive and negative symptoms in schizophrenia--as discussed in the literature--can be confirmed by a factor analysis and whether such a distinction proves stability over time. In a further step, symptom factors are correlated to different external variables for the purpose of validation. Processed data cover 36 months obtained from a prospective 5-year follow-up study of 163 initially hospitalized schizophrenics. The results permit for dividing the symptoms into a total of five factors--two representing positive and negative symptoms and one representing the general neurotic syndrome. This factor structure proved to be stable over time. Correlations between symptom factors and external variables justify a trait-interpretation of the negative factor anhedonia.

Patient Rejection Scale: correlations with symptoms, social disability and number of rehospitalizations

The Patient Rejection Scale (RPS), which was developed to assess rejecting attitudes and feelings of relatives toward mental patients, was administered to a German sample of 44 family members or significant others living with first-admitted schizophrenics. Both at admission (t0) and 6 months later (t6), the PRS was significantly correlated with the number of rehospitalizations during the first 3 years after admission. In comparison, the association between PRS scores and different measures of psychopathology during the 2-year follow-up period was weak. Thus, rejecting attitudes of patients' relatives seem to imply a higher risk of relapse without substantial medication by symptoms. We suspect that relatives with rejecting attitudes towards a patient might tend to apply for readmission more easily than more accepting relatives.

Effects of dose, age, inhibition of metabolism and elimination on the toxicokinetics of 2-butoxyethanol and its metabolites

Acute exposure to 2-butoxyethanol (BE) causes dose- and age-dependent hemolytic anemia in rats. Recently, we have shown that butoxyacetic acid (BAA) is the proximate hemolytic agent and that inhibition of alcohol or aldehyde dehydrogenases protected rats against BE-induced hemolytic anemia. In the present investigations, the kinetics of 14C-BE metabolism and clearance were studied in control adult (3-4 months old) and old (12-13 months old) male F344 rats and in adult male F344 rats treated with pyrazole, cyanamide or probenecid. Our results showed that the area under the curve (AUC), maximum plasma concentration (Cmax) and systemic clearance (Cls) of BE were dose-dependent. In contrast, there was no effect of dose on half-life (T1/2) or volume of distribution (Vd) of BE. These results also showed that there was no age effect on T1/2, Vd or Cls of BE. However, Cmax and AUC of BE increased as a function of age. Also, analysis of variance indicated no significant interactions (P less than or equal to .05) between dose and age in relation to BE kinetics. As expected, inhibition of BE metabolism by pretreatment of rats with pyrazole or cyanamide resulted in a significant increase in the T1/2 and AUC of BE, whereas it caused a significant decrease in the Cls. Furthermore, pyrazole had no effect, whereas cyanamide had decreased Vd of BE. Analysis of the toxicokinetic parameters of BAA revealed that T1/2, AUC and Cmax of BAA were directly related to the age of the rats and the dose of BE administered.(ABSTRACT TRUNCATED AT 250 WORDS)

Acquired immunity to Fasciola hepatica in splenectomised rats

Significant resistance to a second infection with Fasciola hepatica was obtained in splenectomised and sham operated rats (P less than 0.001, 78 and 76 per cent respectively) when compared with singly infected splenectomised or sham operated control groups. For both the stimulating and challenge infections, there were no significant differences in the number of flukes recovered from rats that had been splenectomised as compared to those receiving the sham operation. Thus, splenectomy did not significantly affect the ability of rats to develop an acquired immunity to F hepatica, nor were fluke recoveries from a particular schedule of infection significantly affected by the presence of absence of a spleen. It is concluded that the presence of a spleen is not necessary for the development of acquired immunity to F hepatica in the rat.