Informal caregivers and the intention to hasten AIDS-related death - Cooke, M.; Gourlay, L.; Collette, L.; Boccellari, A.; Chesney, M.A.; Folkman, S. (Archives of Internal Medicine, 1998)
Objectives: To determine the extent to which homosexual men dying of the acquired immunodeficiency syndrome (AIDS) receive medication intended to hasten death. To assess the impact on caregivers of administering medications intended to hasten death. Methods: In a prospective study of caregiving partners of men with AIDS (n=140), characteristics of the ill partner, the caregiver, and the relationship were assessed at baseline and 1 month before the ill partner's death. Three months after the death, caregivers were asked if they had increased their partner's narcotic and/or sedative-hypnotic medication dose and if so, what had been the objective of the increase, and their comfort with their medication decisions. Results: Of 140 ill partners who died of AIDS, 17 (12.1%) received an increase in the use of medications immediately before death intended to hasten death. Diagnoses and care needs of ill partners who received increases in the use of medications to hasten death did not differ from those of ill partners receiving medication for symptoms. Fourteen increases (10%) in use of medications were administered by caregivers. These caregivers did not differ from those administering medication for symptom control in level of distress, caregiving burden, relationship characteristics, or comfort with the medication decision, but they reported more social support and positive meaning in caregiving. Conclusion: The decision to hasten death is not a rare event in this group of men. There is no evidence that it is the result of caregiver distress, poor relationship quality, or intolerable caregiving burden; and it does not cause excessive discomfort in the surviving partner. This study, although small, has implications for the policy debate on assisted suicide.
Keywords: morphine; acquired immune deficiency syndrome; adult; article; bereavement; caregiver; coping behavior; distress syndrome; drug overdose; euthanasia; human; major clinical study; male; palliative therapy; priority journal; psychological aspect; social support; terminal care

The relationship between suicide risk and sexual orientation: Results of a population-based study - Remafedi, G.; French, S.; Story, M.; Resnick, M.D.; Blum, R. (American Journal of Public Health, 1998)
Objectives. This study examined the relationship between sexual orientation and suicide risk in a population-based sample of adolescents. Methods. Participants were selected from a cross-sectional, statewide survey of junior and senior public high school students. All males (n = 212) and females (n = 182) who described themselves as bisexual/homosexual were compared with 336 gender-matched heterosexual respondents on three outcome measures: suicidal ideation, intent, and self-reported attempts. Logistic regression analyses were used to examine the association between sexual orientation and outcome measures with adjustment for demographic characteristics. Results. Suicide attempts were reported by 28.1% of bisexual/homosexual males, 20.5% of bisexual/homosexual females, 14.5% of heterosexual females, and 4.2% of heterosexual males. For males, but not females, bisexual/homosexual orientation was associated with suicidal intent (odds ratio [OR] = 3.61; 95% confidence interval [CI] = 1.40, 9.36) and attempts (OR = 7.10; 95% CI = 3.05, 16.53). Conclusions: There is evidence of a strong association between suicide risk and bisexuality or homosexuality in males.
Keywords: article; bisexuality; female; heterosexuality; homosexuality; human; male; normal human; risk assessment; sexual orientation; suicide

Death by homicide in Special Hospitals - Gordon, H.; Oyebode, O.; Minne, C. (Journal of Forensic Psychiatry, 1997)
Homicide by psychiatric inpatients is rare. This paper outlines initially a review of the literature on patients who have killed fellow patients or staff whilst admitted to psychiatric hospitals. It then describes cases of such homicide by patients in Special Hospitals. Various factors which may be associated with such homicides are then discussed. These include the relationship of homicide to suicide, risk of homosexual interaction and associations between psychopathic disorder, homicide and escape. After a homicide has occurred a range of options may then occur according to clinical and administrative factors.
Keywords: article; cause of death; homicide; homosexuality; hospital patient; human; mental hospital; priority journal; psychopathy; risk; suicide

Autopsy findings on patients with AIDS in Taiwan. - Hsiao, C.H.; Huang, S.H.; Huang, S.F.; Song, C.L.; Su, I.J.; Chuang, C.Y.; Yao, Y.T.; Lin, C.T.; Hsu, H.C. (Zhonghua Minguo wei sheng wu ji mian yi xue za zhi = Chinese journal of microbiology and immunology, 1997)
At National Taiwan University Hospital, from 1986 to 1996, autopsies were performed on 16 patients with acquired immunodeficiency syndrome. There were 15 men and 1 woman. Fourteen of these male patients had contracted the disease as a result of sexual practice, among which 9 were homosexual, 1 was bisexual and 4 were heterosexual. One of the patients had become infected by sharing a syringe during intravenous drug use. The female was a sex worker. Among these patients, only 2 had been tested for HIV before developing AIDS. On autopsy, lymphoid depletion and thymus atrophy were found in all patients. Testicular atrophy was noted in all the male patients. Three patients died of malignant lymphoma. Twelve patients died of opportunistic infections and 1 committed suicide. The initial opportunistic infection was usually oral candidiasis. Pneumocystis carinii pneumonia (PCP) was the most common opportunistic infection developed in the early stage while cytomegalovirus (CMV) infection was the most common one found in the late stage. Mycobacterium infection had developed in 8 patients. Six patients had disseminated Kaposi's sarcoma (KS) and 4 of them were homosexual. In 4 patients, biopsy specimens were proved to have KS associated viral (HHV-8) genome. Malignant lymphoma was found in 4 cases, all were of high grade B cell type. Epstein-Barr virus (EBV) encoding small RNA (EBER1) was demonstrated in all the lymphomas. In conclusion, (1) the prevalence of tuberculosis (38%) in patients with AIDS in Taiwan is high; (2) the most common opportunistic infections in this series are candidiasis, PCP and CMV infections; (3) the incidence of AIDS related non-Hodgkin's lymphoma in Taiwan has increased since 1995.
Keywords: acquired immune deficiency syndrome; adult; AIDS related complex; article; autopsy; B cell lymphoma; candidiasis; cytomegalovirus infection; female; human; Kaposi sarcoma; male; middle aged; pathology; Pneumocystis pneumonia; Taiwan

Suicidal behaviors in homosexual and bisexual males. - Bagley, C.; Tremblay, P. (Crisis, 1997)
A stratified random sample of 750 males in Calgary, Canada, aged 18-27 years, were given questions on sexual activity and orientation. Mental health questions included a measure of suicidality and of acts of deliberate self-harm. A computerized response format, which has been established as a good method for eliciting sensitive personal data, ensured anonymity. Almost 13% of the males were classified as homosexual or bisexual on the basis of being currently homosexually active or by self-identification. Significantly higher rates of previous suicidal ideas and actions were reported by homosexually oriented males than by heterosexual males. Homosexually oriented males accounted for 62.5% of suicide attempters. These findings, which indicate that homosexual and bisexual males are 13.9 times more at risk for a serious suicide attempt, are consonant with previous findings. The predominant reason for the suicidality of these young males may be linked to the process of "coming out," especially for those who currently have high levels of depression. These results underscore the need for qualified services rarely available to homosexually oriented youth.
Keywords: adolescent; adult; article; bisexuality; Canada; chi square distribution; cluster analysis; cross-sectional study; depression; epidemiology; homosexuality; human; male; psychological aspect; statistics; suicide attempt

D.C. hospital must pay $400,000 for forced test and denial of care. (AIDS policy & law, 1997)
Keywords: article; compensation; confidentiality; Estate of Doe v. Howard University Hospital; Health Care and Public Health; health care delivery; homosexuality; human; Human immunodeficiency virus infection; interpersonal communication; Legal Approach; legal aspect; male; patient abandonment; social psychology; suicide attempt; United States; university hospital

Working toward recovery with the lesbian patient. - Lynch, M.A. (The American journal of nursing, 1997)
Keywords: alcohol; anxiolytic agent; benzodiazepine derivative; adult; article; case report; female; human; intoxication; homosexual female; mental disease; nurse patient relationship; nursing; patient care planning; psychiatric nursing; psychological aspect; suicide attempt

The association of weapon carrying and fighting on school property and other health risk and problem behaviors among high school students - DuRant, R.H.; Kahn, J.; Beckford, P.H.; Woods, E.R. (Archives of Pediatrics and Adolescent Medicine, 1997)
Objective: To examine the association between weapon carrying on school property and engaging in health risk and problem behaviors such as fighting and substance use on school property, fear of attending school, and victimization at school. Designs: A complex 2-stage probability survey (Massachusetts Youth Risk Behavior Survey). Setting: High schools in Massachusetts. Participants: Three thousand fifty-four high school students. Main Outcome Measures: Number of days a weapon was carried on school property during the 30 days prior to the survey. Results: The prevalence of self- reported weapon carrying on school property was 15% among male students and 5% among female students (P< .001). Weapon carrying on school property was significantly (P<.001) associated with frequency of physical fights on school property (r=0.26), being a victim of threat or injury with a weapon on school property (r=0.27), being a victim of stolen or damaged goods on school property (r=0.14), not attending school owing to fear (r= 0.15), and substance use while at school, including smoking cigarettes (r=0.20), using chewing tobacco (r=0.18), smoking marijuana (r=0.24), and using alcohol (r=0.29). The association between weapon carrying and alcohol use in school was higher among students who were afraid to come to school (r= 0.49) than among students who were not afraid (r= 0.28). Students who had engaged in same-sex sexual activity (P<.001) or had been offered, given, or said illicit drugs at school (P<.001) were more likely to carry a weapon at school. Multiple regression analysis showed that male sex and the frequencies of physical fighting, being a victim of a threat or injury, drinking alcohol, smoking cigarettes, and being offered or said an illicit drug while on school property accounted for 21% of the variance in weapon carrying in school. When weapon carrying was dichotomized and analyzed with logistic regression, a model containing age, male sex, lower academic achievement, days not attending school owing to fear, times threatened or injured with a weapon at school, frequency of fighting at school, cigarette smoking, alcohol use, and being offered or said illicit drugs on school property correctly classified 91.83% of the students who did or did not carry weapons. Conclusions: Weapon carrying at school was more strongly associated more with use of violence and the use of substances at school than with previous victimization and fear of attending school. However, there is a subgroup of students that seems to have been victimized at school, is afraid to come to school, is using alcohol at school, and is carrying weapons at school.
Keywords: adolescence; adolescent; aggression; article; cigarette smoking; fear; female; gunshot injury; health hazard; high school; human; major clinical study; male; priority journal; probability; regression analysis; self report; substance abuse; victim; violence; weapon

Genes and human behavior: the emerging paradigm. - Drew, A.P. (Zygon, 1997)
The physical properties of human beings and other organisms as well as their social behavioral traits are manifestations of both genetic inheritance and environment. Recent behavioral research has indicated that certain characteristics or behaviors--such as schizophrenia, divorce, and homosexuality--are highly heritable and are not governed exclusively by social environment. A balanced view of human behavior includes the effects of social learning as well as of genetically determined behavior. A new paradigm promotes enhanced understanding and acceptance of human diversity, be it cultural, racial, or sexual, and has the potential to unite scientists and theologians by creating common grounds of understanding.
Keywords: alcoholism; article; behavior genetics; behavioral research; Biomedical and Behavioral Research; divorce; genetics; Genetics and Reproduction; heredity; homosexuality; human; schizophrenia; sociobiology; suicide; twins

Comorbidity of gender dysphoria and other major psychiatric diagnoses - Cole, C.M.; O'Boyle, M.; Emory, L.E.; Meyer III, W.J. (Archives of Sexual Behavior, 1997)
Previous studies suggest that many transsexuals evidence an Axis I diagnosis according to the DSM-IV classification (e.g., psychoses, major affective disorder). The current study examined retrospectively the comorbidity between gender dysphoria and major psychopathology, evaluating the charts of 435 gender dysphoric individuals (318 male and 117 female). All had undergone an extensive evaluation, addressing such areas as hormonal/surgical treatment, and histories of substance abuse, mental illness, genital mutilation, and suicide attempts. In addition, a subgroup of 137 individuals completed the MMPI. Findings revealed over two thirds were undergoing hormone reassignment, suggesting a commitment to the real-life cross-gender process. One quarter had had problems with substance abuse prior to entering treatment, but less than 10% evidenced problems associated with mental illness, genital mutilation, or suicide attempts. Those completing the MMPI (93 female and 44 male) demonstrated profiles that were notably free of psychopathology (e.g., Axis I or Axis II criteria). The one scale where significant differences were observed was the Mf scale, and this held true only for the male-to-female group. Psychological profiles as measured by the MMPI were more 'normal' in the desired sex than the anatomic sex. Results support the view that transsexualism is usually an isolated diagnosis and not part of any general psychopathological disorder.
Keywords: article; comorbidity; differential diagnosis; disease classification; dysphoria; female; human; major clinical study; male; mental disease; Minnesota Multiphasic Personality Inventory; transsexualism

Physician-assisted suicide and patients with human immunodeficiency virus disease - Slome, L.R.; Mitchell, T.F.; Charlebois, E.; Benevedes, J.M.; Abrams, D.I. (New England Journal of Medicine, 1997)
Background: Data are limited on the attitudes and practices of physicians regarding assisting the suicide of patients with human immunodeficiency virus (HIV) disease. Methods: Between November 1994 and January 1995, we used an anonymous, self-administered questionnaire to survey all 228 physicians in the Community Consortium, an association of providers of health care to patients infected with HIV in the San Francisco Bay area. The responses were compared with those in a 1990 survey of consortium physicians. Physician assisted suicide was defined as 'a physician providing a sufficient dose of narcotics to enable a patient to kill himself.' Respondents were to 'assume that the patient is a mentally competent, severely ill individual facing imminent death.' Results: One hundred eighteen of the questionnaires were evaluated. Respondents reported a mean of 7.9 'direct' and 13.7 'indirect' requests from patients for assistance. In responses based on a case vignette, 48 percent of the physicians said they would be likely or very likely to grant the request of a patient with the acquired immunodeficiency syndrome (AIDS) for assistance in a suicide, as compared with 28 percent of the respondents in 1990. Asked to estimate the number of times they had granted the request of a patient with AIDS for assistance in committing suicide, 53 percent said they had done so at least once (mean number of times, 4.2; median, 1.0; range, 0 to 100). In a multivariate analysis, factors positively associated with a physician's having, in fact, assisted a suicide were having had a higher number of patients with AIDS who had died; having received a higher number of indirect requests from patients for assistance; having a stated gay, lesbian, or bisexual orientation him- or herself; and having a higher 'intention to assist' score (as calculated from the physician's responses to the case vignette). Conclusions: Within a group of physicians caring for patients with HIV disease, the acceptance of assisted suicide increased between 1990 and 1995. A majority of respondents in 1995 said they had granted a request for assisted suicide from a patient with AIDS at least once.
Keywords: article; euthanasia; human; Human immunodeficiency virus infection; medical practice; physician attitude; priority journal; suicide

Induction of invasive squamous cell carcinomas in the forestomach of (C3H x MSM)F1, MSM, and C3H mice by N-methyl-N-nitrosourea and mutational analysis of the H-ras and p53 genes - Masui, T.; Tezuka, N.; Nakanishi, H.; Inada, K.-I.; Miyashita, N.; Tatematsu, M. (Cancer Letters, 1997)
Genetic analysis of tumors developing in F1 hybrids between genetically separate strains of mice makes it possible to search for loss of heterozygosity (LOH), information on which provides clues to finding tumor-suppressor genes. For this purpose, however, reproducible carcinogenic conditions for the organ of interest need to be first determined. In the present study, a forestomach model of squamous cell carcinomas (SCCs), induced in (C3H x MSM)F1 mice by N-methyl-N-nitrosourea (MNU), was established and mutational changes in the H-ras and p53 genes were examined in tumors. Male (C3H x MSM)F1, MSM and C3H mice were given MNU by i.g. intubation once a week at a dose of 0.03 mg/g body weight for 10 weeks, then kept without further treatment. At experimental weeks 38-46, markedly invasive SCCs were observed in the forestomach at incidences of 9/14 (64.3%), 9/16 (56.3%), and 2/10 (20.0%), respectively. In the three strains of mice, DNA analysis of SCCs by PCR-SSCP analysis followed by direct DNA sequencing revealed low incidences of point mutations in the H-ras (4/20, 20%) and p53 (3/20, 15%) genes. The results demonstrate the usefulness of the present animal experimental protocol for induction of high grade SCC in the forestomach of (C3H x MSM)F1 mice, and suggest the possibility that point mutations in the H-ras or p53 genes may play some role in pathways leading to the development of such lesions.
Keywords: DNA; methylnitrosourea; protein p53; animal experiment; animal model; animal tissue; article; cancer genetics; cancer incidence; chemical carcinogenesis; controlled study; forestomach; mouse; mutation rate; nonhuman; oncogene H ras; point mutation; polymerase chain reaction; priority journal; single strand conformation polymorphism; squamous cell carcinoma; stomach carcinogenesis; stomach carcinoma; tumor suppressor gene

Lesbian Uses of and satisfaction with mental health services: Results from Boston Lesbian Health Project - Sorensen, L.; Roberts, S.J. (Journal of Homosexuality, 1997)
In response to the dearth of specific information about lesbians' health status and practices in the health literature, a national study utilizing a self-administered questionnaire was conducted in 1987 by four associates of the Fenway Community Health Center in Boston to access data in these areas. The questionnaire solicited information about demographics, health practices, stress in personal and work lives, mental and physical health problems, sexual practices, family history of health related problems, and genetic attributes hypothesized to be related to 'gayness.' Questionnaires from 1,633 lesbian women provided the database for the study. This paper discusses the portion of the survey that dealt with mental health services and life experiences. Past studies that investigated mental health needs of lesbians focused on the quality of treatment by mental health providers, rates of suicide attempts, and alcoholism. This paper compares these past findings with the responses of the lesbians in this national, community-based study. Findings indicate that although a significant number of the lesbian women in this sample had been in therapy, they sought out therapy as a coping strategy to deal with similar issues as other women, i.e., depression and relationships. Suicide attempts decreased considerably after adolescence and 'coming out.' Rates of alcohol use and abuse, although difficult to compare with other studies, were higher than other women but similar to other studies investigating a community sample of lesbians. Even with a high family history of alcoholism, less than 5 percent reported having sought out therapy to deal with any issues of alcohol or drug use.
Keywords: adolescent; adult; aged; article; female; health care utilization; human; homosexual female; major clinical study; mental health; mental health service; patient satisfaction; questionnaire; United States

Suicidal ideation, bereavement, HIV serostatus and psychosocial variables in partners of men with AIDS - Rosengard, C.; Folkman, S. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 1997)
This prospective 2-year study examines suicidal ideation in 86 HIV-positive and 167 HIV-negative caregiving partners of men with AIDS. One hundred and fifty-six of the caregivers became bereaved during the course of the study. The study focuses on the relationship between suicidal ideation and bereavement status (bereaved vs non-bereaved), HIV serostatus (HIV-positive vs HIV-negative), and psycho-social factors (caregiving burdens, social support, coping, and optimism). Bereavement was related to suicidal ideation, but HIV serostatus was not. High suicidal ideators were characterized by feeling burdened by caregiving, perceiving low levels of social support and subjective social integration, and the use of behavioural escape-avoidance coping. Those who reported never having suicidal ideation were characterized by higher levels of optimism. Clinical implications are discussed.
Keywords: acquired immune deficiency syndrome; article; avoidance behavior; bereavement; bisexuality; caregiver; coping behavior; homosexuality; human; human experiment; male; priority journal; social support; sociology; spouse; suicide

The agony of Pyotr Ilyich Tchaikovsky - Vogelaar, P.W. (Medical Problems of Performing Artists, 1996)
This article intends to establish that the likely cause of death of Pyotr Ilyich Tchaikovsky at the age of 53 was enforced suicide. His homosexuality is examined in light of recent medical research, which appears to indicate that sexual orientation is biologically determined. His psychological profile is also analyzed, highlighting the period around his marriage at the age of 37, and the period shortly before his death. In addition, Tchaikovsky's emotional states during the composition of his Manfred Symphony and of the Sixth Symphony (Pathetique) are discussed.
Keywords: article; cause of death; emotional stress; genetic analysis; homosexuality; human; male; marriage; medical research; musician; posthumous care; suicide

Issues in the treatment of lesbian women and gay men with chronic mental illness - Hellman, R.E. (Psychiatric Services, 1996)
A growing theoretical and practical body of knowledge recognizes the common clinical concerns of chronic psychiatric patients who are homosexual and promotes their affirmative inclusion in psychiatric programs for other persons with chronic mental illness. This paper provides a clinical context for understanding essential issues in the inpatient and outpatient treatment of chronic psychiatric patients who are gay men or lesbian women. Such patients are largely an ignored or invisible subgroup in long-term psychiatric programs and in the gay and lesbian community. They are dependent on therapeutic communities, residences, and families that are heterosexually acculturated and often unaware of their needs. Most have experienced antihomosexual prejudice and the stigmatizing effects of mental illness. Affirmative models of treatment can be adapted to this population but must be modified to accommodate their psychiatric deficits. Increased efforts to destigmatize both mental illness and homosexuality are needed.
Keywords: affective neurosis; alcoholism; article; chronic disease; female; homosexuality; human; homosexual female; major clinical study; male; risk assessment; risk factor; schizophrenia; social support; suicide attempt; victim

Longitudinal change in youth suicide mortality in Okinawa after World War II: A comparative study with mainland Japan - Kageyama, T.; Naka, K. (Psychiatry and Clinical Neurosciences, 1996)
Okinawa prefecture has a unique socio-cultural status in Japan including the experience of having been occupied by the USA from the end of World War II to 1972. In this study, the longitudinal change in youth suicide mortality for those aged 10-29 years in Okinawa (1960-90) was compared with that for the same sex-age groups in mainland Japan (1950-90). In contrast with mainland Japan, no dramatic change in the youth suicide mortality was observed in Okinawa in the 1960s. The rise and fall of teenage suicide mortality in Okinawa during the 1970-80s might be associated with 'reversion anxiety', rather than with the traumatic experience of World War II itself. This seems to be inconsistent with previous speculation regarding the change in youth suicide mortality in mainland Japan. The suicide mortality for men aged 20-29 in Okinawa was significantly higher than that for the same sex age group in mainland Japan through the observed period. The possible effects of the USA occupation, economic anomie or migration on the suicide in Okinawa should be further examined.
Keywords: adolescent; adult; anxiety neurosis; article; child; controlled study; disease association; female; group psychology; human; Japan; juvenile; longitudinal study; major clinical study; male; mortality; posttraumatic stress disorder; social class; social problem; suicide

Methemoglobinemia secondary to cleaning solution ingestion - Freeman, L.; Wolford, R.W. (Journal of Emergency Medicine, 1996)
Methemoglobinemia is a rare cause of cyanosis in pediatric patients. A 16-month-old male presented to the Emergency Department cyanotic and short of breath after ingestion of a hair-care-equipment cleaning solution. After calling the salon and consulting Polsindex, the substance was found to be Mar-V-cide, containing 20% Hyamine 3500, 50% cationic detergents, 20% isopropyl alcohol, and 1% sodium nitrite, which caused the methemoglobinemia in this case. Initial pulse oximetry on room air was 72% and improved minimally with supplemental oxygen. The patient's methemoglobin level was 63%. Methylene blue was administered (2 mg/kg intravenously), and the patient rapidly improved. Nitrates occur in high concentrations in some fond and water. Infants are particularly susceptible to chronic nitrate-induced methemoglobinemia because of their low stomach acid production, large numbers of nitrite-reducing bacteria, and the relatively easy oxidation of fetal hemoglobin. Acute nitrite toxicity results from industrial exposure, accidental ingestion (e.g., abuse of organic nitrites as an aphrodisiac, especially in the male homosexual population), and suicidal ingestion. Methemoglobinemia may occur in a number of drug or chemical ingestions, but a comprehensive review of the literature failed to identify a similar reported case.
Keywords: hemoglobin F; methylene blue; nitrite; article; case report; cleaning; cyanosis; human; hypoxia; ingestion; male; methemoglobinemia; preschool child; priority journal; suicide attempt

Sex, death, and the courts: Compassion in Dying v. State of Washington; Quill v. Vacco; Romer v. Evans. - Dworkin, R. (The New York review of books, 1996)
Keywords: article; assisted suicide; Bowers v. Hardwick; civil rights; Compassion in Dying v. State of Washington; Death and Euthanasia; Fourteenth Amendment; freedom; government; government regulation; homosexuality; human; induced abortion; jurisprudence; Legal Approach; morality; passive euthanasia; personal autonomy; policy; political system; Popular Approach/Source; public opinion; Quill v. Vacco; right to die; Romer v. Evans; sexuality; social control; social psychology; standard; United States

A simulation model of the dynamics of HIV transmission in intravenous drug users - Atkinson, J. (Computers and Biomedical Research, 1996)
The complex dynamics of HIV transmission and subsequent progression to AIDS make the use of traditional mathematical modeling techniques problematic. In a previous paper for this journal, Leslie and Brunham established the utility of a nonmathematical simulation language in modeling HIV transfer under conditions similar to those found among homosexual males. This study considers the application of such an approach in modeling HIV spread among intravenous drug users (IDUs) injecting within a 'shooting gallery,' a location providing a common needle supply to a large number of users. Modeling HIV transmission in this population involves not only consideration of heterogeneity in partnership selection, but also of the fact that spread of the virus is not directly from person to person, but via injection equipment. The General Purpose Simulation System was used to create a hypothetical cohort of IDUs, drawing from a common needle supply. Following introduction of an index case, the HIV infection rate in this cohort was followed over 5 simulated years. The model was then used to consider the effects of systematic variation in the frequency of injection and needle-cleaning behavior.
Keywords: article; computer simulation; disease transmission; drug abuse; Human immunodeficiency virus; mathematical model; priority journal

AIDS, euthanasia and nursing. - Ogden, R. (Nursing standard (Royal College of Nursing (Great Britain) : 1987), 1996)
Requests for euthanasia can pose a dilemma for nurses. Some of the arguments for and against euthanasia are presented here together with a summary of a study into the phenomenon of 'underground' euthanasia. These are considered in relation to the law and nursing ethics.
Keywords: acquired immune deficiency syndrome; article; assisted suicide; case report; Death and Euthanasia; euthanasia; friend; Health Care and Public Health; homosexuality; human; male; medical ethics; nurse attitude; nursing; voluntary euthanasia

Homicide in homosexual victims: A study of 67 cases from the Broward County, Florida, Medical Examiner's Office (1982-1992), with special emphasis on 'overkill' - Bell, M.D.; Vila, R.I. (American Journal of Forensic Medicine and Pathology, 1996)
Forensic pathologists often state that homosexual homicides are more violent than those with heterosexual victims. Overkill or wounding far beyond that required to cause death is a frequently used descriptor of these deaths. We quantified the number and extent of injuries between homosexual and heterosexual homicide victims to determine whether one group suffered more violence than the other. This case-control study involved 67 homosexual homicide victims and 195 age, race, and gender-matched heterosexual (control) homicide victims from the Broward County Medical Examiner's Office in Fort Lauderdale, Florida, between 1982 and 1992. The sexual preference of the victims was determined by police and medical examiner investigation. We compared the percentage of cases with multiple causes of death, mean number of injuries/case, and the mean number of different body sites with injuries/case between the two groups. The percentage of cases with multiple causes was 12% (n = 8) and 5% (n = 10) in the homosexual and heterosexual victims, respectively, with no significant statistical difference detected (Fisher exact test, two-tail, p = 0.088). The mean number of fatal sharp (5.4 vs 3.3, p < 0.05), blunt (9.0 vs 6.5, p < 0.05), and total (14.5 vs 6.5, p < 0.001) injuries/case was greater among the homosexual victims than among the heterosexual group. These differences were all statistically significant using the Mann Whitney rank sum test. The mean number of different body sites with injuries/case was also greater (3.5 vs 2.4, p < 0.001) among the homosexual victims than among the heterosexual group. This difference was statistically significant using the Mann Whitney rank sum test. Homosexual homicides are more violent than heterosexual homicides when one compares the mean number of injuries (fatal sharp, blunt, and total)/case and the extent of injuries on the body. The mean number of stab wounds wounds/case and percentage of cases with multiple causes of death were also greater among the homosexual group, but the differences were not statistically significant.
Keywords: adult; aged; article; asphyxia; blunt trauma; case control study; cause of death; controlled study; coroner; female; heterosexuality; homicide; homosexuality; human; major clinical study; male; penetrating trauma; United States; victim

Euthanasia and physician-assisted suicide in homosexual men with AIDS - Bindels, P.J.E.; Krol, A.; Van Ameijden, E.; Mulder-Folkerts, D.K.F.; Van Den Hoek, J.A.R.; Van Griensven, G.P.J.; Coutinho, R.A. (Lancet, 1996)
Background: In the Netherlands a nationwide study has shown that, in 38% of deaths, there have been medical decisions concerning the end of life (MDEL); 2.1% of all deaths were brought about by euthanasia or physician-assisted suicide (PAS). We investigated the incidence of MDEL in homosexual men with AIDS, suspecting that it might be higher, and studied the effect of euthanasia/PAS on survival time. Methods: The patients were 131 male homosexual participants in a cohort study in Amsterdam, diagnosed between 1985 and 1992 as having AIDS; all had died before Jan 1, 1995. Clinical and laboratory data and information on mode of death were obtained from their physicians and by review of hospital records. Those who died by euthanasia/PAS or in whom there had been other MDEL were then compared with those who died naturally. Findings: 29 men (22%) had died by euthanasia/PAS and in 17 (13%) another MDEL had been made; thus, more than one-third of these men had made medical decisions concerning the end of life. The greatest difference between the groups was in age at time of diagnosis - 72% aged 40 or more in the euthanasia/PAS group compared with 38% in the natural death group. The likelihood (relative risk) of euthanasia/PAS increased with duration of survival after AIDS diagnosis. Comparison of the groups in terms of three laboratory markers (CD4+ and CD8+ cells and phytohaemagglutinin responses) in the two years before death, and estimates of these markers at the time of death, did not indicate any substantial shortening of life by euthanasia/PAS; in the judgment of the physicians, most of these patients would have died naturally within one month. Interpretation: A possible reason for the high incidence of MDEL in this cohort was a good knowledge of the characteristics of AIDS acquired through long-term awareness of HIV infection. The higher rate of euthanasia in those with long survival from AIDS diagnosis could reflect either additional suffering or the greater opportunity to discuss this option with friends and physicians. Our findings indicate that euthanasia and other MDEL did little to shorten life; rather, they were an extreme form of palliation, applied in the terminal phase of a lethal disease.
Keywords: acquired immune deficiency syndrome; adult; article; cohort analysis; euthanasia; homosexuality; human; major clinical study; male; medical decision making; mortality; Netherlands; physician; priority journal; suicide; survival time

Primary care of lesbian and gay patients: Educating ourselves and our students - Harrison, A.E. (Family Medicine, 1996)
Although a significant proportion of the population is gay or lesbian, physicians receive little formal training about homosexuality, and the unique health care needs of these patients are often ignored. Gay men and women may have higher rates of depression, suicide, alcoholism, certain cancers, and cardiovascular disease than their heterosexual counterparts. In addition, they are at risk of being victims of violence because of their sexual orientation. Due to fear of stigmatization by the medical community, the most significant health risk for lesbians, gays, and bisexuals may be that they avoid routine health care. Gay youth are particularly vulnerable to internal and external pressures, resulting in higher rates of substance abuse, suicide, and homelessness. Older gay men and women, who generally view themselves positively, may be troubled by declining health and loneliness. Physicians can improve the health care of gay and bisexual men and women and their families by maintaining a non-homophobic attitude toward these patients, distinguishing sexual behavior from sexual identity, communicating with gender-neutral terms, and maintaining awareness of how their own attitudes affect clinical judgment. Medical educators should avoid making assumptions about the sexuality of their residents and students. Institutions need to realize that the presence of supportive heterosexual and openly gay faculty will help create an environment that fosters learning for all students. Scant research exists about the best ways to teach about the special challenges gay men and lesbians face. However, the majority of surveyed medical students prefer that issues regarding gays and lesbians be integrated throughout the entire medical school curriculum.
Keywords: alcoholism; article; depression; disease predisposition; health care availability; health service; homosexuality; homosexual female; medical education; medical student; patient attitude; primary health care; suicide

AIDS and suicide - Kirchner, J.T. (Journal of Family Practice, 1995)
An association between suicide and the acquired immune deficiency syndrome (AIDS) has been noted in several epidemiologic studies. Numerous case reports also support the trend of an increased suicide risk in persons infected with human immunodeficiency virus (HIV) and persons with AIDS. A variety of medical, neurologic, and psychiatric factors may contribute to the death of an HIV patient. I present the case of a 27-year-old man who committed suicide approximately 2 years after he received a diagnosis of AIDS. He had no previous psychiatric history. It is imperative that physicians caring for such patients be aware of the various neurologic and psychiatric manifestations of HIV infection. If appropriate, an assessment of suicide risk should be included in the regular office visit.
Keywords: acquired immune deficiency syndrome; adult; anxiety; article; case report; clinical feature; homosexuality; human; Human immunodeficiency virus infection; male; patient care; suicide; thrombocytopenia; body weight loss

Introduction to supplemental issue: research issues in suicide and sexual orientation. - Mościcki, E.K.; Muehrer, P.; Potter, L.B. (Suicide & life-threatening behavior, 1995)
Keywords: adolescent; adult; article; female; gender identity; homosexuality; human; homosexual female; male; psychological aspect; research; risk factor; suicide

AIDS, euthanasia and grief. - van den Boom, F. (AIDS care, 1995)
Almost 50% of people with AIDS in the Netherlands make the necessary arrangements for a possible death by the administration of thanatic drugs. In approximately 50% of those who arranged for it, euthanasia is performed. Euthanasia is a well-considered decision. By means of euthanasia people with AIDS want to prevent unbearable suffering and a degrading existence. Those who have arranged for euthanasia were proven to have adapted to the disease better than those who had not. No relationship was found between ending life by means of euthanasia and complicated grief in survivors. However, if the euthanasia process itself was complicated, the risk of complicated grief increased.
Keywords: acquired immune deficiency syndrome; article; bereavement; decision making; euthanasia; female; homosexuality; human; legal liability; male; Netherlands; pain; prevalence; psychological aspect; self concept; sexual behavior; suicide; suicide attempt

AIDS and euthanasia. - Green, G. (AIDS care, 1995)
This paper estimates the proportion of people with HIV who have considered asking assistance to end their lives and explores their motivations and plans of action to hasten death. 16/57 (28%) people with HIV have considered asking for assistance to hasten death, significantly more than seronegative controls (4/67) (3%) (p < 0.001). In follow-up interviews with seropositive respondents the figure increased to 19/57 (33%). The main motivations are fear of being dependent and losing dignity and control in the final stages of the disease. These results are discussed in the light of current legislation about euthanasia and recent evidence that about one-half of NHS doctors would be prepared to comply with requests for euthanasia were it legal to do so.
Keywords: acquired immune deficiency syndrome; addiction; adult; article; euthanasia; female; hemophilia A; homosexuality; human; Human immunodeficiency virus infection; legal aspect; legal liability; male; middle aged; psychological aspect; self concept; sexual behavior; suicide; suicide attempt; United Kingdom

Multiple personality disorder manifesting itself under the mask of transsexualism - Modestin, J.; Ebner, G. (Psychopathology, 1995)
The case of a young female patient is described who presented symptoms of transsexualism; surgical intervention was considered. Admitted to the hospital after having become depressed and suicidal, a thorough examination and observation revealed the presence of multiple personality disorder (MPD). Even though transsexualism and MPD represent two different conditions, there are many similarities between them. The possibility of MPD should be considered in every case of transsexualism.
Keywords: adult; article; case report; clinical feature; female; human; multiple personality; transsexualism

The health status of adolesents in Canada - Tonkin, R.S.; Frappier, J.-Y.; Goldberg, E.; Westwood, M. (International Pediatrics, 1995)
Adolescents in Canada share similar developmental challenges and health concerns to those experienced elsewhere. However, there are differences in how these issues manifest themselves, and in the way that adolescent health services are funded and delivered. This article describes these differences from both a historical and an international perspective. Canada's youth are healthy and have ready access to prepaid hospital and medical care. Primary care services are largely provided by family physicians while there is a network of specialists and tertiary care hospitals. In some provinces, adolescents can access a range of community-based services such as community health centers, family planning and/or sexually transmitted disease clinics, and mental health units. The main health concerns of adolescents in Canada include: mental health problems, issues related to sexual health, alcohol and substance misuse, and injuries. Issues such as teen pregnancy, multiple drug use, physical and sexual abuse, and suicide are more common in marginalized adolescents (aboriginals, gay and lesbian, disabled or chronically ill) in Canada than in the general adolescent population.
Keywords: indigenous people; adolescent; adolescent pregnancy; alcohol consumption; article; Canada; child health; chronic patient; disability; drug abuse; family planning; health center; health status; homosexuality; hospital charge; human; injury; homosexual female; mental health; primary medical care; sexual abuse; sexually transmitted disease; suicide

Suicide risk among people living with AIDS. - Mancoske, R.J.; Wadsworth, C.M.; Dugas, D.S.; Hasney, J.A. (Social work, 1995)
Using data from Louisiana vital statistics records, the authors found an increased suicide risk for people with AIDS. Between 1987 and 1991 the suicide rate of people with AIDS (175 per 10,000) was 134.6 times that of the general population (1.3 per 10,000). The suicide rate for people with AIDS in the metropolitan New Orleans area (126 per 10,000) was half that of the state's nonmetropolitan areas (249 per 10,000). This article explores the implications of this astounding suicide rate for social work practice.
Keywords: acquired immune deficiency syndrome; article; homosexuality; human; incidence; male; psychological aspect; rural population; social work; statistics; suicide; United States; vital statistics

The lethal paraphiliac syndrome: Accidental autoerotic deaths in Denmark 1933-1990 - Behrendt, N.; Modvig, J. (American Journal of Forensic Medicine and Pathology, 1995)
A new definition of accidental autoerotic death (AAD) is proposed. A death is an AAD if it is solitary, accidental, and caused by a lethal paraphilia. On the basis of a series of 46 AADs, all occurring among men in the period 1933-1990 in Denmark, the definition cannot be rejected. A paraphilia is regarded as lethal if it is inherently life-threatening. The results of this study have been related to previous reports of similar autoerotic deaths in the literature. It is suggested that the present distinction between asphyxial AAD as typical and nonasphyxial ADD as atypical be replaced with lethal paraphilia with accompanying nonlethal paraphilia or props as typical AAD and lethal paraphilia with no accompanying nonlethal paraphilia or props as atypical AAD.
Keywords: accidental death; adolescent; adult; aged; article; asphyxia; cause of death; child; clinical article; Denmark; erotism; sexual fetishism; forensic psychiatry; hanging; human; male; sexual behavior; sexual deviation; socioeconomics; strangulation; suicide attempt; syndrome delineation; cross-dressing

Incest and other intrafamilial sexual abuse. - Aw, S.C.; Kok, L.P. (Annals of the Academy of Medicine, Singapore, 1995)
This study describes eight female adolescents who were sexually abused in childhood. Four were victims of incest. The mean age of onset of sexual abuse was 9.8 years and except for one, all had multiple incidents. All were from the lower socioeconomic class. The majority had disorganised families. The reactions of the majority of the victims were fear, intense anger and self mutilation. All were separated from their families on disclosure of the abuse. A significant clinical sequela was that of suicidal tendency in all of them, six of whom attempted suicide repeatedly. Promiscuous behaviour at adolescence occurred in one victim of father-child incest. Lesbianism resulted in one other. None suffered from any formal psychiatric disorder.
Keywords: adolescent; adult; article; child; child sexual abuse; female; human; incest; male; psychological aspect; psychosomatic disorder

The science and politics of gay teen suicide. - Richardson, J. (Harvard review of psychiatry, 1995)
Keywords: adolescent; article; female; health care policy; homosexuality; human; male; politics; psychological aspect; school health service; suicide; United States

Homosexuality, type 1: An Xq28 phenomenon - Turner, W.J. (Archives of Sexual Behavior, 1995)
Despite the absence of phenotypic manifestations in alternating generations characteristic of X-linked disorders, a thesis is presented that a major type of Kinsey grades 5 and 6 male homosexuality is determined by a gene in the Xq28 region. A total of 133 families in 78 kinships of male and female homosexual probands, in addition to 116 families (including those of 40 famous homosexuals) from the literature, revealed an unbalanced secondary sex ratio in the maternal generation of male, but not of female, homosexuals. On the maternal side, in this study, the ratio of all uncles to all aunts of 90 males homosexuals was 132/209, χ2 = 8.52, p = 0.004. On the maternal side for the total of all sources, the ratio of uncles to aunts of male homosexuals was 241/367, χ2 = 13.20; p < 0.0001. The male/female ratio of the total number of maternal sibships bearing homosexuals (310/628: 0.491) was a measure of fetal wastage of the mothers' male sibs: 49%. This ratio was very close to that of the total number of children born to fathers affected with any one of nine Xq28-linked male semilethal conditions (255/508: ratio 0.556); for the difference between the two populations χ2 = 0.859, p = 0.354. The male/female ratio of the total number of children born to female carriers of any one of these same conditions (1,232/1,062: ratio 1.16), χ2 = 13.8 p ≤0.0001, is close to that of the total number of children in homosexual sibships: 511/413, χ2 = 10.4, p = 0.005. Between the number of children born to Xq28 mothers and to those born of mothers of homosexuals χ2 = 0.581, p = 0.446. One may readily surmise that the maternal influence so often related to homosexuality may lie in the mother being a genetic carrier, with traits thereto associated. In this study, 65% of the mothers of homosexuals had no or only one live-born brother. Additional support for a genetic hypothesis is found in the occurrence of multiple instances-almost exclusively among maternal relatives-of infertility, spontaneous abortions, miscarriages, stillbirths, remaining single past age 30, and suicide. Of 109 male and 43 female homosexual index cases in the present series there were 6 instances of brother/sister homosexual sibships. Instances of homosexual parent-to-homosexual child transmission occurred as follows: one father-to- son; one father-to-daughter; one bisexual father-son; one father/mother-to-2 sons; one of mother-to-son, and one of father-to-son and father-to-bisexual daughter. There were 16 instances of presumptive transmissions from heterosexual father-to-homosexual son and 5 of heterosexual father-to- homosexual daughter. A hypothesis is proposed: Homosexuality is due to a gene at Xq28 characterized by (i) elongated cytosine-containing trinucleotide repeats upstream to translation of a gene, (ii) elongated CpG islands upstream of the trinucleotides, and (iii) cytosine methylation of CpG islands and of the cytosine-containing trinucleotides.
Keywords: cytosine; trinucleotide; article; chromosome Xq; female; fetus wastage; homosexuality; human; infertility; homosexual female; major clinical study; male; methylation; sex ratio; spontaneous abortion; stillbirth; suicide; vertical transmission; X chromosome linked disorder

Going early, going late: the rationality of decisions about suicide in AIDS. - Battin, M.P. (The Journal of medicine and philosophy, 1994)
Where assistance in suicide is readily available to those dying of AIDS, as in the west coast gay communities of the United States and in the Netherlands, we must examine the different roles of physicians and friends (including lovers, spouses, family members, religious advisors, members of support groups, and intimate others) in helping a person with AIDS decide about and carry out suicide. This paper makes a central assumption: that where assistance in suicide is available, it is the moral obligation of others to protect and enhance as much as possible the rationality of that choice. Four components are identified in a rational choice about suicide in AIDS-whether it is a choice for or against suicide. Phrased as questions a person with AIDS might ask him- or herself, they are: (1) "Is suicide an option I want to consider?" (2) "Shall I hold out for the chance of a cure?" (3) "How shall I time my suicide?" (4) "What weight shall I give to the welfare and interests of others?" Although physicians often make assertions relevant to (1), they are appropriately involved only in (3); and although friends or intimate partners often provide the patient with anecdotal information relevant to (3), they should be involved primarily in (1). In short, both physicians and friends often intervene in the wrong parts of choices made by a person with AIDS about suicide.
Keywords: acquired immune deficiency syndrome; Analytical Approach; article; assisted suicide; attitude to death; Death and Euthanasia; decision making; euthanasia; Health Care and Public Health; homosexuality; human; male; mental stress; social psychology

Factitious hermaphrodism - Warren, A.; Sutherland, A.J.; Lenz, R. (Psychosomatics, 1994)
Keywords: carbamazepine; diazepam; diclofenac; estrogen; insulin; lithium; medroxyprogesterone acetate; phenytoin; adult; article; case report; factitious disease; hermaphroditism; human; intramuscular drug administration; male; suicide attempt; transsexualism; dilantin; provera; tegretol; valium; voltaren

Human immunodeficiency virus infection in Taiwan, 1984 to 1994. - Chen, M.Y.; Wang, G.R.; Chuang, C.Y.; Shih, Y.T. (Journal of the Formosan Medical Association = Taiwan yi zhi, 1994)
From 1984 to September 1994, a total of 9,099,734 serum samples from six population groups were tested for the antibody to human immunodeficiency virus type 1 (HIV). Mandatory testing was carried out for blood donors, military recruits, immigrants and prisoners; other population groups were tested anonymously with consent. A total of 695 samples were seropositive and, of these HIV carriers, 142 developed acquired immunodeficiency syndrome (AIDS). Although the prevalence of HIV infection and AIDS has remained low, there has been a rapid increase since 1991. Of the 142 AIDS cases, 68 were in homosexuals/bisexuals, 6 were in hemophiliacs, 7 were in prisoners/intravenous drug users, 49 were in heterosexuals and for 12 cases, the risk factors were unknown. Before 1987, 69 (90.8%) of the 76 HIV-infected persons were homosexuals or hemophiliacs. Thereafter, the risk groups diversified, with the main group shifting from hemophiliacs to intravenous drug users, and the number of heterosexuals surpassing that of homosexuals. Among the 142 cases of AIDS, 135 were males and only 7 were females. Despite the short period of follow-up, 114 have died (including 3 suicides).
Keywords: acquired immune deficiency syndrome; adolescent; adult; aged; article; Asia; biology; child; China; developing country; diseases; Eastern Asia; Examinations And Diagnoses; female; human; Human immunodeficiency virus infection; infant; male; measurement; methodology; middle aged; Population At Risk; preschool child; prevalence; risk factor; screening; Taiwan; Viral Diseases

Emotional, behavioral, and HIV risks associated with sexual abuse among adult homosexual and bisexual men - Bartholow, B.N.; Doll, L.S.; Joy, D.; Douglas Jr., J.M.; Bolan, G.; Harrison, J.S.; Moss, P.M.; McKirnan, D. (Child Abuse and Neglect, 1994)
From May 1989 through April 1990, 1,001 adult homosexual and bisexual men attending urban sexually transmitted disease clinics were interviewed regarding abusive sexual contacts during childhood and adolescence. Sexual abuse was found to be significantly associated with mental health counseling and hospitalization, psychoactive substance use, depression, suicidal thought or actions, social support, sexual identity development, HIV risk behavior including unprotected anal intercourse and injecting drug use, and risk of sexually transmitted diseases including HIV infection. Data suggest that sexual abuse may have a wide-ranging influence on the quality of life and health risk behavior of homosexual men. Increased awareness as to the potential outcomes of male sexual abuse is critically important to the design and implementation of medical and psychological services for sexually abused men.
Keywords: adult; article; child abuse; depression; disease association; emotional stress; gender identity; health hazard; homosexuality; human; human experiment; Human immunodeficiency virus infection; infection risk; male; normal human; patient counseling; psychological aspect; quality of life; sexual abuse; sexual behavior; sexually transmitted disease; substance abuse; suicidal behavior

Safety profile of didanosine among patients with advanced HIV disease who are intolerant to or deteriorate despite zidovudine therapy: Results of the Canadian open ddI treatment program - Montaner, J.S.G.; Rachlis, A.; Beaulieu, R.; Gill, J.; Schlech, W.; Phillips, P.; Auclair, C.; Boulerice, F.; Schindzielorz, A.; Smaldone, L.; Wainberg, M.; Singer, J.; et al. (Journal of Acquired Immune Deficiency Syndromes, 1994)
The aim of this study was to ascertain the safety profile of didanosine (Videx; ddI) within the Canadian Open Treatment Program. Symptomatic HIV+ subjects with AIDS or ARC or CD4 <200/mm3 were eligible to receive didanosine if they were either (a) intolerant to zidovudine (Retrovir, ZDV) or (b) deteriorating despite ZDV therapy. The dose of didanosine (powder formulation) was based on body weight as follows: ≥75 kg, 375 mg b.i.d.; 50- 74 kg, 250 mg b.i.d.; 35-49 kg, 167 mg b.i.d. Participants were monitored with physical examinations and prespecified laboratory studies by their treating physicians on a monthly basis. Follow-up data were collected in a central database through five regional coordinators. A total of 168 physicians across Canada participated in the program, and 825 subjects who started didanosine after July 1, 1990, were included in the analysis. Of these, 97% were male, 88% homosexual, and 59% had a prior diagnosis of AIDS. Reasons for enrolling was ZDV intolerance in 39%, failure in 25%, both in 32%, and other in 4%. Data were prospectively collected until July 31, 1991. Total follow-up was 3,440 patient-months and median follow-up was 4.3 months. A total of 78 deaths were reported, 44 of which occurred within a month after the last dose of didanosine. Causes of death included AIDS-related unspecified causes (13 patients), MAC (11), wasting (7), AIDS-related CNS involvement other than OI's (7), Kaposi's sarcoma (7), Pneumocystis carinii pneumonia (6), sudden death, including suicides and accidents (6), lymphoma (5), toxoplasmosis (4), cryptococcosis (4), cytomegalovirus (3), unspecified causes (2), tuberculosis (1), PML (1), and disseminated histoplasmosis (1). Didanosine was discontinued in 140 (17%) subjects during the study period due to adverse events. The most common severe adverse events were diarrhea (16 patients), nausea and vomiting (11), peripheral neuropathy (7), and pancreatitis (6). We conclude that didanosine has a favorable safety profile, even among individuals with advanced HIV disease who have failed or are no longer tolerant of ZDV therapy.
Keywords: didanosine; ganciclovir; zidovudine; acquired immune deficiency syndrome; adult; AIDS related complex; article; Canada; cause of death; central nervous system infection; clinical trial; data base; diarrhea; drug hypersensitivity; female; homosexuality; human; Human immunodeficiency virus infection; Kaposi sarcoma; lymphoma; major clinical study; male; mortality; mycobacteriosis; oral drug administration; pancreatitis; peripheral neuropathy; Pneumocystis pneumonia; priority journal; prospective study; sudden death; toxoplasmosis; didanosine; retrovir

Sudden unexpected death in a male homosexual cohort - Ndimbie, O.K.; Perper, J.A.; Kingsley, L.; Harty, L.; Winkelstein, A. (American Journal of Forensic Medicine and Pathology, 1994)
There has been considerable debate as to the risk of suicide, accidents, and homicide in populations at high risk for HIV infection. The purpose of the present investigation was to determine the incidence of sudden and unexpected deaths in a well-defined cohort of homosexual and bisexual men prospectively studied since 1984. All subjects were enrolled in the Pitt Men's Study, the Pittsburgh, Pennsylvania, component of the Multicenter AIDS Cohort Study. Of this group, 861 were between the ages of 20 and 44, and 35% were seropositive for HIV. There were 70 deaths attributed to AIDS. Five additional deaths were classified as sudden and unexpected, an annual rate of 0.08% (80/100,000). Only one of these was classified by the coroner's office as a suicide; three were due to accidents, and one was a drug overdose of undetermined cause. Only two of the five unexpected deaths were HIV seropositive, and none had the diagnosis of AIDS. The sudden and unexpected death rate in this cohort did not significantly differ from the 0.07% (70/100,000) yearly incidence in the age- and race-matched male population. Thus, in this well-defined male gay cohort, there does not appear to be an increased risk of violent and drug-related deaths in persons at risk for, or with a diagnosis of, AIDS.
Keywords: acquired immune deficiency syndrome; adult; article; cause of death; drug induced disease; homosexuality; human; Human immunodeficiency virus infection; incidence; major clinical study; male; patient counseling; prospective study; seroconversion; suicide

Psychoanalysis as a lifeline: A clinical study of a transference perversion - Baker, R. (International Journal of Psycho-Analysis, 1994)
Case material from the analysis of a fetishistic cross-dresser is reported. The evolution of a transference perversion and treatment impasse, in the form of the recalcitrant symptom of anal flatulence, is described. The patient's contrasting needs to cling perversely and addictively to the analyst, on the one hand, and to provoke an acting out of the countertransference, on the other, are placed in the context of his dread of rejection and potentially suicidal reaction. The author argues in favour of offering psychoanalysis as a lifeline, but with the condition that the psychoanalytic setting and boundaries are maintained and that gratifications are denied. Limited but precise interpretive psychoanalytic work in the transference was maintained. The relatively good outcome is explained in terms of the provision of safety, survival of the analyst and avoidance of countertransference acting out, which, in the author's view, represents an implicit and mutative transference interpretation, the specific factor in bringing about psychic change. This enabled the patient to recognise and accept the analyst as a 'new' object and, as a consequence, to question and reject his idealisation of the anal universe that he inhabited.
Keywords: adult; article; case report; counter transference; sexual fetishism; flatulence; human; male; psychoanalysis; transference

Risk factors for suicide among gay, lesbian, and bisexual youths. - Proctor, C.D.; Groze, V.K. (Social work, 1994)
The study described in this article explores risk factors for suicide among gay, lesbian, and bisexual youths. A convenience sample of 221 self-identified gay, lesbian, and bisexual youths who attended youth groups across the United States and Canada were given the Adolescent Health Questionnaire, which assessed family issues, the social environment, and self-perceptions. The youths' scores were significantly associated with suicidal ideation and attempts. Implications for social services are discussed.
Keywords: adolescent; article; bisexuality; female; homosexuality; human; homosexual female; male; psychological aspect; risk factor; self concept; social support; suicide

HIV and tuberculosis infection in San Francisco's homeless adults: Prevalence and risk factors in a representative sample - Zolopa, A.R.; Hahn, J.A.; Gorter, R.; Miranda, J.; Wlodarczyk, D.; Peterson, J.; Pilote, L.; Moss, A.R. (Journal of the American Medical Association, 1994)
Objective. - To determine the prevalence and risk factors for human immunodeficiency virus (HIV) and tuberculosis (TB) infection and investigate the relationship between these two infections in homeless adults. Design. - Cross-sectional study. Setting. - Inner-city shelters and free meal programs. Participants. - A representative sample of 1226 adults (≥18 years) were enrolled from community sites. Main Outcome Measures. - Serum HIV-1 antibody status and tuberculin skin test reactivity. Results. - Human immunodeficiency virus seroprevalence was 8.5% (95% confidence interval [CI], 7.0% to 10.1%) and the prevalence of TB infection was 32% (95% Cl, 30% to 37%). Nineteen percent of the HIV-seropositive subjects had positive tuberculin skin tests. Independent risk factors for HIV infection included younger age, black race, male homosexual contact, injection drug use, use of injection drugs in shooting galleries, and selling sex. Tuberculosis infection was associated with the duration of homelessness and living in crowded shelters or single- room-occupancy hotels. Injection drug use, a risk factor for HIV, was also a risk factor for TB, with a particularly strong association in women. No evidence of an association between TB and HIV infection was found, even after accounting for anergy. Conclusions. - The homeless population in the United States should be considered a group at high risk for HIV infection and TB. Given the constellation of risk factors present, the high prevalence of infection, and lack of access to medical services, we anticipate that these communicable diseases in this population will represent a growing public health problem.
Keywords: Human immunodeficiency virus antibody; adult; article; drug abuse; female; high risk population; homelessness; homosexuality; human; Human immunodeficiency virus 1; Human immunodeficiency virus infection; Human immunodeficiency virus prevalence; infection risk; major clinical study; male; Black person; prevalence; priority journal; prostitution; tuberculin test; tuberculosis

A new perspective on the Oedipal complex: A voice therapy session - Firestone, R.W. (Psychotherapy, 1994)
This article reports the case of a young man who experienced suicidal impulses in competitive situations involving both relationship and career issues. The clinical data illustrate the concept of 'identification with the aggressor' in relation to a father's angry, rivalrous feelings toward his son. The author discusses dynamics operating in families where immature or insecure parents compete with and show resentment toward the child of the same sex and direct overt or covert aggression toward him/her. Later, the internalized aggression emerges as a negative thought process when the individual strives to achieve personal or vocational goals. An exploration of the theoretical implications of the case contributes to an understanding of unresolved Oedipal issues that can affect young people at risk for suicide, particularly high-achieving adolescents who seemingly have everything to live for.
Keywords: adult; aggression; article; attitude; case report; child parent relation; clinical feature; family life; human; male; Oedipus complex; psychotherapy

National Lesbian Health Care Survey: Implications for mental health care - Bradford, J.; Ryan, C.; Rothblum, E.D. (Journal of Consulting and Clinical Psychology, 1994)
This article presents demographic, lifestyle, and mental health information about 1,925 lesbians from all 50 states who participated as respondents in the National Lesbian Health Care Survey (1984-1985), the most comprehensive study on U.S. lesbians to date. Over half the sample had had thoughts about suicide at some time, and 18% had attempted suicide. Thirty- seven percent had been physically abused as a child or adult, 32% had been raped or sexually attacked, and 19% had been involved in incestuous relationships while growing up. Almost one third used tobacco on a daily basis, and about 30% drank alcohol more than once a week, 6% daily. About three fourths had received counseling at some time, and half had done so for reasons of sadness and depression. Lesbians in the survey also were socially connected and had a variety of social supports, mostly within the lesbian community. However, few had come out to all family members and coworkers. Level of openness about lesbianism was associated with less fear of exposure and with more choices about mental health counseling.
Keywords: alcoholism; article; child abuse; counseling; depression; female; health survey; human; incest; homosexual female; mental health care; smoking; suicide

The impact of hate violence on victims: emotional and behavioral responses to attacks. - Barnes, A.; Ephross, P.H. (Social work, 1994)
Criminal acts stemming from prejudice based on race, religion, sexual orientation, or ethnicity--frequently referred to as "hate violence"--have increased during recent years. This study explored the nature of hate attacks and victims' responses to them. The sample consisted of 59 victims and included black, white, and Southeast Asian people. Data were obtained through focus group meetings, individual interviews, and questionnaires. More than half of the victims reported experiencing a series of attacks rather than a single attack. Anger, fear, and sadness were the emotional responses most frequently reported by victims. About one-third of the victims reported behavioral responses such as moving from the neighborhood or purchasing a gun. The responses of hate violence victims were similar to those of victims of other types of personal crime. Implications for social work intervention are discussed.
Keywords: adaptive behavior; adolescent; adult; aged; article; emotion; female; hate; human; male; middle aged; religion; social problem; social psychology; United States; violence

Depressive distress among homosexually active African American men and women - Cochran, S.D.; Mays, V.M. (American Journal of Psychiatry, 1994)
Objective: Although early surveys of psychological adjustment among gay men and lesbians suggest only minor and not clinically relevant differences from heterosexual populations, concerns about psychiatric morbidity associated with HIV infection have renewed interest in the prevalence of psychological distress in this population, particularly among gay men. These later studies have focused primarily on white men. However, research indicates higher crude prevalence rates of psychological distress in community-drawn samples of African American subjects than in white subjects and also higher rates in women than in men. The authors examined rates of depressive distress and suicidal thoughts among homosexually active African American men and women who might be especially at risk for psychiatric morbidity due to multiple stigmatized social statuses. Method: Two nationally recruited groups of homosexually active African Americans (829 men and 603 women) completed self-administered questionnaires, including the Center for Epidemiologic Studies Depression Scale. Results: Homosexually active black women were as distressed as HIV-infected gay black men. Men with symptomatic HIV disease were significantly more distressed than men who were HIV infected but asymptomatic, HIV-antibody negative, or whose HIV status was unknown. Both men and women reported distress levels in excess of those previously reported in studies of blacks or primarily white gay men. Conclusions: Further research is needed to identify specific predictors of life stressors and lack of social support among homosexually active African Americans who appear to be at higher risk for depressive distress.
Keywords: acquired immune deficiency syndrome; adult; article; clinical trial; depression; distress syndrome; female; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; morbidity; Black person; priority journal; sex difference; social status; social support; suicidal behavior

Vitality and growth in HIV-infected gay men - Schwartzberg, S.S. (Social Science and Medicine, 1994)
The emphasis in the psychosocial literature on Human Immunodeficiency Virus (HIV) has been placed, correctly, on the traumatic impact of AIDS in terms of mortality, bereavement, suicide, psychopathology, and coping with life amid enormous multiple stressors. However, an important aspect of the HIV epidemic has been paid only minimal attention: many HIV-positive gay men have experienced beneficial, or even life-transforming, aspects of their situation. Seven HIV-positive gay men are described here who have successfully integrated HIV into a framework of world- and self-beliefs that allows for coherence, stability, emotional vitality, and positive self-regard. Eight general characteristics of these men are presented. These men represent a subgroup from a sample of 19 subjects in a qualitative clinical interview study exploring how HIV-positive gay men ascribe meaning to AIDS and their own HIV infection.
Keywords: acquired immune deficiency syndrome; adult; article; bereavement; clinical article; coping behavior; emotion; homosexuality; human; Human immunodeficiency virus infection; male; mental disease; mental health; mortality; suicide

HIV seroconversion in intravenous drug users in San Francisco, 1985-1990 - Moss, A.R.; Vranizan, K.; Gorter, R.; Bacchetti, P.; Watters, J.; Osmond, D. (AIDS, 1994)
Objective: To examine the HIV seroconversion rate, risk factors for seroconversion, and changes in risk behavior over time in intravenous drug users (IVDU) in San Francisco, 1985-1990. Design: Observational study. Setting: All methadone maintenance and 21-day methadone detoxification programs in San Francisco. Participants: A total of 2351 heterosexual IVDU, of whom 681 were seronegative at first visit and seen at least twice ('repeaters'). Main outcome measures: HIV seroconversion rates, risk factors for seroconversion, and changes in behavior. Results: The HIV seroconversion rate in repeaters was 1.9% per person-year (ppy) of follow-up [2.1% in women versus 1.7% in men (not significant); 4% in African Americans versus 1% in whites (P = 0.006); 3.9% ppy in the first third of the study, 1.2% in the second (P = 0.007), and 1.9% in the last (not significant)]. Risk factors for seroconversion were five or more sexual partners per year [hazard ratio (HR) = 2.6; P = 0.02], use of shooting gallery ever (HR = 2.9; P = 0.02), and less than 1 year (lifetime) in methadone maintenance (HR = 2.7; P = 0.02). Self-reported intravenous cocaine use fell from 33 to 15% over 5 years, shooting gallery use fell from 19 to 6%, and the proportion with five or more sexual partners fell from 25 to 10%. Bleach use rose to 75% of needle-sharers. Conclusions: The 1985-1990 HIV seroconversion rate in IVDU (1.9% ppy) was comparable to that in San Francisco cohorts of homosexual men (1.4% ppy). A decline in HIV seroconversion coincided with changes in risk behavior. Stable attendance of methadone maintenance was highly protective: the seroconversion rate in subjects with 1 year or more in methadone was 12% ppy.
Keywords: cocaine; methadone; adult; article; Caucasian; comparative study; drug dependence; drug detoxification; drug reexposure; female; heterosexuality; high risk population; homosexuality; human; Human immunodeficiency virus infection; instrument sterilization; intravenous drug administration; major clinical study; male; Black person; observation; priority journal; self report; seroconversion; sexual behavior; statistical analysis; United States

Suicidality in AIDS long-term survivors: What is the evidence? - Rabkin, J.G.; Remien, R.; Katoff, L.; Williams, J.B.W. (AIDS Care - Psychological and Socio-Medical Aspects of AIDS/HIV, 1993)
This study was designed to investigate suicidal ideation and attempts, thoughts about living and dying, and the maintenance, diminution and loss of hope in a sample of long-term AIDS survivors. The study sample consisted of 53 gay men enrolled as clients at Gay Mens Health Crisis in New York City who had had an AIDS-defining opportunistic infection at least 3 years prior to study entry. Despite the experience of protracted biological stress associated with life-threatening illness and the psychological stress of living with AIDS, we found low rates of current syndromal mood disorders (6%) or psychiatric distress. While thoughts about death and wishes to die were reported by a significant portion of men, they were context-specific, occurring almost exclusively during serious illness, often accompanied by severe pain or at times of bereavement. Only two men had made a suicide attempt after being diagnosed with AIDS and both had a history of prior (pre-AIDS) suicide attempts. While anger was a prominent affect, hopelessness was not. Overall, we found a high level of positive psychological health independent of HIV illness stage or degree of illness-induced physical limitation.
Keywords: acquired immune deficiency syndrome; anger; article; death; distress syndrome; homosexuality; human; major clinical study; male; mental stress; mood; opportunistic infection; priority journal; physiological stress; suicidal behavior; suicide attempt; survival; United States

Seroprevalence of and risk factors for HIV-1 infection in injection drug users in Montreal and Toronto: A collaborative study - Lamothe, F.; Bruneau, J.; Coates, R.; Rankin, J.G.; Soto, J.; Arshinoff, R.; Brabant, M.; Vincelette, J.; Fauvel, M. (Canadian Medical Association Journal, 1993)
Objective: To determine the prevalence of antibodies to HIV-1 and risk factors for HIV-1 infection among injection drug users. Design: Questionnaire survey. A venous blood sample was taken for HIV-1 antibody testing. Setting: Montreal and Toronto. Participants: A total of 810 subjects who had used injection drugs in the previous 6 months recruited mainly from treatment centres and from the street in Montreal (425 subjects) and from treatment centres in Toronto (385 subjects) between September 1988 and September 1990. The overall participation rate was 82%. Outcome measures: HIV-1 seropositivity, sociodemographic and behavioural risk factors for HIV-1 infection. Results: The overall seroprevalence rate of HIV-1 infection was 4.8% (95% confidence limits [CL] 3.5 and 6.5). In Montreal the rate was 8.2% (95% CL 6.0 and 11.2), and in Toronto 1.0% (95% CL 0.4 and 2.6) (p < 0.001). Seropositive subjects were significantly older (p = 0.041) and were more likely to have a history of imprisonment (p = 0.006) than seronegative subjects. In univariate analysis seropositivity was associated with the following behaviours: more frequent cocaine use (p < 0.001), injecting drugs in 'shooting galleries' (p = 0.002), sharing equipment with a person known to be HIV-1 seropositive (p = 0.006), 'booting' fresh blood (p = 0.004), homosexual or bisexual orientation (p = 0.006), engaging in prostitution (p < 0.001) and, for men, number of male sexual partners in the previous 6 months (p = 0.007). In multivariate analysis the determinants of HIV-1 seropositivity were Montreal as the city of recruitment (odds ratio [OR] 6.7, 95% CL 2.32 and 19.42), engaging in prostitution (OR 2.13, 95% CL 1.01 and 4.75), a history of imprisonment (OR 3.51, 95% CL 1.33 and 9.29) and sharing equipment with a person known to be HIV-1 seropositive (OR 4.43, 95% CL 1.43 and 13.74). Conclusions: Our findings show that HIV-1 is circulating among injection drug users in Montreal and Toronto and that both drug use and sexual behaviours are implicated in the transmission of infection in the populations studied. Adapted preventive programs should be developed to prevent further spread of HIV-1 infection in this population.
Keywords: acquired immune deficiency syndrome; article; Canada; controlled study; drug abuse; female; human; Human immunodeficiency virus 1; Human immunodeficiency virus infection; major clinical study; male; prevalence; priority journal; risk factor; sexual behavior; virus transmission

Social work with gay and lesbian adolescents. - Morrow, D.F. (Social work, 1993)
Gay and lesbian adolescents are a socially oppressed group discriminated against by a heterosexist and homophobic society. Because of the negative stigma society places on lesbian and gay adolescents, they face numerous difficulties that require social support and intervention. Issues pertinent to social work with lesbian and gay adolescents are examined in the context of three main social institutions: the family, the social culture, and the educational setting. Suggestions are made for improving intervention with this population, including increasing personal awareness of one's own homophobia and heterosexist bias in working with client groups; educating oneself and client groups about homosexuality; establishing positive social support programs to serve lesbian and gay adolescents; advocating for sanctions to end gay and lesbian harassment in the educational system; supporting the hiring of openly gay and lesbian teachers to serve as positive role models; and advocating for the inclusion of sexual orientation information in school sex education curricula.
Keywords: adolescent; article; child psychology; family; female; gender identity; homosexuality; human; male; psychological aspect; school; social support; social work; suicide; violence

"Gotcha covered". Puzzling out the mysteries of health insurance benefits coverage. - Bruder, P. (Hospital topics, 1993)
Keywords: alternative medicine; article; assisted suicide; chiropractic; economics; health care policy; homosexuality; human; mental health service; psychological aspect; reimbursement; United States

Lesbian, gay, and bisexual youth in community settings: personal challenges and mental health problems. - D'Augelli, A.R.; Hershberger, S.L. (American journal of community psychology, 1993)
Studied 194 lesbian, gay, and bisexual youth aged 21 and younger who attended programs in 14 community centers to determine the personal challenges they face due to their sexual orientation and their responses to these stresses. First awareness of sexual orientation typically occurred at age 10, but disclosure to another person did not occur until about age 16. There was much variability in sexual behavior, and many youths reported both same-sex and opposite-sex sexual experiences. Although most had told at least one family member about their sexual orientation, there remained much concern about family reactions. Suicide attempts were acknowledged by 42% of the sample. Attempters significantly differed from nonattempters on several milestones of sexual orientation development, social aspects of sexual orientation, parents' knowledge of sexual orientation, and mental health problems.
Keywords: adaptive behavior; adolescent; adult; article; bisexuality; female; homosexuality; human; male; mental disease; problem solving; psychological aspect; risk factor; self disclosure; self help; social environment; social support; suicide; suicide attempt

Intentional self-infection with HIV by long-term partners of HIV-positive homosexual men: Four case reports - Morgan, M.; Jones, J. (AIDS Patient Care, 1993)
Keywords: adult; article; case report; grief; high risk population; homosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infection; human relation; male; psychological aspect; risk assessment; risk factor; sexuality; social isolation; suicide; virus transmission

Stevie. - Wootton, M. (Nursing praxis in New Zealand inc, 1993)
Keywords: article; case report; dysgerminoma; human; male; nursing; suicide attempt; testis tumor; transsexualism

Chlamydia trachomatis colitis in an aged male homosexual - Ikeda, M.; Fukuda, K.; Kawai, T.; Fujino, M.A. (Digestive Endoscopy, 1993)
An 83-year-old male was admitted to our hospital complaining of hematochezia and anal pain. He was an active homosexual. His physical examination was normal except for anal pain and bloody stool which were discovered on digital examination. Serum samples showed positive antibodies to Chlamydia trachomatis (C. trachomatis) by EIA. Stool cultures were negative for pathogenic bacteria and parasites. A colonoscopy revealed multiple aphthous erosions in the rectosigmoid and ileocecal regions. The histological findings were non-granulomatous colitis with inflammatory cell infiltration and atrophy of the glands. An immunohistological staining of biopsy specimens was positive for C. trachomatis. Antibiotic therapy was an effective treatment for the symptoms. This case appears to be a non-lymphogranuloma type C. trachomatis infection to the large bowel. Ileocecal lesions have not been reported in non-lymphogranuloma type C. trachomatis colitis.
Keywords: aged; article; case report; Chlamydia trachomatis; colitis; endoscopy; homosexuality; human; immunohistochemistry; male

Suicide among AIDS patients - Copeland, A.R. (Medicine, Science and the Law, 1993)
I studied 25 cases of suicide in people diagnosed as having the acquired immunodeficiency syndrome (AIDS) or who thought that they had that disorder, during 1985-1989. Case reports are presented. A discussion ensues concerning the occurrence of this phenomenon and the medical examiner's role in AIDS' public health situation in general.
Keywords: acquired immune deficiency syndrome; adult; article; clinical article; coroner; depression; homosexuality; human; male; priority journal; public health; social work; suicide; United States

Six strains of human immunodeficiency virus type 1 isolated in Japan and their molecular phylogeny - Shimizu, N.; Takeuchi, Y.; Naruse, T.; Inagaki, M.; Moriyama, E.; Gojobori, T.; Hoshino, H. (Journal of Molecular Evolution, 1992)
Five strains of human immunodeficiency virus type 1 (HIV-1) were isolated from five Japanese hemophilia patients. Two isolates, HIV-1[GUN-1] and HIV- 1[GUN-2], were from brother patients with hemophilia B and the other three isolates, HIV-1[GUN-3], HIV-1[GUN-4], and HIV-1[GUN-5], were from hemophilia A patients. Another HIV-1 strain, HIV-1[GUN-6], was isolated from a Canadian male homosexual with AIDS. The restriction endonuclease cleavage maps of the proviral genomes of these six HIV-1 strains revealed that they were apparently different from each other. The phylogenetic trees constructed using restriction maps and nucleotide sequences were quite similar, indicating that phylogenetic analyses of Japanese HIV-1 isolates can be done using restriction maps of the proviruses. Phylogenetic analyses showed that they were more closely related to HIV-1s which had been reported to be isolated from homosexual patients in the United States than those isolated from African patients. In particular, GUN-1 and GUN-2 isolates were on the branch of a San Francisco isolate, ARV2, while GUN-5 and GUN-6 isolates were on the branch of HTLV-III(B)-related isolates.
Keywords: restriction endonuclease; acquired immune deficiency syndrome; article; geographic distribution; hemophilia A; hemophilia B; Human immunodeficiency virus 1; nonhuman; nucleotide sequence; phylogeny; priority journal; provirus; restriction mapping; Southern blotting; virus isolation; virus strain

Surveillance of human immunodeficiency virus (HIV) antibodies in medicolegal autopsies in Finland - Monitoring early changes in HIV- seropositivity among risk groups and average population - Karhunen, P.J.; Brummer-Korvenkontio, H.; Laaksonen, H.; Kantanen, M.-L.; Arstila, P.; Leinikki, P. (Journal of Forensic Sciences, 1992)
In order to cooperate with voluntary screening programs aimed at the surveillance of the HIV epidemic in Finland, we have studied medicolegal autopsies for HIV antibodies since 1986 using an enzyme immunoassay on postmortem sera. The investigation covered 47.4% and 39.2%, respectively, of all deaths under the age of 65 years in the metropolitan areas of Helsinki and Turku-two cities on the densely populated southern coast of Finland from which most HIV infections have thus far been detected. Nine HIV-positive cases (0.12%) were detected among the 7305 medicolegal autopsies tested in 1986 to 1990. This figure is higher than the prevalence of 0.01 to 0.03% in voluntary screening programs for the general population would suggest. Seven of our cases had previously tested positive, and two were previously unknown cases, indicating that people at high risk are clustered in the medicolegal autopsy series. Of the six cases in an early stage of infection, three committed suicide suggesting the importance of HIV-screening in suicide cases in tracing symptomless HIV carriers. Five of the cases were detected in 1990, a year when the number of new HIV infections had more than doubled compared to the previous two years. This suggests that testing of medicolegal autopsies as surrogate tests for the population gives useful information even in low-prevalence areas like Finland. Such testing has none of the ethical problems of many other back-up surveys, and may be particularly sensitive to early changes in epidemiology.
Keywords: Human immunodeficiency virus antibody; acquired immune deficiency syndrome; adult; article; autopsy; female; Finland; high risk population; homosexuality; human; Human immunodeficiency virus; Human immunodeficiency virus infection; male; medicolegal aspect; priority journal; screening; serology

Rational suicide and AIDS: considerations for the psychotherapist. - Werth, J.L. (The Counseling psychologist, 1992)
Keywords: acquired immune deficiency syndrome; addiction; age; article; attitude; counseling; Death and Euthanasia; decision making; depression; family; Health Care and Public Health; health care personnel; homosexuality; human; mental capacity; Mental Health Therapies; mental stress; motivation; pain; passive euthanasia; patient; psychology; psychotherapy; right to die; social psychology; suicide; terminally ill patient

Creating a safer school environment for lesbian and gay students. - Treadway, L.; Yoakam, J. (The Journal of school health, 1992)
Information obtained from clinical experiences of the University of Minnesota Youth and AIDS Project (YAP), a primary AIDS prevention program for gay and bisexual males ages 14-21, is described. More than 300 YAP clients have been interviewed regarding sexual behavior, suicide attempts, drug use, and experiences in disclosing their homosexuality to peers and parents during their high school years. The authors also have drawn from their experiences as support group leaders for gay, lesbian, and bisexual youth in high school and community settings. Constructive and destructive coping strategies employed by gay, lesbian, and bisexual students are described. Roles and responsibilities of school professionals to create a safer school environment also are presented. Key issues include how school professionals support or deny the existence of homosexuality in young people; how adults' biases against homosexuality, as well as institutionalized heterosexism, prevent lesbian and gay students from succeeding in school; how language, behaviors, and environmental cues contribute to school professionals' approachability; how children of lesbian and gay parents suffer when negative attitudes toward homosexuality are not challenged; and what resources and referrals can help lesbian and gay young people.
Keywords: acquired immune deficiency syndrome; adolescent; article; cultural anthropology; disease transmission; female; homosexuality; hostility; human; male; school; sexual behavior; social environment; social support; United States

Risk of deliberate self-harm and factors associated with suicidal behaviour among asymptomatic individuals with human immunodeficiency virus infection - Gala, C.; Pergami, A.; Catalan, J.; Riccio, M.; Durbano, F.; Musicco, M.; Baldeweg, T.; Invernizzi, G. (Acta Psychiatrica Scandinavica, 1992)
The study was aimed at evaluating the risk of deliberate self-harm (DSH) and factors associated with suicidal behaviour in 213 asymptomatic individuals with human immunodeficiency virus (HIV) infection in 3 transmission categories (68 gay men, 123 intravenous drug users and 22 heterosexuals). The results showed that 12 HIV-seropositive (HIV+) subjects were involved in DSH after the notification of a positive HIV test result, of which 8 occurred within 6 months and 4 between 6 months and 3 years. HIV+ subjects with a past psychiatric history showed a 7.7-fold increase in the relative risk of DSH, and HIV+ subjects with a history of DSH showed a 5-fold increase in the relative risk of DSH compared with HIV+ individuals without a past psychiatric history and a history of DSH. Professionals involved in the care of HIV+ individuals need to be aware of this risk, especially in the first few months after notification of HIV status and also at later stages of acquired immunodeficiency syndrome.
Keywords: adult; article; drug abuse; drug overdose; female; homosexuality; human; Human immunodeficiency virus infection; injury; major clinical study; male; risk factor; suicidal behavior

Early brain changes in HIV infection: Neuropathological study of 11 HIV seropositive, non-AIDS cases - Gray, F.; Lescs, M.-C.; Keohane, C.; Paraire, F.; Marc, B.; Durigon, M.; Gherardi, R. (Journal of Neuropathology and Experimental Neurology, 1992)
We examined 11 brains of human immunodeficiency virus (HIV) seropositive cases who died from unnatural causes (10 intravenous drug abusers who died from heroin overdose and 1 homosexual dead from a gunshot injury); 10 brains of HIV seronegative heroin addicts who died from overdose and 1 seronegative drug abuser who died from gunshot injury served as controls. Complete postmortem examination did not show evidence of acquired immune deficiency syndrome (AIDS) or AIDS related complex. Terminal changes including nerve cell ischemia, edema and diffuse vascular congestion were observed in all cases. Perivascular pigment deposition with macrophages was a constant finding in drug addicts and was probably related to chronic intravenous injection. In contrast, cerebral vasculitis was significantly more frequent and marked in HIV seropositive cases and was often associated with lymphocytic meningitis. Granular ependymitis, myelin pallor with reactive astrocytosis and microglial proliferation were also more frequent and more severe in HIV seropositive cases. Immunocytochemistry was negative for HIV antigens. Our study further supports the view that early central nervous system changes occur in HIV infection.
Keywords: acquired immune deficiency syndrome; article; blood brain barrier; brain edema; brain ischemia; brain vasculitis; controlled study; female; gliosis; human; Human immunodeficiency virus infection; human tissue; male; nerve cell; priority journal; white matter

Legal trends in bioethics. - Onel, S.; Fry-Revere, S. (The Journal of clinical ethics, 1992)
Keywords: acquired immune deficiency syndrome; adolescent; art; article; assisted suicide; bioethics; Bioethics and Professional Ethics; confidentiality; counseling; donor; fee; female; fetus; fetus death; government; health care personnel; homosexuality; human; human experiment; Human immunodeficiency virus infection; induced abortion; infection control; information dissemination; information service; informed consent; jurisprudence; juvenile; law; Legal Approach; living will; malpractice; medical record; mother; nutritional support; pain; parent; parental notification; passive euthanasia; persistent vegetative state; pregnancy; pregnant woman; prisoner; military personnel; terminally ill patient; transplantation; treatment refusal; treatment withdrawal; United States

Suicide related to human immunodeficiency virus infection in Stockholm - Rajs, J.; Fugelstad, A. (Acta Psychiatrica Scandinavica, 1992)
During a 5-year period (July 1, 1985 to June 30, 1990), a systemic investigation of medicolegal autopsy cases with regard to the occurrence of human immunodeficiency virus (HIV) infection was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Cases where a positive result was obtained from enzyme-linked immunosorbent assay and Western blotting were counted as HIV-positive (85 instances among 16,938 deaths, or 0.50%). Of these deaths, 21 (25%) were suicides. The number and proportion of suicides among HIV-positive homo- and bisexual males increased during the study period but remained unchanged for infected intravenous drug addicts. This increase of suicides among homo- and bisexual males could be related to the duration of the infection and to the manifestation of acquired immunodeficiency syndrome (AIDS) symptoms. Only 1 of the 21 suicides occurred in a hospital; 17 were committed in the homes of the deceased and 3 outdoors. Medicinal drug overdosage was the dominant choice of suicide method. Six of 12 homo- and bisexual males who committed suicide were of non-Swedish origin, i.e. immigrants, likely to have a less stable social network and thereby probably receiving less psychosocial support than the native population.
Keywords: adult; article; drug dependence; female; homosexuality; human; Human immunodeficiency virus infection; major clinical study; male; suicide; Sweden

Human T cell lymphotropic virus types I and II in intravenous drug users in San Francisco: Risk factors associated with seropositivity - Feigal, E.; Murphy, E.; Vranizan, K.; Bacchetti, P.; Chaisson, R.; Drummond, J.E.; Blattner, W.; McGrath, M.; Greenspan, J.; Moss, A. (Journal of Infectious Diseases, 1991)
Serologic assays for human T cell lymphotropic virus types I and II (HTLV I/II) infection were done in 676 intravenous drug users (IVDUs) in San Francisco between 1985 and 1987: 150 in 1985, 44 in 1986, and 482 in 1987. All sera were tested by Western blot, ELISA, and p24 RIA. A total of 111 participants were seropositive in a minimum of two assays. Duration of intravenous heroin use was strongly associated with the risk of HTLV I/II seropositivity: ≥21 years odds ratio, 6.1 (95% confidence interval [CI], 2.2-17.5), compared with ≤10 years of heroin use. Additional independent risk factors included black or Hispanic race, female sex, and the use of drugs in a shooting gallery. Coinfection of HTLV I/II and human immunodeficiency virus was less frequent than expected by chance (P < .02). Longitudinal specimens were available in 154 participants. The age- and race-adjusted seroconversion rate was 3.4% (95% CI, 1.3-8.9) per person per year. Of the 349 homosexual men tested, none were HTLV I/II-seropositive.
Keywords: adult; article; drug abuse; ethnic group; female; human; Human T-lymphotropic virus 1; Human T-lymphotropic virus 2; major clinical study; male; nonhuman; priority journal; risk factor; seroconversion; sexual behavior; United States; virus infection

Risk factors for shooting gallery use and cessation among intravenous drug users - Celentano, D.D.; Vlahov, D.; Cohn, S.; Anthony, J.C.; Solomon, L.; Nelson, K.E. (American Journal of Public Health, 1991)
Background. Shooting galleries, locations where intravenous drug users (IVDUs) can rent or borrow needles and syringes, are a high-risk environment for HIV-1 transmission. This study investigates risk factors for lifetime attendance at shooting galleries and differentiates characteristics of those who continue to frequent shooting galleries and those who have stopped. Methods. We interviewed 2615 active IVDUs in Baltimore in 1988 and 1989 and determined patterns of IV drug use, sociodemographics, and HIV-1 serostatus as related to persistence vs cessation of shooting gallery use. Results. Over half (52%) of active IVDUs reported ever using a shooting gallery, with 33% reporting use within the prior 3 months. In multivariate analysis, lifetime shooting gallery use was associated with male gender, homosexuality/bisexuality, low socioeconomic status, Black race, and heavier drug involvement. Persistent shooting gallery users were more frequently male, homosexual/bisexual, homeless, less educated, and started IV drug use more recently compared with those who ceased going to shooting galleries. Conclusions. Shooting gallery attendance may be pragmatic from a sociological and economic perspective, but it carries with it a heightened risk of acquiring HIV-1 infection.
Keywords: adult; article; controlled study; drug abuse; epidemiology; female; human; Human immunodeficiency virus 1; Human immunodeficiency virus infection; intravenous drug administration; male; needle; prevention; priority journal; risk factor; syringe; United States

AIDS-related factors predictive of suicidal ideation of low and high intent among gay and bisexual men - Schneider, S.G.; Taylor, S.E.; Kemeny, M.E.; Hammen, C. (Suicide and Life-Threatening Behavior, 1991)
AIDS-related stressors were studied in relationship to suicidal ideation and suicide intent among 778 gay and bisexual men (none with AIDS). Over the previous six months, 27% (n = 212) reported suicidal ideation. Subjects who reported suicidal ideation (compared to those who did not) were more likely to report recent (last 6 months) bereavement of partner, recent ARC diagnosis, and multiple close friends with ARC. Suicide ideators were divided by a median split on a self-report scale of suicide intent into low (n = 105) and high (n = 107) intent suicide ideators. News of HIV seropositivity was specifically related to low intent suicidal ideation. High intent suicidal ideation was associated with having a partner with AIDS or ARC, or multiple close friends with AIDS, or having ARC. Generally speaking, while temporally discrete AIDS-related events were associated the report of suicidal ideation, ongoing stressors which may more greatly challenge adaptational capacities were more associated with high intent suicidal ideation.
Keywords: acquired immune deficiency syndrome; adult; article; bereavement; homosexuality; human; major clinical study; male; physiological stress; suicidal behavior

Factor influencing suicide intent in gay and bisexual suicide ideators: differing models for men with and without human immunodeficiency virus. - Schneider, S.G.; Taylor, S.E.; Hammen, C.; Kemeny, M.E.; Dudley, J. (Journal of personality and social psychology, 1991)
Of 778 gay and bisexual men (none with acquired immunodeficiency syndrome [AIDS]), 27% (n = 212) reported suicidal ideation over the previous 6 months. Covariance structure models were used to explore predictors of suicide intent among (n = 112) suicide ideators with (n = 100) and without (n = 112) human immunodeficiency virus (HIV). Current AIDS-related stressors (deaths and illnesses and perceived AIDS risk) and past levels of adaptive functioning (social isolation and depression) were significantly more powerful predictors of suicide intent among HIV-positive than among HIV-negative ideators. Biological AIDS risk predicted neither suicide intent, current distress, nor perceived AIDS risk. Pathways to suicide intent appear to be psychologically, rather than biologically, mediated. Among HIV-positive ideators, AIDS-related death and illness events predicted suicide intent but not current distress symptoms. Some suicidal ideation in response to AIDS-related events may be an effort to cope rather than a manifestation of psychological distress.
Keywords: adaptive behavior; adult; article; bisexuality; homosexuality; human; Human immunodeficiency virus infection; male; psychological aspect; risk factor; social support; suicide; thinking

Lance: a gay recovering alcoholic misdiagnosed as HIV-positive. - Kus, R.J.; Carpenter, M.A. (Archives of psychiatric nursing, 1991)
Lance is a 29-year-old gay alcoholic who was misdiagnosed as human immunodeficiency virus (HIV)-positive. In reaction to the diagnosis, Lance subsequently engaged in a series of destructive behaviors towards himself and others. When he was told that his diagnosis was in error, Lance was able to break out of his self-destructive cycle. This article explores the symbolic interactionist concepts of definition of the situation and of stigma and provides nursing implications for caring for people with HIV infection and the acquired immune deficiency syndrome.
Keywords: adult; alcoholism; article; automutilation; case report; diagnostic error; homosexuality; human; Human immunodeficiency virus infection; human relation; male; psychological aspect; suicide attempt

A question of mercy. - Selzer, R. (The New York times magazine, 1991)
Keywords: drug; acquired immune deficiency syndrome; article; assisted suicide; case report; Death and Euthanasia; euthanasia; Health Care and Public Health; homosexuality; human; physician; Popular Approach/Source; right to die; terminally ill patient; voluntary euthanasia

Pathways to infection: AIDS vulnerability among the Navajo. - Sullivan, C. (AIDS education and prevention : official publication of the International Society for AIDS Education, 1991)
Though the development of AIDS cases among Native Americans has paralleled the early stages of the epidemic in the United States, there are socio/cultural distinctions among many U.S. tribes that could lead to transmission differences. Patterns of sexual behavior, IV drug use, suicidality, use of disinhibitors, and the rural-urban migration found among some members of the Navajo Nation are reviewed, along with recommendations for education/prevention program development. The efficacy of anthropological techniques of rapport building and information gathering about sensitive information is also discussed.
Keywords: acquired immune deficiency syndrome; alcoholism; American Indian; anthropology; article; cultural factor; disease transmission; ethnology; female; homosexuality; human; male; migration; organization and management; preventive health service; psychological aspect; risk factor; sexual behavior; standard; statistics; substance abuse; suicide attempt; United States

Risk factors for attempted suicide in gay and bisexual youth - Remafedi, G.; Farrow, J.A.; Deisher, R.W. (Pediatrics, 1991)
Studies of human sexuality have noted high rates of suicidality among homosexual youth, but the problem has not been systematically examined. This work was undertaken to identify risk factors for suicide attempts among bisexual and homosexual male youth. Subjects were 137 gay and bisexual males, 14 through 21 years of age, from the upper Midwest and Pacific Northwest. Forty-one subjects (41/137) reported a suicide attempt; and almost half of them described multiple attempts. Twenty-one percent of all attempts resulted in medical or psychiatric admissions. Compared with nonattempters, attempters had more feminine gender roles and adopted a bisexual or homosexual identity at younger ages. Attempters were more likely than peers to report sexual abuse, drug abuse, and arrests for misconduct. The findings parallel previous studies' results and also introduce novel suicide risk factors related to gender nonconformity and sexual milestones.
Keywords: adolescent; adult; article; behavior disorder; bisexuality; child abuse; drug abuse; homosexuality; human; male; priority journal; risk factor; sex role; suicide attempt

Christian psychiatry: The impact of evangelical belief on clinical practice - Galanter, M.; Larson, D.; Rubenstone, E. (American Journal of Psychiatry, 1991)
Objective: The authors surveyed psychiatrists in the Christian Psychiatry movement to assess the role of religious belief in their practices. Method: The psychiatrists were members of the Christian Medical and Dental Society; questionnaires were sent to 260, and usable responses were received from 193. The subjects were asked about demographic and practice variables, 'born again' religious experiences, group cohesion, and beliefs about using the Bible and prayer in treatment. Results: The respondents were somewhat more religious than Americans overall, who are themselves more religious than most psychiatrists. Nearly all reported having been 'born again', after which they generally experienced a decrease in emotional distress. There was a significant difference in the respondents' affiliative feelings toward psychiatrists in the Christian Psychiatry movement and other psychiatrists. For acute schizophrenic or manic episodes, the respondents considered psychotropic medication the most effective treatment, but they rated the Bible and prayer more highly for suicidal intent, grief reaction, sociopathy, and alcoholism. Whether or not a patient was 'committed to Christian beliefs' made a significant difference in whether the respondents would recommend prayer to the patient as treatment. About one-half said they would discourage strongly religious patients from an abortion, homosexual acts, or premarital sex, and about one-third said they would discourage other patients from these activities. Conclusions: Many studies have suggested a need for more sensitivity to religious issues by psychiatrists, and this study provides systematic findings on one approach. It remains important to evaluate ways in which a religious perspective can be related to clinical practice and what benefits and problems may derive from such a relationship.
Keywords: abortion; alcoholism; article; distress syndrome; drug therapy; emotion; human; priority journal; psychiatrist; religion; sexual behavior; antisocial personality disorder

Mortality attributable to HIV infection/AIDS--United States, 1981-1990. (MMWR. Morbidity and mortality weekly report, 1991)
From 1981 through 1990, 100,777 deaths among persons with acquired immunodeficiency syndrome (AIDS) were reported to CDC by local, state, and territorial health departments; almost one third (31,196) of these deaths were reported during 1990. During the 1980s, AIDS emerged as a leading cause of death among young adults in the United States. By 1988, human immunodeficiency virus (HIV) infection/AIDS had become the third leading cause of death among men 25-44 years of age and, by 1989, was estimated to be second, surpassing heart disease, cancer, suicide, and homicide (Figure 1). In 1988, HIV infection/AIDS ranked eighth among causes of death among women 25-44 years of age (Figure 2); in 1991, based on current trends, HIV infection/AIDS is likely to rank among the five leading causes of death in this population (1).
Keywords: acquired immune deficiency syndrome; adolescent; adult; article; child; ethnology; female; health survey; homosexuality; human; Human immunodeficiency virus infection; male; middle aged; mortality; preschool child; substance abuse; United States

Free will versus determinism in bioethics: comparative philosophical and Jewish perspectives. - Steinberg, A. (Assia--Jewish medical ethics, 1991)
Keywords: altruism; article; beneficence; bioethics; Bioethics and Professional Ethics; doctor patient relationship; freedom; homosexuality; human; human rights; informed consent; medical ethics; paternalism; personal autonomy; religion; Religious Approach; social psychology; socioeconomics; suicide; treatment refusal

Psychological functioning in a cohort of gay men at risk for AIDS. A three-year descriptive study - Joseph, J.G.; Caumartin, S.M.; Tal, M.; Kirscht, J.P.; Kessler, R.C.; Ostrow, D.G.; Wortman, C.B. (Journal of Nervous and Mental Disease, 1990)
This study describes the mental health of a large cohort of gay men participating in the Chicago Multicenter AIDS Cohort Study/Coping and Change Study. Six biannual questionnaires were self-administered between 1984 and 1988. General mental health was determined by the Hopkins Symptom Checklist (HSCL). An abbreviated version of the Center for Epidemiologic Study Depression Scale (CESD-5) and an adapted Diagnostic Interview Schedule (DIS) question also measured depression. Suicidal ideation was assessed by one question in the HSCL. AIDS-specific distress was determined by three subscales specifically developed for this study. While mean HSCL and CESD-5 scores were stable during the observational period, AIDS-specific distress increased over time. The HSCL scores for the cohort were somewhat elevated above general population norms but considerably below psychiatric outpatient norms. Fewer than 12% of the men reported elevated HSCL or CESD-5 scores three or more times. A self-reported episode of depression of two weeks or more, measured by the DIS screening question, was experienced by 40.1% of the sample. Suicidal ideation was reported on three or more visits by 18.8% of the men. The younger members of this cohort exhibit greater general and AIDS-specific distress. Income was inversely associated with general distress. HIV-seropositive participants had generally higher AIDS-specific distress scores than those who were seronegative, but their scores were equivalent on the HSCL and CESD-5.
Keywords: acquired immune deficiency syndrome; adult; article; depression; homosexuality; human; major clinical study; male; priority journal; psychological aspect; physiological stress; suicide attempt

Psychopathologic features among drug addicts and homosexuals with HIV infection - Cazzullo, C.L.; Gala, C.; Martini, S.; Pergami, A.; Rossini, M.; Russo, R. (International Journal of Psychiatry in Medicine, 1990)
Personal and familial psychopathological histories and information about early losses were collected and the results of the locus of control test and tests for psychological responses were determined for a series of ninety-two HIV-infected subjects (58 drug addicts; 26 homosexuals; 8 heterosexuals, partners of drug addicts). A higher percentage of drug addicts reported past histories of attempted suicide than the homosexuals. Early loss events were more frequent for homosexuals than for drug addicts. There was a higher psychopathological risk for asymptomatic HIV seropositivity in homosexuals, drug addicts who had attempted suicide, subjects that acknowledged that they have serious illness and subjects with external coping mechanisms rather than internal.
Keywords: adult; article; coping behavior; drug dependence; homosexuality; human; Human immunodeficiency virus; major clinical study; psychological aspect; suicide attempt

Risk factors for human immunodeficiency virus infection among parenteral drug abusers in a low-prevalence area - Chandrasekar, P.H.; Molinari, J.A.; Kruse, J.A. (Southern Medical Journal, 1990)
Information is scant regarding epidemiologic risk factors for human immunodeficiency virus (HIV) infection among parenteral drug abusers (PDAs) residing in areas of low seroprevalence. A detailed interview and HIV serologic testing were conducted among PDAs hospitalized at Detroit Receiving Hospital for reasons unrelated to HIV infection. The study involved 22 seropositive (17 men, 5 women) and 52 seronegative (34 men, 18 women) drug abusers in Detroit, Michigan, an area of relatively low HIV prevalence. The interviews included inquiries regarding risk factors such as duration of drug abuse, visits to 'shooting galleries', use of 'hit men', needle sharing, sterile injection techniques, use of 'street' antibiotics, promiscuity, visits to prostitutes, homosexuality, history of sexually transmitted diseases, and history of travel to areas of high HIV prevalence. A strong association was noted between the number of risk factors present and HIV seropositivity. The presence of any three or more risk factors was significantly associated (P < .05) with seropositivity. Awareness of epidemiologic risk factors for HIV infection among PDAs in a low-prevalence area is useful in identification of seropositive drug abusers and is crucial in designing educational interventional strategies to interrupt viral transmission.
Keywords: adult; article; drug abuse; female; human; Human immunodeficiency virus infection; male; nonhuman; priority journal; risk factor; United States; virus transmission

Sexual confusion among certain college males. - Goff, J.L. (Adolescence, 1990)
In dealing with college age (18-22) males, clinical observations have shown a fairly common inability to successfully form intimate relationships with same-age females. This problem often appears to be due to an inability to bond and trust that is rooted in the formative years in the nuclear home. When this happens, the young male frequently develops a fear of being sexually abnormal, perhaps even homosexual. This manifests itself in shame, anxiety, depression, denial, reaction formation, performance anxiety, concern about being found out, isolation, substance abuse and, occasionally, acting out. Getting such persons to admit these fears is generally extremely difficult, requiring gentle and empathetic, but persistent, probing on the part of the therapist. Therapy consists of understanding and acceptance by the client that these fears are most often reactive, that they are commonly held, and that when they are seen in proper perspective, they often diminish. The present paper reviews some of the literature on sexual developmental issues of the adolescent male as a backdrop for this problem. The specific difficulties related to reactive homophobia are explored, and some therapeutic approaches suggested.
Keywords: adolescent; adult; article; case report; confusion; control; denial; depression; gender identity; homosexuality; human; male; psychological aspect; psychosexual development; sexual behavior; social psychology; suicide attempt

Needle sharing among male prostitutes: Preliminary findings of the prospero project - Waldorf, D.; Murphy, S.; Lauderback, D.; Reinarman, C.; Marotta, T. (Journal of Drug Issues, 1990)
To date there is only sketchy information about the needle-sharing practices of IV drug users. This article reviews the existing literature on needle-sharing practices and presents quantitative findings on IV drug use, needle-sharing practices and the utilization of shooting galleries of male sex workers. Self-reports of 178 street hustlers, male prostitutes who sell sexual favors in public places, indicate a high incidence of IV drug use, particularly methamphetamines, cocaine and heroin. They also report considerable syringe sharing, as well and needle sharing in social settings such as shooting galleries, bath houses and sex clubs. Pragmatic issues, such as availability of syringes and convenience, are said to be the principle reasons to share needles. Race and ethnicity were not important factors for this group. It would appear from this preliminary data that a sizeable percentage of street hustlers in San Francisco are at risk to contract the HIV virus because of their needle-sharing practices.
Keywords: article; drug abuse; homosexuality; human; intravenous drug administration; major clinical study; male; prostitution

Followup observations of operated male-to-female transsexuals - Stein, M.; Tiefer, L.; Melman, A. (Journal of Urology, 1990)
We performed an in-depth interview to ascertain the psychosocial and functional status in 10 of 22 male-to-female transsexuals who underwent vaginoplasty from May 1985 to December 1988. Followup from 5 to 48 months was available for 14 patients. Our patients comprised a well educated, mostly employed, law abiding group with a low abiding group with a low incidence of drug use. Most patients were able to develop strong support systems and showed a marked decrease in suicidal tendencies postoperatively. Functionally, the majority of the patients were able to lubricate the neovagina and have painless intercourse with a potential for orgasm. The cosmetic result was judged to be good, with no patient reporting being discovered of having had a prior operation by the sexual partner. We experienced a 21% rate of vaginal stenosis with 40% of these patients fully functional after a corrective operation.
Keywords: article; clinical article; female; human; male; priority journal; psychological aspect; sex difference; social psychology; transsexualism; vagina reconstruction

Search for early lesions following human immunodeficiency virus type 1 infection. A study of six individuals who died a violent death after seroconversion - Madea, B.; Roewer, H.J.; Krueger, G.R.F.; Ablashi, D.V.; Josephs, S.F. (Archives of Pathology and Laboratory Medicine, 1990)
Histologic studies supplemented by in situ hybridization for human immunodeficiency virus type 1 (HIV-1), Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 were performed on tissues obtained from the autopsy of six patients who died either by homicide or suicide shortly after learning of their seroconversion. Except for mild nonspecific tissue reactions, no lesions were noted that would indicate HIV-1 infection. DNA from all viruses was detected in some lymphoid cells. The amount of DNA for Epstein-Barr virus, cytomegalovirus, and human herpesvirus type 6 corresponded to that observed for clinically occult latent infection. Lymphoid cells carrying HIV-1 DNA were even less frequent. Cells positive for HIV-1 were noted in the lamina propria of the large intestine in three male homosexuals and in one female prostitute. The cells were arranged similar to antigen-presenting cells. The present findings are consistent with current theories regarding the pathogenesis of HIV-1-associated disease.
Keywords: article; clinical article; Cytomegalovirus; diagnosis; Epstein Barr virus; fatality; Herpes simplex virus; histology; human; Human immunodeficiency virus 1; hybridization; legal aspect; priority journal

AIDS-related illness and AIDS risk in male homo/bisexual substance abusers: Case reports and clinical issues - Westermeyer, J.; Seppala, M.; Gasow, S.; Carlson, G. (American Journal of Drug and Alcohol Abuse, 1989)
Little has been written about the treatment of substance use disorders among seropositive HIV patients or high-risk seronegative substance abusers. Demographic and clinical characteristics, along with treatment issues, were examined based on experience with 18 patients in a substance abuse program in a university medical center (3 AID, 3 ARC, 9 seropositive only, and 3 seronegative high risk). Scores on a substance abuse rating scale were extremely high. Most of them abused three or more different substances, had used drugs parenterally, had more than 50 sex partners, and/or had received previous substance abuse treatment. Affective disorder, suicide attempt, and antisocial personality were frequent in this group. About half of the patients complied with treatment and showed improvement in their substance disorder. Several common themes in the management of these patients are described.
Keywords: acquired immune deficiency syndrome; adult; affect; antisocial behavior; article; clinical article; drug abuse; homosexuality; human; priority journal; psychological aspect; suicide attempt

Suicidal behavior in adolescent and young adult gay men - Schneider, S.G.; Farberow, N.L.; Kruks, G.N. (Suicide and Life-Threatening Behavior, 1989)
The relationship of homosexuality to suicidal behavior was explored by questionnaire responses from 52 men in gay-and-lesbian college organizations and 56 men in gay rap groups. A family background of alcoholism and physical abuse, social supports perceived as rejecting of homosexuality, and no religious affiliation were associated with a history of suicidal ideation, reported by 55% of the participants. Racial/ethnic minorities tended to be overrepresented among suicidal as compared to nonsuicidal gay men. Suicide attempts, reported by 20% of the sample, were most often associated with intrapersonal distress, and occurred most often while individuals were 'closeted' and/or in the context of recent rejection for being homosexual. Nearly all attempters were aware of their homosexual feelings, but had not yet established a 'positive gay identity' at the time of their first suicide attempt. Suicidal behavior in gay youths may be the product both of familial factors that predispose youths to suicidal behaviour, and of social and intrapersonal stressors involved in coming to terms with an emerging homosexual identity.
Keywords: adolescent; adult; alcoholism; article; child abuse; distress syndrome; female; homosexuality; human; major clinical study; male; psychological aspect; religion; suicidal behavior

Substance abuse and suicide. The San Diego study - Rich, C.L.; Fowler, R.C.; Young, D. (Annals of Clinical Psychiatry, 1989)
We investigated 283 suicides in San Diego between November 1981 and June 1983. The first 204 cases were collected consecutively. The next 79 were consecutive cases under age 30. The sample consisted, then, of three separate but overlapping consecutive series: 133 cases under age 30, 150 cases age 30 and over, and 204 cases of all ages. Overall, substance abuse/dependence was diagnosed in about two thirds of the cases, both over and under age 30. Depressive disorders were most commonly diagnosed in association with substance abuse (SA) in both age groups. Many other disorders also accompanied SA. There were significantly more diagnoses of ' drug' abuse among the younger cases than among the older suicides. The frequency of alcohol abuse was the same. There were no significant differences in the rates of SA between the men and women in the 204 consecutive cases. Of the 45 suicides with psychotic disorders in the consecutive series, more than half (62%) were also substance abusers. Of the 15 cases who had personality disorders, 14 also were substance abusers. Also, 12 of 13 gay males were known to be substance abusers. In all cases, the drugs most frequently abused were alcohol, sedatives, marijuana, and stimulants. Depressive symptoms were common in the cases with SA even if an affective disorder was not formally diagnosed. We conclude that SA is possibly fat more important as a primary etiology of suicides than was previously believed.
Keywords: adult; age; alcoholism; article; drug abuse; fatality; human; major clinical study; personality disorder; psychological aspect; psychosis; suicide

Mortality and morbidity in transsexual patients with cross-gender hormone treatment - Asscheman, H.; Gooren, L.J.G.; Eklund, P.L.E. (Metabolism: Clinical and Experimental, 1989)
Sex steroid treatment is associated with side effects. The number of deaths and morbidity cases in 425 transsexual patients treated with cross-gender hormones were evaluated retrospectively and compared with the expected number in a similar reference group of the population. The number of deaths in male-to-female transsexuals was five times the number expected, due to increased numbers of suicide and death of unknown cause. Combined treatment with estrogen and cyproterone acetate in 303 male-to-female transsexuals was associated with a 45-fold increase of thromboembolic events, hyperprolactinemia (400-fold), depressive mood changes (15-fold), and transient elevation of liver enzymes. Androgen treatment in 122 female-to-male transsexuals was associated with weight increase > 10% (17.2%) and acne (12.3%). In both groups persistent liver enzyme abnormalities could be attributed to other causes than sex steroids (hepatitis B and alcohol abuse). Much of the morbidity was minor and reversible with appropriate treatment or temporary discontinuation of hormone treatment. Thus, the dilemma of prescribing cross gender hormones in view of the needs of these patients is not resolved. Explanation of possible side effects and careful clinical judgment remain the cornerstone of the clinical decision to prescribe cross-gender hormones. Furthermore, follow up of this relatively young population to disclose long-term side effects and to elucidate the association of sex steroids with coronary heart disease, as well as efforts to reduce the risk of thromboembolic events, are required.
Keywords: cyproterone acetate; estradiol undecylate; estrogen; lynestrenol; testosterone; controlled study; coronary artery disease; female; human; human cell; human experiment; hyperprolactinemia; major clinical study; male; mood; morbidity; mortality; normal human; priority journal; transsexualism

Sexual acting out and the desire for revenge. - Hull, J.W.; Lane, R.C.; Okie, J. (Psychoanalytic review, 1989)
Keywords: acting out; adolescent; adult; article; borderline state; case report; child sexual abuse; female; homosexuality; hostility; human; male; psychoanalysis; psychoanalytic theory; psychological aspect; psychotherapy; sexual behavior; suicide attempt

Hiv-related deaths outside medical institutions in Stockholm - Rajs, J.; Karlsson, T.; Eklund, B.; Bergendahl, K. (Forensic Science International, 1989)
During a 3-year period (August 1st, 1985 to July 31st, 1988) a systematic investigation of medico-legal autopsy cases with regard to the presence of antibodies for HIV-virus was carried out at the Department of Forensic Medicine in Stockholm, Sweden. Prior to autopsy, blood samples were taken from femoral or subclavian veins and were investigated by use of ELISA-screening and Western blotting test. During the first year of study, HIV infection was demonstrated in 11 out 3464 deaths (0.32%), during the second year in 29 out of 3483 deaths (0.83%), and during the last year in 13 out of 3107 deaths (0.42%). It was shown that 48 out of the total of 53 HIV positive cases were previously registered, but information about the infection was available to the autopsist in only 27 cases. Drug addicts dominated 41 of 53 cases. There were only eight homo- and bisexual males, two non drug addict Central Africans and two persons who received blood transfusions. Eight of the 53 persons died of natural causes whereas 45 deaths were due to violence and drugs. The causes of death of the HIV positive drug addicts were compared to the causes of death of the HIV negative addicts. The HIV positive drug addicts tended to die suddenly in connection with the intravenous administration of heroin and at lower blood concentrations of morphine more often than the HIV-negative addicts. No increase in the suicide frequency was noted in drug addicts in Stockholm during the studied period.
Keywords: age; autopsy; cause of death; drug abuse; education; epidemiology; fatality; female; human; Human immunodeficiency virus; Human immunodeficiency virus infection; male; preliminary communication; priority journal; sex difference; Sweden

Acquired immunodeficiency syndrome and adolescents: Knowledge, attitudes, beliefs, and behaviors in a New York City adolescent minority population - Goodman, E.; Cohall, A.T. (Pediatrics, 1989)
In this survey, the knowledge, attitudes, beliefs, and behaviors concerning acquired immunodeficiency syndrome (AIDS) in a group (n = 196) of innercity adolescents in New York City were assessed. Sexual activity was the major risk factor for AIDS in this population; 58% of the adolescents had engaged in sexual intercourse; 12% of these had never used contraception. There were small reported rates of homosexuality, anal intercourse, and prostitution. Of respondents, 22% reported alcohol use and 22% had tried recreational drugs. None had ever taken drugs intravenously. Knowledge of human immunodeficiency virus (HIV) transmission was generally good, although there were prominent misconceptions. For example, 52% of the adolescents believed that donating blood could transmit HIV. Of respondents, 47% 'never' or 'rarely' worried about the disease. Of the total group, 39% reported behavior changes because of concern about AIDS in the previous 6 months. Those who changed behaviors tended to have a greater perceived risk, worry more frequently about the disease, and have a better knowledge of means of HIV transmission. Of those reporting behavior changes, 66% (25% of the total study group) claimed to be using condoms currently, and 16% (6% of the total study group) claimed to be abstemious. More black adolescents than Hispanic adolescents instituted behavior changes. Of black female adolescents, 71% were sexually active, as compared with 30% of Hispanic female adolescents. Assessment of beliefs in methods of risk reduction indicated that although female adolescents were more likely to believe that condoms were a good way to decrease their risk of acquiring HIV, those who were sexually active were less likely than men to institute the behavior change of insisting on condom use or of having their partners use condoms the last time they had sexual intercourse. Of sexually active female adolescents, 73% did not insist on condom use the last time they had sexual relations, whereas 51% of sexually active male adolescents did use a condom. These adolescent women were not using their knowledge concerning HIV transmission and protection to alter behavior effectively and thereby decrease their risk. Also, 21% of respondents spontaneously claimed that they would commit suicide if they tested positive for the HIV antibody. Other motivational and educational strategies besides education, targeting female adolescents, must be used and the consequences of the use of the HIV antibody test must be carefully considered in this age group.
Keywords: Human immunodeficiency virus antibody; acquired immune deficiency syndrome; adolescent; condom; contraception; ethnic or racial aspects; female; human; Human immunodeficiency virus infection; disease transmission; male; normal human; priority journal; psychological aspect; review; risk factor; sex difference; sexual behavior; sexual intercourse

AIDS: ethical implications for psychological intervention. - Morrison, C.F. (Professional psychology, research and practice, 1989)
Keywords: acquired immune deficiency syndrome; addiction; American Psychological Association; article; confidentiality; counseling; Health Care and Public Health; health care organization; health care personnel; homosexuality; human; Human immunodeficiency virus infection; informed consent; medical ethics; Mental Health Therapies; patient abandonment; privacy; professional-patient relationship; psychology; psychotherapy; social psychology; suicide

Providing sensitive health care to gay and lesbian youth. - Sanford, N.D. (The Nurse practitioner, 1989)
While the years of adolescence are usually very difficult, for gay and lesbian youth they are tremendously traumatic. Gay and lesbian youth face many problems because of the homophobia in our culture; such a young person often hides his or her gay or lesbian identity, and health care professionals often deny its existence. Increased anxiety and fear cause gay and lesbian youth to be particularly vulnerable to the major problems of adolescence, such as drug and alcohol abuse, sexual acting-out, pregnancy, AIDS, homelessness and suicide. The etiology of homosexuality is still not understood, and a number of theories are discussed in this article. Troiden's model of gay and lesbian identity development is presented, covering sensitization, identity confusion, assumption and commitment. A lack of appropriate role models has been a significant problem, although some change is occurring. Specific ways of helping these troubled adolescents are given, with a particular emphasis on education and providing methods of support.
Keywords: adolescent; article; child psychology; female; gender identity; health care delivery; health personnel attitude; homosexuality; human; male; psychological aspect; shame; social psychology; telephone

Mortality in psychiatric inpatients - Casadebaig, F.; Quemada, N. (Acta Psychiatrica Scandinavica, 1989)
The number of persons taken into psychiatric hospital care during 1982 in France was estimated using data on length of stay and analysing these by the person-year method. The number of observed deaths was compared by sex and age group with the number of deaths expected if the mortality in the general French population in 1982 were applied to the numbers of inpatients of the same sex and age group. The result of this comparison was that the mortality in mentally ill inpatients was found to be 3 times higher than that in the general population. This higher rate is further accentuated in younger age groups, especially women. This excess mortality has been observed with respect to natural causes of death as well as to unnatural causes, i.e. injury and suicide. Deaths from diseases of the circulatory system are overrepresented. As is true in the general population, these diseases account for the greatest number of deaths. Excess mortality is also high from diseases of the respiratory system. There is a high excess mortality due to signs, symptoms and ill-defined conditions, especially among women. Only in the case of neoplasms is there no excess mortality. Finally, excess mortality is found for deaths by injury and poisoning, especially for women, and suicides, particularly among men. Nevertheless, up to the age of 34, the female suicide rate is higher than that of men.
Keywords: adult; age; female; France; human; major clinical study; male; mental hospital; mortality; physical disease; sex; sex difference; suicide

The role of culture and family in mental illness - Jaschke, V.; Doi, T. (Bulletin of the Menninger Clinic, 1989)
Keywords: adult; case report; ethnic or racial aspects; homosexuality; human; male; religion; suicide attempt

Cocaine use and HIV infection in intravenous drug users in San Francisco - Chaisson, R.E.; Bacchetti, P.; Osmond, D.; Brodie, B.; Sande, M.A.; Moss, A.R. (Journal of the American Medical Association, 1989)
We assessed risk factors for human immunodeficiency virus (HIV) infection in 633 heterosexual intravenous drug users. The HIV seroprevalence was 26% in blacks, 10% in Hispanics, and 6% in whites. Intravenous cocaine use significantly increased the risk of HIV infection, with a seroprevalence of 35% in daily cocaine users (odds ratio, 6.4; 95% confidence interval, 3.0 to 13.3). Black subjects were more likely to use cocaine regularly. Drug use in shooting galleries and sharing of drug injection equipment were also associated with HIV infection and were more common in cocaine users. By multivariate analysis, black race, daily cocaine injection by blacks and Hispanics, all other cocaine injection, heavy use prior to entry into methadone treatment by blacks, and use of drugs in shooting galleries were independent predictors of HIV infection. Methadone therapy was associated with substantial reductions in heroin use and some reduction in cocaine use, but 24% of cocaine users receiving methadone began or increased cocaine injection after entry into treatment.
Keywords: cocaine; diamorphine; methadone; drug abuse; ethnic or racial aspects; homosexuality; human; Human immunodeficiency virus infection; intravenous drug administration; major clinical study; male; nonhuman; priority journal; risk factor; United States

Sodomy in enlightenment Prussia: From execution to suicide - Steakley, J.D. (Journal of Homosexuality, 1988)
Keywords: adult; Germany; history; homosexuality; human; male; theoretical study

Gay clients with AIDS: New challenges for hospice programs - Andersen, H.; MacElveen-Hoehn, P. (Hospice Journal, 1988)
Keywords: acquired immune deficiency syndrome; adult; bereavement; body image; dementia; fatality; homosexuality; hospice; human; male; pain; psychological aspect; religion; short survey; subculture; suicide

Company halting health plan on some 'life style' illnesses. - Noble, K.B. (The New York times, 1988)
Keywords: acquired immune deficiency syndrome; addiction; alcoholism; article; Circle K Corporation; economics; employment; Health Care and Public Health; health insurance; homosexuality; human; industry; jurisprudence; lifestyle; Popular Approach/Source; suicide; United States

Psychosocial differences between Dutch male and female transsexuals - Verschoor, A.M.; Poortinga, J. (Archives of Sexual Behavior, 1988)
One-hundred sixty-eight male and 55 female transsexuals, in hormonal treatment at the Gender Foundation in Amsterdam, were compared with respect to psychosocial characteristics. Results indicated that females more frequently had displayed cross-gender behavior during childhood than males, that they cross-dressed more often, and that, contrary to males, none had married in her anatomical sex. Females also applied for surgical gender reassignment at an earlier age than did males. More of the females lived in a stable relationship with a partner of their own biological sex. Relations with the parental home were better for females than for males, and the former were more often employed or enrolled in a study. No significant differences existed with respect to psychiatric treatment, substance abuse, or attempted suicides. It is concluded that unambiguous cross-gender behavior is more common in female than in male transsexuals and that the social conditions of the female are more satisfactory. However, a relatively high incidence of psychiatric treatment and attempted suicides indicates severe psychological problems in both the male and female groups.
Keywords: adult; age; female; human; major clinical study; male; priority journal; sex; sex difference; sex transformation; suicide attempt; transsexualism; cross-dressing

AIDS: a guide to suicide assessment. - Hall, J.M.; Stevens, P.E. (Archives of psychiatric nursing, 1988)
Keywords: acquired immune deficiency syndrome; addiction; adult; AIDS related complex; article; depression; homosexuality; human; male; psychological aspect; right to die; social psychology; suicide

Risk factors for infection with human immunodeficiency virus among intravenous drug abusers in New York City - Marmor, M.; Des Jarlais, D.C.; Cohen, H.; Friedman, S.R.; Beatrice, S.T.; Dubin, N.; El-Sadr, W.; Mildvan, D.; Yancovitz, S.; Mathur, U.; Holzman, R. (AIDS, 1987)
We report here the results of a survey of 308 intravenous drug abusers recruited from hospital-based methadone maintenance or drug detoxification programmes located in Manhattan, New York City. Complete interviews and serological analyses for antibodies to human immunodeficiency virus (HIV) using both enzyme-linked immunosorbent and Western blot assays were obtained from 290 (94%) of the subjects. HIV antibodies were found by both assays in 147 (50.7%) of the tested subjects; conflicting results were found in three (1%) of the subjects; and negative results on both tests were found in 140 (48.3%) of the subjects. Logistic regression analysis identified significant relative risks for HIV infection associated with the frequency of drug injection and the proportion of injections in 'shooting galleries'. Additional risk among men was associated with a history of homosexual relations. Traditional efforts taken by subjects to clean syringes between uses, such as washing with water or alcohol, showed no evidence of being protective. Programmes aimed at prevention of HIV infection should focus on reducing use of shooting galleries and sharing of needles and syringes as well as reducing intravenous drug abuse generally.
Keywords: virus antibody; controlled study; drug abuse; epidemiology; human; Human immunodeficiency virus; intravenous drug administration; major clinical study

Gender identity and gender transposition: Longitudinal outcome study of 24 male hermaphrodites assigned as boys - Money, J.; Norman, B.F. (Journal of Sex and Marital Therapy, 1987)
The longitudinal case histories of 24 male-assigned male hermaphrodites aged 18 or older were indexed and abstracted for the presence or absence of variables related to gender transposition, namely, bisexualism, homosexuality, or sex reassignment to live as a female. The sample was biased in favor of cases (N = 20) not showing signs of gender transposition. In these cases, there was no gender transposition even if the following variables were in evidence; neonatal ambivalence in annoucing the sex; cosmetic inadequacy of masculine genital appearance; sitting posture for urination; and feminizing (N = 9) instead of virilizing (N = 11) puberty. Despite the small size of the minority subsample (N = 4), it showed a trend toward an association between gender transposition and sitting to urinate, and being stigmatized in childhood. This trend is consistent with the association between stigmatization and gender transposition found in a counterpart study of male hermaphrodites announced and reared as girls. Freedom from gender transposition did not prevent suicidal depression, drug or alcohol addiction, marital failure, or death from testicular cancer.
Keywords: adult; bisexuality; central nervous system; clinical article; gender identity; heredity; hermaphroditism; homosexuality; human; male; male genital system; psychological aspect; social stigma

HIV-infection in forensic autopsy cases - Puschel, K.; Lieske, K.; Hashimoto, Y. (Forensic Science International, 1987)
Sudden and unexpected death and violent death of persons with a high risk of acquiring HIV-infections, especially homosexual males and intravenous drug abusers, have to be investigated by forensic autopsies. Therefore every forensic pathologist has to be aware of this infection and should try to make the proper diagnosis. Three typical cases are described: (1) suicide by hanging, (2) homocide by cutting the throat and (3) intravenous heroin overdose. Merely retrospectively it could be cleared up that the deceased were homosexual but did not manifestly suffer from AIDS. The morphological findings in the lymph nodes and the postmortem serological findings are described in details.
Keywords: acquired immune deficiency syndrome; adult; autopsy; blood and hemopoietic system; case report; drug abuse; editorial; fatality; forensic medicine; Germany; histology; homosexuality; human; human T cell leukemia virus; priority journal

Physicians' assessment of deficiencies and desire for training in adolescent care - Blum, R. (Journal of Medical Education, 1987)
Over the past decade, there has been growing awareness among medical educators and care providers of the deficits in the training of primary care physicians to meet the health care needs of adolescents. The study reported here is the first national survey of primary care physicians' perceptions of their competency in dealing with adolescents' health concerns. In the survey, 351 internists, family practitioners, and pediatricians rated their competency in 19 areas of adolescent health care. Approximately three-quarters or more of the internists indicated deficits in all 19 areas. In areas related to gynecologic concerns, more pediatricians reported deficits than family physicians; but more family physicians than pediatricians reported deficiencies in managing acute conditions of youth (growth and developmental problems, endocrinopathies, school-based problems, and chronic illnesses). All physicians indicated deficiencies in dealing with high-risk health behaviors: eating disorders, drug and alcohol abuse, homosexuality, and delinquency. Finally, more than 45% of the physicians overall reported deficiencies in areas related to social and/or emotional concerns, including suicide, depression, and family conflicts. Despite these acknowledged deficits, most of the primary care physicians did not indicate adolescents to be the least desirable age group with which to work. However, few of the physicians expressed a desire to improve their skills. Overall, in none of the 19 areas did more than 30% of the physicians who had reported deficiencies in an area express interest in improving their competency.
Keywords: desire; education; medical education; priority journal; training

Suicide among homosexual adolescents. - Kourany, R.F. (Journal of homosexuality, 1987)
Little attention has been given in the professional literature to suicide among homosexual adolescents. Sixty-six adolescent psychiatrists responded to a questionnaire on the subject. Results from this survey suggest that many experts are not working with homosexual adolescents. On the other hand, the majority of those treating them considered them to be at higher risk for suicide and agreed that their suicidal gestures were more severe than those of other adolescents.
Keywords: adolescent; article; homosexuality; human; psychological aspect; risk; suicide; suicide attempt

The acquired immune deficiency syndrome (AIDS) and suicidal behavior in alcohol-dependent homosexual men - Flavin, D.K.; Franklin, J.E.; Frances, R.J. (American Journal of Psychiatry, 1986)
Three alcohol-dependent homosexual men with suicidal ideation and behavior consciously attempted to contract the acquired immune deficiency syndrome (AIDS) as a means of committing suicide. The authors briefly examine the interrelationship among alcoholism and substance abuse, homosexuality, suicidal behavior, and AIDS; implications for the substance abuse treatment setting are noted. Early diagnosis and treatment of depression and substance abuse in homosexual men or parenteral drug abusers may prevent the spread of AIDS and reduce hidden suicidal potential.
Keywords: acquired immune deficiency syndrome; adult; alcoholism; case report; central nervous system; drug abuse; editorial; forensic medicine; homosexuality; human; legal aspect; male genital system; priority journal; psychological aspect; social aspect; suicidal behavior

San Diego suicide study: Comparison of gay to straight males - Rich, C.L.; Fowler, R.C.; Young, D.; Blenkush, M. (Suicide and Life-Threatening Behavior, 1986)
Keywords: adult; central nervous system; clinical article; drug abuse; fatality; homosexuality; human; suicide

AIDS health education for intravenous drug users. - Friedman, S.R.; Des Jarlais, D.C.; Sotheran, J.L. (Health education quarterly, 1986)
Intravenous (IV) drug users are the second largest risk group for AIDS and the main source of infection for heterosexual partner and pediatric AIDS cases. IV drug users have an addiction and a subculture that make risk reduction difficult; for example, to refuse to share needles can endanger personal relationships, and carrying clean works (rather than renting them in a shooting gallery) risks arrest. In New York City, at least, knowledge about AIDS transmission is widespread among IV drug users, and most drug injectors report having changed their drug use practices to reduce their risks. The main functions of health education in areas where IV drug users have this level of knowledge are to disseminate news of new discoveries; reach those drug users who have not yet learned AIDS basics; reinforce what is already known; and provide information about new programs to help drug users deal with AIDS-related problems. To encourage behavior change requires going beyond simple education, however; it entails trying to change IV drug user subculture. Drug user groups in the Netherlands and in New York City are attempting to do this from within the subculture. Outside intervention requires repeated messages from multiple sources; face-to-face, interactive communication; and perhaps the use of ex-addicts as health educators.
Keywords: drug; acquired immune deficiency syndrome; Acquired Immunodeficiency Syndrome--prevention and control; addiction; article; behavior; Behavior--changes; disease transmission; diseases; education; Educational Activities; health education; homosexuality; human; Human immunodeficiency virus infection; human relation; Iec; interpersonal communication; intravenous drug administration; knowledge; mass medium; methodology; North America; organization and management; Population At Risk; Printed Media; Program Activities; Programs; psychological aspect; publication; risk; social behavior; social problem; drug dependence; treatment; United States; Viral Diseases; Western Hemisphere

Lending an ear. - Armstrong, J. (Nursing times, 1986)
Keywords: adult; article; case report; homosexuality; human; male; mental disease; nurse patient relationship; nursing; suicide attempt

16PF research into addiction: Meta-analysis and extension - Tuite, D.R.; Luiten, J.W. (International Journal of the Addictions, 1986)
Meta-analysis of 34 studies on Cattell's 16PF test reveals ragged egos (C-), guilt (O), distrust (L), frustration (Q4), alienation (G-), vague identity (Q3-), alarm (H-), resentment (Q1), quasi-autism (M), scattered intellect (B-), grandiosity (E), autonomy (Q2), infantilism (I), avoidance (A-), and deviousness (N). The aberrant scores on E, G, I, Q1, and Q2 discriminate addicts from suicidals and the chronically ill or unemployed. We found nine types of addicts in our developmental study of 83 members of Alcoholics Anonymous. On the more stable second-order 16PF factors, 43% were highest on Autonomous, 37% on Desperate, 16% on Tough Poise, and 4% on Extravert. Profiles differed more by sexual preference than by gender. Recidivism was highest among homosexual men (38%) and the desperate (25%). Only the Fourth and Fifth Steps of the AA program seem crucial to recovery. Treatment programs based on these and tailored to sexual preference and the second-order personality types seem highly advisable.
Keywords: alcoholism; central nervous system; chronic disease; diagnosis; differential diagnosis; human; human experiment; intoxication; mental disease; personality; psychological aspect; psychometry

Intravenous drug abusers and the acquired immunodeficiency syndrome (AIDS). Demographic, drug use, and needle-sharing patterns - Friedland, G.H.; Harris, C.; Butkus-Small, C. (Archives of Internal Medicine, 1985)
We studied the demographic characteristics, drug use patterns, and sexual habits of intravenous (IV) drug abusers to further define this population at risk for acquired immunodeficiency syndrome (AIDS). Sixteen IV drug abuser patients with AIDS, 24 IV drug abuser patients with AIDS-related complex (ARC), and 14 IV drug abuser controls without evidence of AIDS or ARC were evaluated. The subjects in each group were similar demographically, in drug use practice, and in sexual orientation and experience. Of the AIDS and ARC patients, 34 (88%) of 40, including all seven homosexual men, shared needles, as did all drug abusers without AIDS or ARC. Seventy-four percent of patients, including all homosexual men, attended 'shooting galleries', where anonymous multiple-partner needle sharing took place. Needle sharing supports the hypothesis of AIDS transmission by a blood-borne route, can explain the spread of AIDS and the high rate of seropositivity to the putative AIDS agent among IV drug abusers, and is a logical link between IV drug abusers and male homosexuals, the two largest groups with AIDS.
Keywords: acquired immune deficiency syndrome; clinical article; drug abuse; homosexuality; human; intoxication; priority journal

Micropenis: Gender, erotosexual coping strategy, and behavioral health in nine pediatric cases followed to adulthood - Money, J.; Lehne, G.K.; Pierre-Jerome, F. (Comprehensive Psychiatry, 1985)
In nine cases of micropenis followed from pediatric age until adulthood (aged 22 to 31) the adult penis size was 2.5 SD below the mean or smaller, with one exception. Pubertal virilization was inadequate in six cases, in five of which there was also a history of neglecting follow-up and androgen-replacement therapy. In six cases there was a low incidence of erotosexual activity. In three there was a long-term pair-bonded attachment. There was one case of homosexual hustling, one of homosexual pair-bondedness, and one of homosexual attraction frustrated by the concealment of a skin-grafted phalloplasty. In the latter two cases, there was a history of agonizing over the option of possible sex reassignment and contemplating death by suicide. In one other case there was a hisory of paraphilic sadomasochism, in fantasy only, with a woman victim. The juvenile experience of micropenis in the family, the clinic, and the community may dislocate what should be the normal juvenile erotosexual rehearsal play and fantasy of uncomplicated heterosexual differentiation.
Keywords: adult; case report; homosexuality; human; male genital system; masculinization; micropenis; priority journal

Mortality in a follow-up of 500 psychiatric outpatients. II. Cause-specific mortality - Martin, R.L.; Cloninger, C.R.; Guze, S.B.; Clayton, P.J. (Archives of General Psychiatry, 1985)
In a six- to 12-year follow-up study of 500 psychiatric outpatients, death from natural causes occurred 1 1/3 times the expected rate, although the excess was not significant. Death from unnatural causes occurred 3 1/2 times the expected rate, a significant elevation. Suicide and homicide rates were particularly excessive. Unnatural mortality was excessive among younger, but not older, patients, and among all sex-race groups except black women, none of whom died unnaturally. Initial psychiatric diagnoses highly predictive of unnatural death included alcoholism, antisocial personality, drug addiction, and homosexuality. Secondary affective disorder was predictive of excess unnatural mortality, but in all cases of such death one of the four disorders associated with excess mortality antedated the affective disturbance. No patient with an index diagnosis of primary affective disorder died of an unnatural cause. Despite a frequent history of suicide attempts, hysteria was not associated with excess unnatural mortality.
Keywords: age; alcoholism; antisocial behavior; central nervous system; clinical article; drug dependence; epidemiology; fatality; homicide; homosexuality; human; mortality; priority journal; psychiatric outpatient; psychological aspect; sex; suicide

Diagnosing homosexuality in a State Department of Mental Health - Shachar, S.A.; Hagan, B.J.; Evenson, R.C. (Psychological Reports, 1983)
Keywords: acting out; adult; central nervous system; clinical article; depression; diagnosis; drug abuse; homosexuality; human; suicide

Brain purinergic activity linked with depressive symptomatology: Hypoxanthine and xanthine in CSF of patients with major depressive disorders - Agren, H.; Niklasson, F.; Hallgren, R. (Psychiatry Research, 1983)
The purine metabolites hypoxanthine and xanthine were analyzed in cerebrospinal fluid (CSF) of 70 patients with major depressive disorders (diagnosed according to Research Diagnostic Criteria) and, for reference, in 26 nonpsychiatric individuals. In the patient group, levels adjusted by analysis of covariance to same sex, age, height, and weight were univariately and multivariately correlated with both depressive subdiagnoses and indidvidual depressive symptoms. Results indiate that raw CSF levels in depressed patients are significantly correlated with the four variables used in adjustment (for hypoxanthine mainly negatively with height; for xanthine mainly positively with age). Hypoxanthine and xanthine both appear to be linked with the expression of depressive symptomatology: lower levels of hypoxanthine are associated with anger and suicidal tendencies, and higher levels are related to memory disturbance; lower xanthine levels characterize patients with subjective feelings of depression, and in patients with higher levels appetite is poor.
Keywords: hypoxanthine; xanthine; adult; anger; central nervous system; cerebrospinal fluid; clinical article; depression; human; memory; suicide

Scandal in Hong Kong - Johnson, H. (Medico-Legal Journal, 1983)
Keywords: fatality; forensic medicine; homosexuality; human; injury; police; suicide

Depression and somatosensory evoked potentials: II. Correlations between SEP and depressive phenomenology - Agren, H.; Osterberg, B.; Franzen, O. (Biological Psychiatry, 1983)
In 32 patients with major depressive disorders according to Research Diagnostic Criteria (RDC), symptomatology was rated using the Schedule for Affective Disorders and Schizophrenia (SADS), and somatosensory evoked potentials (SEP) elicited by tactile fingertip stimuli were recorded at the vertex of the scalp. Patients were drug-free except for benzodiazepines. Amplitudes and amplitude/stimulus intensity slopes were adjusted to same sex, age, height, and weight. Uni- and multivariate correlations revealed associations between the N140-P200 amplitude and hypothyroidlike aspects of depression with symptoms such as poor appetite and indecisiveness, and between P100-N140 slope and intrapunitive aspects of depression with symptoms such as negative self-evaluation and suicidal attempts. Neither attention level nor benzodiazepine medication were reflected in these relationships.
Keywords: adult; appetite; central nervous system; clinical article; depression; evoked response; human; suicide attempt

Increasingly Ruth: Toward understanding sex reassignment - Levine, S.B.; Shumaker, R.E. (Archives of Sexual Behavior, 1983)
Both the clinician and the patient present accounts of a 44-year-old male's search for a comfortable gender identity. The juxataposition of these two perspectives illustrates many of the dilemmas inherent in the therapy of gender dysphoria. Ruth underwent sex reassignment surgery in 1976 - one year after the assumption of a full-time female gender role. Six months after surgery, she made a serious suicide attempt. At age 50, she has now consolidated her feminine gender identity and has become a thoughtful, unusually honest, articulate person. The physician's 'objective' and the patient's retrospective perspectives provide evidence of the psychodynamic nature of transsexualism and the limitations of evaluation criteria for sex reassignment surgery.
Keywords: adult; case report; central nervous system; gender identity; human; male genital system; therapy; transsexualism

Life at risk: markers of suicidality in depression. - Agren, H. (Psychiatric developments, 1983)
One hundred and ten patients with Research Diagnostic Criteria (RDC) diagnoses of major depressive disorders were assessed for present or recent suicidal ideation and behavior and for suicidal acts earlier in life before current depression using the Schedule for Affective Disorders and Schizophrenia (SADS). Suicidal scores were correlated uni- and bivariately with levels of CSF monoamine metabolites (HVA, 5HIAA, MHPG), urinary MHPG, the proportion post-/predexamethasone plasma cortisol at 1100 h, and platelet MAO activity (all standardized to same sex, age, height and weight). Results indicate that all 3 monoamine metabolites and their interactions are involved in various aspects of suicidality, at least in unipolar patients. MHPG and 5HIAA (both low or both high) were involved in current or recent suicidal ideation, and low HVA was mainly associated with past potential lethality of suicidal acts. Current hypercortisolism was found in patients that earlier in life had tried to commit dangerous suicides. Bipolar patients (depressives with a history of manic or hypomanic episodes) had earlier in life significantly more, and more dangerous, suicidal attempts than the unipolars.
Keywords: 4 hydroxy 3 methoxyphenylethylene glycol; 5 hydroxyindoleacetic acid; amine oxidase (flavin containing); dexamethasone; diagnostic agent; homovanillic acid; hydrocortisone; adult; article; blood; cerebrospinal fluid; depression; female; human; male; psychological aspect; risk; suicide attempt

A follow-up study of operated transsexual males - Sorensen, T. (Acta Psychiatrica Scandinavica, 1981)
The opportuneness of operating on transsexuals has often been discussed but it has obviously been the only form of treatment they wish themselves. Most transsexuals in Denmark have been assessed at the Rigshospital prior to surgery. Since 1951, when the first operation on a transsexual took place, we have had a thorough pre-operative knowledge of a total of 29 transsexual males who have all obtained official status as females and who have subsequently been followed up. A phenomenologically based clinical theory of the dynamic coherence of the symptomatology of transsexuals has been advanced. A special core group of transsexual males has been described as characterized by a stable defence in the form of a pseudofeminine narcissism, a stable ego strength, an intact reality testing and a poor genital interest. These patients are expected to have a relatively stable life postoperatively. Of the 29 operated transsexual males six were not interviewed, three had committed suicide and two refused to take part in the follow-up. These last five did not belong to the core group, whereas one patient, who emigrated to Canada after sex-reassignment, belonged to the core group. The remaining 23 have all been interviewed, of these 14 belonged to the core group. The average for the follow-up period is 6 years. The operations turned out not to be resocializing, rather the contrary. The majority had no occupation at follow-up and the number of persons with disablement pension had increased considerably. About 66% lived alone and the majority of those with sexual relationships had had problems. Both before and after operation the majority felt socially isolated. About 66% were satisfied with the surgical outcome, nevertheless 50% wished for supplementary plastic surgery. None of the patients showed signs of more severe psychic sufferings or psychoses postoperatively. Psychically, 83% felt better after than before sex-reassignment. The majority have had complications and subjective trouble in connection with plastic surgery leading to reoperations of the vagina in most of them. Almost 75% have had sexual relationships postoperatively but not without difficulties. Characteristic of the persons in the core group is a better economy, a better adjustment to the environment and less problems with neighbours, they are more satisfied with the surgical outcome and have had fewer surgical corrections and also have a better psychic condition than the rest. It is the general impression at follow-up that the advantages of sex-reassignment outweigh the disadvantages where the core group is concerned. But among the persons who do not belong to the core group subjective and objective problems seem so pronounced that operation must be advised against in spite of the often extremely, subjectively unsatisfactory condition of these patients pre-operatively.
Keywords: central nervous system; major clinical study; male genital system; sex difference; sex transformation; surgery; therapy; transsexualism

Self-inflicted ocular mutilation - Yang, H.K.; Brown, G.C.; Magargal, L.E. (American Journal of Ophthalmology, 1981)
Self-inflicted mutilation of the eyes is an uncommon but fairly distinct entity. Patients are typically young men; they often have criminal records and histories of drug abuse. Underlying schizophrenia is a common feature. The patients frequently suffer from castration fears, oedipal conflicts, repressed homosexual impulses, severe guilt, and a need for punishment. The authors treated two patients with this disorder. The first, a 26-yr-old prison inmate convicted of murdering his grandfather, cut his eyes with a razor blade. He had previously attempted to commit suicide, suffered from delusions and experienced auditory hallucinations. Surgical repair of his injuries improved his visual acuity to R.E.: 6/15 (20/50) and L.E.: 6/30 (20/100). The second patient, a 24-yr-old inmate of a mental institution, had previously undergone a lensectomy for a hypermature cataract induced by a self-inflicted lye burn in his left eye. One year later, he was treated for lacerations of his right eye and partial amputation of his tongue. In the year between admissions, he had enucleated his left eye. Visual acuity in his remaining eye was no light perception, so no surgery was performed.
Keywords: automutilation; case report; drug abuse; eye injury; injury; psychological aspect; schizophrenia; sex differentiation; visual system

Childhood and adolescent development of ten female prostitutes - MacVicar, K.; Dillon, M. (Journal of the American Academy of Child Psychiatry, 1980)
The study of ten adolescent and young adult female prostitutes revealed that three of them had schizophrenic psychoses, while the remainder had borderline character structures. The psychotic adolescents participated in prostitution in an attempt to preserve some vestige of object relationships. The borderline adolescents, all of whom had chaotic family histories, had severe splits in the world of self and object, with the result that all-good and all-bad images were kept apart. The all-good image was that of the pimp, while the all-bad image was that of the customer. Other aspects of prostitution such as the high incidence of suicide attempts, homosexuality, and the use of money are also discussed.
Keywords: adolescent; adult; case report; central nervous system; character disorder; homosexuality; object relation; prostitution; schizophrenia

The pink triangle. The persecution of homosexual males in concentration camps in Nazi Germany. - Lautmann, R. (Journal of homosexuality, 1980)
Having analyzed the fragmentary records of Nazi concentration camps, the author reports on the number and treatment of male homosexual prisoners. The total number of inmates officially defined as homosexual is estimated at about 10,000, although the number incarcerated varied greatly from camp to camp and as the war progressed. Pink-triangle prisoners had low social status, often were isolated from other inmates, and as compared to political prisoners and Jehovah's Witnesses, more frequently were given the most difficult work assignments and less frequently were assigned to light duties. They had a higher death rate and a lower survival rate upon release. Suicide rates were not significantly different from those of the other inmate groups studied. Pink-triangle prisoners were not subjected to exceptionally cruel treatment in all camps and at all times, however, and were not the only group of prisoners subjected to extreme abuse.
Keywords: article; crime; Germany; history; homosexuality; human; male; political system; politics; correctional facility; prisoner

A comparison of three psychological testings of a transsexual - Hill, E. (Journal of Personality Assessment, 1980)
This case illustrates the use of psychological testing in assessing change over a period of eight years. Evaluations were done six years before transsexual surgery, after surgery, and at the completion of psychotherapy. The initial tests were rife with morbid suicidal and pathological content. Psychotherapy in a residential setting was recommended and accepted. Psychological testing after surgery revealed identity conflicts, guilt, and underlying depression. The final evaluation revealed remarkable changes. Her ego was good. She was not handicapped by defenses. She was using her intelligence for systematic thinking. Her anxiety level was within normal limits, and concerns were realistic to her situation.
Keywords: adult; case report; central nervous system; mental test; psychotherapy; surgery; therapy; transsexualism

A case study of autocastration - Pabis, R.; Mirza, M.A.; Tozman, S. (American Journal of Psychiatry, 1980)
Although transsexual surgery has received considerable attention, autocastration remains a rarity. Self-castration is usually performed in a state of psychotic confusion, except for those few men throughout history who castrated themselves for religious reasons. This case report describes a man with minimal psychotic confusion, although elements of psychotic depression were evident, who committed autocastration in a premeditated and carefully thought out manner, possibly as a substitute for suicide.
Keywords: automutilation; case report; castration; central nervous system; injury; male genital system

The risk of breakdown during outpatient psychotherapy - Parsons, M. (American Journal of Psychotherapy, 1980)
It is important to know how often patients break down during psychotherapy and to identify those at risk of it, but there is a lack of information about this. A retrospective case-note survey covering one year's intake into an analytically orientated outpatient psychotherapy unit is reported. Of patients entering therapy 8.4% suffered breakdown during it. The following characteristics have been believed to put patients at greater risk of breakdown, but patients with them in fact broke down no more frequently than others: past psychiatric hospital admissions or suicide attempts, drug or alcohol abuse, antisocial behaviour, homosexuality or other deviations, hypochondriasis or psychosomatic symptoms, a positive psychiatric family history, a disturbed childhood. Duration of symptoms bore no relation to breakdown. Patients with a previous psychiatric history but who had been treated for only six months or less, did break down more often. These findings are shown to be applicable also in selection of patients for psychotherapy.
Keywords: alcoholism; antisocial behavior; central nervous system; homosexuality; major clinical study; psychotherapy; suicide attempt; therapy

Two shootings - Palframan, D.S. (Canadian Journal of Psychiatry, 1979)
These two cases illustrate varying ways in which paranoid states can result in violence. The first case is a non-schizophrenic, non-alcoholic lifestyle, and the second shows the more classical paranoia associated with immigration, symptomatic use of alcohol, homosexual fears, and schizophrenic thought disorder.
Keywords: adult; alcoholism; case report; central nervous system; forensic medicine; homosexuality; paranoia; violence

Peptic ulcer in childhood. Psychological factors - Christodoulou, G.N.; Gargoulas, A.; Papaloukas, A. (Psychotherapy and Psychosomatics, 1979)
Thirty children (20 girls and 10 boys, aged 6-16 years) with primary peptic ulcers, matched in pairs for age, sex and socio-economic standard to a group of 30 ulcer-free controls, were submitted to a structured psychiatric interview, a structured 'present psychiatric state' examination and to personality and intelligence tests. With one exception all patients suffered from duodenal ulcer; 3 male patients had personalities with psychopathic elements, 7 patients had nicknames, 5 suffered from psychiatric disorders, 3 had attempted suicide in the past, and 3 had had homosexual experiences. These parameters were negative in all controls. The patients had lower mean IQ, worse scholastic adaptation, more anxious and overprotective parents, higher frequency of faddiness in food and lower frequency of nail-biting than the controls. Psychotraumatic events had preceded the onset of ulcer symptomatology in 11 cases. The findings are discussed and the contribution of psychological factors in the pathogenesis of childhood peptic ulcer is stressed.
Keywords: adaptation; adolescent; anxiety; central nervous system; intelligence quotient; major clinical study; overprotection; peptic ulcer; psychological aspect; school child; small intestine

Reactions to the family of the suicide - Calhoun, L.G.; Selby, J.W.; Gribble, C.M. (American Journal of Community Psychology, 1979)
The present study investigated reactions to the survivors of a family member's suicide. One hundred and twenty seven adults, members of a large urban Protestant church, responded to a newspaper account of a suicide in which the following factors were systematically varied: sex of the suicide, causal locus of the suicide, and whether the cause was prior or immediate to the suicide. The design was a 2 (sex of respondent) x 2 (sex of suicide) x 2 (locus of cause internal or external to the individual) x 2 (temporally remote cause or immediate cause). Results indicated a slight tendency for males to be somewhat more socially accepting of the surviving spouse of a suicide. There was also a significant interaction between sex of respondent x sex of the suicide, such that respondents indicated they would feel less tension in talking with the surviving family of a suicide of the same sex.
Keywords: central nervous system; family; normal human; suicide; tension

The aging gender dysphoria (transsexual) patient. - Lothstein, L.M. (Archives of sexual behavior, 1979)
Ten aging gender dysphoria patients (eight men and two women, average age 52 years) were the subjects of this study. All had presented to the Gender Identity Clinic at Case Western Reserve University requesting sex-reassignment surgery. A psychiatric-psychological profile of the patients, their sexual functioning, problems with aging, diagnostic issues, and follow-up are discussed. The aging gender dysphoric patient presents in acute crisis, that is, exhibiting marked depression, increased suicidal ideation and behavior, and urgent perception of time. Diagnostic and treatment recommendations for aging gender dysphoria patients and their depressions are provided. Furthermore, guidelines are suggested for differentiating the aging transvestite with transsexual symptoms and the aging transsexual for whom sex-reassignment surgery may be indicated. Specific treatment strategies for an aging population, including sexual surgery, are also discussed.
Keywords: aging; article; depression; female; gender identity; homosexuality; human; male; middle aged; psychologic test; psychological aspect; sexual behavior; transsexualism; cross-dressing

Violent sex and suicide - Danto, B.M. (Mental Health and Society, 1978)
Early literature on sexual disorders and suicidology are reviewed in this paper in the light of relationships between sexual problems, especially violent sexual ones, and suicide. The relationship between guilt feelings and suicide is viewed from the standpoint of current observations about sexually violent behavior and suicide. It was postulated that sexual perversions constitute a defensive means of coping with internal stress. Suicide is viewed as serving the same aim. Specific violent sexual behaviors such as sexual asphyxia and rape are discussed in terms of suicide. Transsexuality and transvestism are treated similarly. It is concluded that sexual violence and perversion in general are forms of self-destruction in themselves.
Keywords: central nervous system; guilt; major clinical study; perversion; psychological aspect; sexual behavior; suicide; violence

Suicide attempts in a female-to-male transsexual. - Herschkowitz, S.; Dickes, R. (The American journal of psychiatry, 1978)
Keywords: adult; article; case report; female; human; psychological aspect; sex difference; suicide attempt; transsexualism

Primary peptic ulcer in childhood. Psychosocial, psychological and psychiatric aspects - Christodoulou, G.N.; Gargoulas, A.; Papaloukas, A. (Acta Psychiatrica Scandinavica, 1977)
Twenty-five children with radiologically confirmed primary peptic ulcers were investigated. All patients suffered from duodenal ulcer and there was an unexpected female preponderance. The frequency of introverted personalities was greater in the patients than in the controls. Five patients suffered from psychiatric disorders, three had histories of suicidal attempts and three reported homosexual experiences. Six patients had nicknames. Eight patients had been operated on for appendicitis. The above parameters were negative in all control cases. The patients had lower mean IQ, worse adaptation to school, more anxious and overprotective parents, higher frequency of faddiness in food and lower frequency of nail-biting than the controls. The onset of symptoms was preceded by psychotraumatic events in eight cases. The findings suggest that the manifestation of the genetic background of duodenal ulcer is strongly influenced by environmental factors and factors associated with the personality of the patients.
Keywords: adaptation; appendicitis; child; childhood; homosexuality; intelligence quotient; introversion; major clinical study; overprotection; peptic ulcer; personality; sex; sex difference; suicide attempt

Epidemiological studies of female prisoners. IV. Homosexual behavior - Climent, C.E.; Ervin, F.R.; Rollins, A. (Journal of Nervous and Mental Disease, 1977)
The existence of homosexual behavior in female offenders is investigated not only as an adaptive process but as an established behavior existing prior to detention. Ninety five prisoners from the Framingham Institution for Women were included: 26 were self reported homosexuals, 42 were considered homosexuals by prison staff, and 27 were nonhomosexuals. Suicidal thoughts, suicidal attempts, psychiatric problems during menstruation, and a history of violent crimes against persons were characteristic of the homosexual group, whereas a history of crimes against self and property as well as history of alcoholism were common in the nonhomosexual group. Violent behavior together with suicidal attempts in homosexual female prisoners support the hypothesis that aggressive impulses may be expressed either externally or toward the self, the problem being one of impairment in control mechanisms. The findings also support the idea that violent behavior, as shown by this group of incarcerated homosexual females, is multidetermined. The factors that influence its appearance and expression could include a history of family violence, impulse control as children, neurological abnormality, sex role identification problems, biochemical abnormalities (manifested as menstrual irregularities), and impulse control problems as adults. A better understanding of human violence must be based on the recognition of the multidimensional nature of the problem using the tools and insights from many disciplines.
Keywords: adaptation; aggression; behavior; epidemiology; forensic medicine; homosexuality; major clinical study; prisoner; sex difference; suicide attempt

The clinical profile of male transsexuals living as females vs. those living as males - Langevin, R.; Paitich, D.; Steiner, B. (Archives of Sexual Behavior, 1977)
The clinical profiles of five male groups were compared: transsexuals who live as females (FEM), those who live as males (MAL), homosexual patients (HOP), homosexual controls (HOC), and heterosexual controls (CON). The MAL group showed psychotic features on the MMPI and a greater frequency of suicide attempts than the other groups. Their sexual behavior was incongruous in that they have had substantial sexual contact with men but less often desired sexual contact with men. They also less often desired to handle the penis of an adult man or to kiss him on the lips. They were more likely to find handling another's penis disgusting. However, they showed considerable involvement of their penis in sex relations with men. The FEM group, in contrast, had MMPI profiles suggestive of character disorders and tended to engage in antisocial behavior. Both MAL and FEM groups were similar in MMPI and 16 PF 'femininity'. The HOP group showed overall similarity to MAL but was not as pathological. The HOC and CON groups were similar in being normal but their sexual behavior differed, as expected. The parodoxical behavior of MAL is discussed as well as the parallel of the FEM group's behavior to that of criminals.
Keywords: central nervous system; character disorder; homosexuality; major clinical study; mental test; personality; psychosis; sex difference; suicide attempt; transsexualism

Autoerotic asphyxial deaths: A medicolegal analysis of forty-three cases - Walsh, F.M.; Stahl III, C.J.; Unger, H.T. (Legal Medicine, 1977)
A series of 43 deaths of white men during autoerotic sexual activity have been reviewed and the results of this study have been related to prior reports of autoerotic deaths in the literature. The majority of the deaths occurred in young men, less than 25 years of age. Although the investigative and pathologic findings were consistent with accidental deaths in 36 cases, there was evidence suggestive of suicide in 3 cases, and in 4 cases the manner of death was undetermined. Transvestism was associated with this activity in one-third of the cases. The psychodynamics of autoerotic sexual activity, as well as the relationship to transvestism, have been discussed. Although this entity is well known among forensic pathologists who consider it an accidental manner of death, insurers are less inclined to provide accidental death benefits in these cases. There is a need for greater public awareness of this entity for it is believed that some of these deaths among young men may be prevented with appropriate psychiatric intervention. The recent widespread dissemination of pornographic literature and films depicting explicit, deviant sexual activity may contribute to knowledge of autoerotic practices among persons with underlying psychiatric illness. Because of an increase in sexual experimentation among young persons and because of an increased awareness among investigators of the entity of autoerotic asphyxial deaths, one may expect the number of reported cases to increase in the future.
Keywords: adult; asphyxia; autoerotism; central nervous system; death; fatality; major clinical study; masochism; sexual behavior; suicide; cross-dressing

Male transsexuals: a long term follow up after sex reassignment operations - Sturup, G.K. (Acta Psychiatrica Scandinavica, 1976)
Since 1953 the Danish law permitting castration has been applied to transsexuals. Case histories are here reported on ten cases, operated up to 19 years before the follow up. Six of these presented typical syndromes. In some of the early cases the reluctance on the part of therapists to adopt an active therapy has been too great. Two subjects had died before the follow up investigation, but both had formerly reported satisfaction with the treatment to their therapists. One case, happily married, had emigrated with the husband. At the interviews the three others confirmed happiness and satisfaction with their female way of life. They are living in reasonably good social circumstances. Three cases were not typical. A promiscuous massive sexual activity exhibited by these patients had made it very difficult to endorse a surgical solution to their strongly presented wish to obtain sex reassignment. At the follow up all three were very satisfied with their female role. After several years in their new sex role, two of these were still promiscuous. The last case presents unusually complicated sex role problems. He continues to live as a male, but he still insists 19 years after castration, that the operation saved his life. In spite of his handicap, he claims to be satisfied that he obtained the permit. None of the operated cases committed suicide, but one case not operated but living as a female developed a paranoid reaction resulting in suicide.
Keywords: castration; major clinical study; suicide; therapy; transsexualism

Transsexualism and social attitudes. A case report. - Jonas, S.P. (Psychiatria clinica, 1976)
After a brief review of the literature, a case of a male-to-female transsexual, with a 4-year follow-up, is presented. The etiological factors and some social responses to this pathology are discussed.
Keywords: adult; article; attitude to health; automutilation; case report; depression; human; male; suicide; transsexualism; United States

A comparison of marijuana users and nonusers on a number of personality variables - Simon, W.E.; Primavera, L.H.; Simon, M.G.; Orndoff, R.K. (J.CONSULT.CLIN.PSYCHOL., 1974)
This study compares marijuana users and nonusers in terms of psychological needs, self descriptions, self esteem, academic achievement, ordinal position of birth, and attitudes toward the legalization of various items. On the adjective scales, users rated themselves as being less careful, less honest, less polite, less reliable, and less ambitious. The two groups did not differ on popular, independent, happy, sincere, secure, strong, interesting, mature, optimistic, intelligent, unanxious, sociable, confident, creative, productive, or on a measure of self esteem obtained by summing responses across the 20 adjective scales. A significantly greater percentage of users favored the legalization of marijuana, prostitution, homosexuality, and abortion, while a significantly greater percentage of nonusers favored the legalization of the 16 yr old vote. A greater percentage of users were opposed to the legalization of LSD, rifles and pistols, while a greater percentage of nonusers were opposed to the legalization of suicide. Nonusers were also more likely to respond 'not sure' to the question of whether or not racial segregation should be legalized. Users and nonusers did not differ in terms of their attitudes toward the legalization of amphetamines, tranquilizers, opiates, tobacco, bullfights, state aid to parochial schools, monopolies, the 18 yr old vote, hunting, labor unions, gambling, guaranteed annual wage, strike by public employees, and noncompulsory school attendance for all ages.
Keywords: cannabis; drug dependence; intelligence; intoxication; law; personality; self esteem

Psychiatric disorders among aborigines of the Australian Western Desert. Further data and discussion - Jones, I.H.; Horne, J.D.L. (Social Science and Medicine, 1973)
This paper describes a psychiatric survey of 959 Australian Western Desert and Kimberley aborigines. This group contains some of the most primitive to be found in Australia now. That is, it contains many of those least affected by western influences and may thereby give some indication of psychiatric disorders pertaining among these people at a time when they were nomadic - now there are virtually no fully nomadic aborigines left. The survey was conducted in a similar manner to 2 other surveys among similar people and conclusions have been drawn from a population of 2360 people. The prevalence of psychiatric illness appears to be somewhat lower than that found in western communities; however, the types of illness, with certain exceptions, are similar. The authors found cases of dementia, schizophrenia, puerperal psychosis, depression, hysterical states, personality disorders, organic brain syndromes, mental deficiency and childhood behavioral disorders. There are negative findings which could be of relevance: the authors found only one case of overt anxiety and this was in a very westernized individual. No cases of suicide or homosexuality have been found among tribal aborigines although these 2 forms of behavior have been found among aborigines who have lost a great part of their indigenous culture. A possible explanation for these negative findings in terms of cultural differences is discussed.
Keywords: indigenous people; anxiety; Australia; behavior disorder; childhood; community; dementia; desert; general aspects of disease; homosexuality; mental deficiency; mental disease; organic brain syndrome; personality disorder; population; prevalence; puerperal psychosis; schizophrenia; suicide

Suicidal and depressive feelings among college students - Murray, D.C. (Psychological Reports, 1973)
A questionnaire concerning their suicidal and depressive thoughts was administered to a sample of university students. Over 40% had thought of killing themselves and less than 10% denied at least having felt deeply discouraged and unhappy. Religion was related to the presence of suicidal thoughts, and sex to reported frequency of such thoughts. Students were most likely to tell a friend of such thoughts, and, at a significant level, the friend was of the same sex as the respondent. Scores on locus of control, social desirability, and test anxiety measures were unrelated to suicidal and depressive thoughts. Results are compared with findings from other studies. The utility of reported depressive and suicidal thoughts as predictors of suicidal behavior is questioned.
Keywords: anxiety; depression; fatality; normal human; religion; sex; sex difference; social desirability; suicide

Sex reassignment: male to female to male. - Money, J.; Wolff, G. (Archives of sexual behavior, 1973)
Keywords: adaptive behavior; adult; article; differential diagnosis; female; homosexuality; human; male; reproduction; suicide attempt; transsexualism; cross-dressing

'I was nineteen and I wanted to die'. (Nursing times, 1973)
Keywords: adult; article; attitude; homosexuality; human; male; psychotherapy; suicide

Dogmatism and opinions about mental illness - Hood Jr, R.W. (Psychological Reports, 1973)
Keywords: dogmatism; homosexuality; mental disease; stereotypy; suicide

Youthful male homosexuality. Homosexual experience and the progress of developing homosexual identity in males aged 16 to 22 years - Roesler, T.; Deisher, R.W. (JAMA (Chicago, Ill.), 1972)
Interviews with young men ages 16-22 who had had at least one homosexual experience to orgasm revealed that certain significant events over a period of time usually preceded the individual's self designation, 'I am a homosexual.' These events include early sex play (whether prepuberty or postpuberty) the individual recalled as homosexual in nature, actually seeking persons for homosexual contact (as adolescents), and 'coming out' (participating in the gay world). Four years separated the mean ages of first homosexual experience to orgasm and self designation as a homosexual. This period was, for many, one of extreme emotional turmoil. Of 60 subjects, 29 (48%) had visited a psychiatrist and 19 (31%) had made what they considered to be a significant suicide attempt.
Keywords: adolescent; adulthood; aged; homosexuality; identity; interview; male; orgasm; prepuberty; psychiatrist; suicide attempt

Psychiatric disorders among Aborigines of the Australian Western Desert. II - Jones, I.H. (Social Science and Medicine, 1972)
A psychiatric survey of 300 full blood Aborigines of the Australian Western Desert living on 2 separate Missions was carried out and these results were compared with similar surveys undertaken among other communities in the Western Desert. No evidence of suicide or homosexuality was found. Only one example of ' free floating' anxiety was seen. Two examples of hysterical fits were described but depression was not seen in contrast to the Warburton Range report Personality disorders were similar at all four Missions, the most prominent being excessive aggressive behaviour. Hypochondriacal symptoms are prominent and these complaints are related to possession states but reporting of this type of symptom seems to be markedly influenced by the attitude of the local medical authorities. The reason for these apparent differences between western and Aborigine communities is briefly discussed.
Keywords: indigenous people; anxiety; Australia; blood; community; desert; homosexuality; mental disease; personality disorder; suicide

Dual suicide in homosexuals - Swartzburg, M.; Schwartz, A.H.; Lieb, J.; Slaby, A.E. (Journal of Nervous and Mental Disease, 1972)
A report of a joint suicide attempt involving two male homosexuals. One of the men involved had an extremely conflictual relationship with his mother and in the past had attempted to arrange a dual suicide with female acquaintances. Unable to find a girl who would agree to this, he turned to a fellow homosexual. The other individual accepted the proposition more out of a desire to play out homosexual and aggressive fantasies than out of any real desire to die. The episode ended when this person called for help following the joint overdose. Ernest Jones and Sadger have noted the presence of homosexual urges and the desire for eternal union with the maternal figure in cases of dual suicide. Contemporary theorists have discussed the role in homosexuality of a primary conflict involving both the desire for and the dread of union with the mother. Such dynamics are clearly demonstrated to be operative in the young man who initiated the suicide pact. The paper further discusses the role of murderous wishes and sexual fantasies as important factors in the second young man's participation in the suicide pact and calls attention to the role of aggression in homosexuality. It is conceivable that dual suicides among homosexuals may be more common than has been reported. In fact, the authors have been informed of other cases appearing in the emergency rooms of big city hospitals that have not been reported.
Keywords: aggression; city; dynamics; emergency ward; fantasy; female; girl; homosexuality; hospital; human; intoxication; homosexual male; mother; suicide; suicide attempt

Suicide attempts and psychiatric diagnosis - Woodruff Jr., R.A.; Clayton, P.J.; Guze, S.B. (Diseases of the nervous system, 1972)
An investigation of suicide attempts by means of various environmental, social, family history, and diagnostic variables among 500 patients randomly selected from a psychiatric clinic indicates that hysteria and homosexuality are particularly associated with suicide attempts. There are few environmental variables for which there is evidence of clear association with suicide attempts independent of these diagnoses. Nearly 100 social, family history, and diagnostic variables were tested; of these, some 23 were found statistically associated with suicide attempts among all patients taken together. Only 4, however, were associated with suicide attempts independent of the diagnoses of hysteria and homosexuality: younger age at interview, a history of psychiatric hospitalization, a family history of attempted suicide, and a history of mother being psychiatrically ill. The impressive findings of this study are the special association between suicide attempts and 2 disorders, hysteria and homosexuality, as well as the fact that very few other variables are clearly associated with suicide attempts independent of these diagnoses.
Keywords: diagnosis; family history; homosexuality; hospitalization; hysteria; interview; mental disease; mental hospital; mother; patient; psychiatric diagnosis; suicide attempt

Toward a general theory of psychosocial deviance: the case of aggressive behavior. - Kaplan, H.B. (Social science & medicine, 1972)
Keywords: addiction; adult; aggression; alcoholism; article; attitude; child; child parent relation; civil disorder; crime; cultural anthropology; defense mechanism; ego development; ethnic group; homosexuality; human; human relation; juvenile delinquency; motivation; psychological model; psychological theory; psychosis; self concept; social class; social psychology; antisocial personality disorder; suicide

Psychosis associated with cannabis smoking. - Davison, K.; Wilson, C.H. (The British journal of addiction to alcohol and other drugs, 1972)
Keywords: cannabis; addiction; adult; article; bipolar disorder; chemically induced disorder; hallucination; homosexuality; human; male; suicide

Clinical features of the female homosexual patient. - Swanson, D.W.; Loomis, S.D.; Lukesh, R.; Cronin, R.; Smith, J.A. (The Journal of nervous and mental disease, 1972)
Keywords: addiction; adolescent; adult; anxiety; article; depression; family size; female; homosexuality; human; schizophrenia; sexual behavior; suicide

Focal suicide: self-enucleation by two young psychotic individuals. - Rosen, D.H.; Hoffman, A.M. (The American journal of psychiatry, 1972)
Keywords: cannabis; lysergide; addiction; adolescent; adult; article; automutilation; castration anxiety; chemically induced disorder; delusion; depression; eye injury; female; guilt; hallucination; homosexuality; human; literature; male; pregnancy; psychosis; rape; schizoidism; symbolism; therapeutic abortion

Demographic and mental status profiles. Patients with homicidal, assaultive, suicidal, persecutory and homosexual ideation. The Missouri Automated Standard System of Psychiatry. - Altman, H.; Sletten, I.W.; Eaton, M.E.; Ulett, G.A. (The Psychiatric quarterly, 1971)
Keywords: adolescent; adult; aged; aggression; article; automation; child; demography; documentation; female; homicide; homosexuality; hospitalization; human; information processing; male; medical record; mental disease; mental function; middle aged; paranoid psychosis; probability; psychological rating scale; suicide; United States

The curse: study in family communication. - Raybin, J.B. (The American journal of psychiatry, 1970)
Keywords: adolescent; adult; article; defense mechanism; ego; family; family therapy; female; homosexuality; human; human relation; identity; interpersonal communication; lifestyle; magic; male; psychoanalytic theory; psychosexual development; psychosis; suicide; superstition

The civilian psychiatrist and the draft. - Frank, I.M.; Hoedemaker, F.S. (The American journal of psychiatry, 1970)
Keywords: adolescent; adult; anxiety; article; child parent relation; death; depression; disability; father child relation; fear; homosexuality; human; male; medical ethics; mental disease; mental stress; military medicine; neurosis; personality disorder; psychiatry; psychopathy; psychosis; schizophrenia; sibling relation; antisocial personality disorder; military personnel; suicide; United States; Viet Nam

Attempted suicide. - Short, C.A. (Nursing times, 1970)
Keywords: article; homosexuality; human; male; mental stress; psychiatric nursing; suicide

Homosexuality. IV. Psychiatric disorders and disability in the female homosexual. - Saghir, M.T.; Robins, E.; Walbran, B.; Gentry, K.A. (The American journal of psychiatry, 1970)
Keywords: achievement; addiction; adult; alcoholism; anxiety; article; drinking behavior; educational status; emotional disorder; employment; family; female; genetics; homosexuality; human; human relation; mental disease; middle aged; psychologic test; sexual behavior; social adaptation; suicide

Sudden death in the gay world. - Rupp, J.C. (Medicine, science, and the law, 1970)
Keywords: accident; article; female; forensic medicine; homicide; homosexuality; human; male; sudden death; suicide

Homosexuality. 3. Psychiatric disorders and disability in the male homosexual. - Saghir, M.T.; Robins, E.; Walbran, B.; Gentry, K.A. (The American journal of psychiatry, 1970)
Keywords: adaptive behavior; addiction; adult; age; aged; alcoholism; article; depression; educational status; emotional disorder; family size; homosexuality; human; male; marriage; mental disease; middle aged; neurosis; occupation; parent; personality disorder; psychologic test; religion; sex difference; sexual deviation; socioeconomics; suicide

Investigations on a case of male transsexualism. - Dellaert, R.; Kunke, T. (Psychotherapy and psychosomatics, 1969)
Keywords: adolescent; adult; article; child development; clinical psychology; defense mechanism; doctor patient relationship; dream; family; fantasy; homosexuality; human; male; personality test; prognosis; psychiatry; psychoanalysis; psychoanalytic theory; psychologic test; psychosexual development; psychotherapy; public relations; sexual behavior; suicide; transsexualism

Suicide pacts. - Hemphill, R.E.; Thornley, F.I. (South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 1969)
Keywords: adolescent; adult; article; homosexuality; human; love; male; mental disease; middle aged; psychology; psychopathy; suicide

Black suicide. - Hendin, H. (Archives of general psychiatry, 1969)
Keywords: adult; African American; age; anger; article; Caucasian; child parent relation; cultural anthropology; female; homicide; homosexuality; human; male; poverty; psychologic test; self concept; social status; suicide; United States; urban population; violence

Suicide clues in psychotic patients. - Singer, R.G.; Blumenthal, I.J. (Mental hygiene, 1969)
Keywords: acting out; affect; anorexia nervosa; article; delusion; depression; dream; emotion; fantasy; fear; hallucination; homosexuality; human; impotence; insomnia; male; mental hospital; object relation; psychosis; psychosomatic disorder; separation anxiety; sexual behavior; suicide

Double suicides (japanese) - Ohara, K.; Alizawa, S.; Shimizu, M. (Psychiat.Neurol.Jap., 1968)
A statistical survey of 474 cases of double suicides handled by the Tokyo Medical Examiner during the past 15 yr. is presented. The absolute number of love-pact suicide cases has been increasing year by year, but the ratio of love-pact to single suicides has not changed much during these years. The incidence of double suicides in this survey was highest in January. Of all the 'hetero-sexual double suicides', the majority of the victims were young people, mostly in their 20's. The incidence of 'double suicide by married couples' was highest among people older than 60 yr. There were 6 cases of 'homosexual double suicides' in which the victims were men, and 17 cases in which the victims were women. The incidence was highest among youths between 15 and 25 yr. of age. Clinical observations of 8 cases of unsuccessful love-pact suicides are also presented. It is suggested that the extrovert character such as a cyclothymic personality and a hysterical tendency plays an important role in perpetrating a love-pact suicide.
Keywords: clinical observation; cyclothymia; extraversion; female; homosexuality; Japan; Japanese (people); juvenile; love; suicide; victim

Transsexualism: considerations regarding sexual reassignment. - Hoopes, J.E.; Knorr, N.J.; Wolf, S.R. (The Journal of nervous and mental disease, 1968)
Keywords: hormone; adolescent; adult; age; aged; article; child; family size; female; human; male; middle aged; occupation; psychotherapy; sex difference; sexual behavior; social behavior; suicide; transsexualism

The aberrational man-a tour de force of legal psychiatry. 3. Psychiatric conditions and resultant responsibility. - Morse, H.N. (Journal of forensic sciences, 1968)
Keywords: anxiety disorder; article; automatism; brain atherosclerosis; forensic psychiatry; human; hypertension; hypochondriasis; hysteria; iatrogenic disease; injury; neurosis; obsessive compulsive disorder; paranoid psychosis; psychosomatic disorder; sexual deviation; suicide; transsexualism; cross-dressing

The treatment of homosexuality and associated perversions by psychotherapy and aversion therapy - Rowe, W.S. (Medical Journal of Australia, 1967)
The author, in this paper, gives his experience of the treatment of homosexuality by a combination of group psychotherapy and aversion therapy. He is of the view that hope of readjustment to heterosexuality is much better than generally realised provided that there is motivation within the personality and some evidence of a heterosexual component in the personality. Even those with no heterosexual drive whatsoever can be helped by placing them on oestrogens although it is admitted that this is purely treatment of the symptoms. Seiler - Edinburgh (17, 8B*).
Keywords: aversion therapy; group therapy; heterosexuality; homosexuality; hope; motivation; personality; psychotherapy; rehabilitation; suicide

Mortality among boys reported to the stockholm child and youth welfare committee - Nylande, R.; Hellströmu, H.; Möllerström, K. (Acta Paedopsychiatrica, 1966)
This investigation, which is of the 'pilot study' type, gives an account of the mortality rate in a group of boys reported to the Stockholm Child and Youth Welfare Committee because of antisocial behavior or social distress. The material, which was a sample of the boys in the 15-20 age group who were reported to the Committee in 1954, comprised 124 cases with an average age of a good 16 yr. At the follow up investigation 10 y r later, 6 boys (4.8%) proved to have died. The causes of death were in 1 case somatic disease and in 5 cases suicide or accident. Of the 6 boys who died, 3 had been reported to the Committee in 1954 on account of sexual misbehavior (homosexual contacts and sexual assault on a young girl). In the whole material only 4 cases had been reported for the same reason. Case reports are given on the boys who died.
Keywords: accident; antisocial behavior; boy; case report; cause of death; child; death; follow up; girl; groups by age; homosexuality; juvenile; mortality; pilot study; sexual crime; social stress; suicide; welfare

Schizophrenia in twins. an epidemiological-cunical study - Kringlen, E. (Psychiatry, 1966)
Investigations have generally shown much higher concordance ratee for monozygotic than for dizygotic twins with respect to schizophrenia and manic-depressive psychosis. Kringlen observed schizophrenia concordance rates of 28 to 38% for monozygotic pairs, and 5 to 14% for same-sex dizygotic pairs. These results were compared with those of previous investigators: Kallmann had found concordance rates of 86% for monozygotic pairs, and 15% for dizygotic pairs; Slater had found 76% concordance for monozygotic pairs, and 14% for dizygotic pairs; etc. The discussion about such inconsistent results observed in the different studies cites various differences - in sampling methods psychiatric diagnostic criteria, statistical correction computations and methods of zygosity diagnosis. Kringlen concludes that: 'The more accurate and careful the samplings, the lower the concordance figures. ' His observations support the involvement of genetic factors in etiology of schizophrenia, but they indicate a less profound role than previously concluded from the earlier studies.
Keywords: diagnosis; dizygotic twins; etiology; heredity; bipolar disorder; sampling; schizophrenia; twins; zygosity

Common problems in the treatment of schizophrenia in adolescents. - Green, M.R. (The Psychiatric quarterly, 1966)
Keywords: adolescent; African American; article; case report; child psychology; dream; homosexuality; human; male; psychotherapy; schizophrenia; sexual behavior; suicide

THE CONCEPT OF THE SELF: ITS SIGNIFICANCE IN THE ETIOLOGY AND THERAPY OF PSYCHIC DISORDERS. - Bressler, B. (Psychoanalytic review, 1965)
Keywords: aggression; article; defense mechanism; depression; homosexuality; mental disease; NEUROSES; neurosis; psychoanalysis; PSYCHOSES; psychosis; psychotherapy; self concept; suicide

SEX-ROLE REVERSAL FOLLOWING CASTRATION OF A HOMOSEXUAL TRANSVESTITE WITH KLINEFELTER'S SYNDROME. REPORT OF AN UNUSUAL CASE. - Miller, A.; Caplan, J. (Canadian Psychiatric Association journal, 1965)
Keywords: article; castration; homosexuality; Klinefelter syndrome; sex; suicide; cross-dressing

D-Lysergic acid diethylamide (LSD): A review of its present status - Hoffer, A. (Clinical Pharmacology and Therapeutics, 1965)
This is a review of an important but controversial subject, written by one of the important figures involved in the controversy. It was not possible to get a review in depth by someone who was not also involved in the controversy. With this in mind, this review was accepted for publication because it was written by an authority actively engaged in the problem and because it was thought important to bring details of the subject to the attention of a large readership. Correspondence is invited.
Keywords: epinephrine; barbituric acid derivative; ceruloplasmin; creatinine; dexamphetamine; diethazine; diphenhydramine; ergot alkaloid; glutamic acid; histamine; indole derivative; lysergide; methylene blue; nicotinic acid; noradrenalin; oxoacid; potassium; psychedelic agent; reserpine; sedative agent; serotonin; sodium dihydrogen phosphate; succinic acid; tranquilizer; adrenergic system; alpha rhythm; article; auditory hallucination; autism; behavior disorder; beta rhythm; body image; cholinergic system; circadian rhythm; confusion; Convolvulaceae; creativity; crystal structure; depression; dose response; drug antagonism; drug dependence; drug half life; educational status; electroencephalogram; electroretinogram; group dynamics; group therapy; groups by age; health status; homosexuality; human; kinesthesia; meal; neurophysiology; nonhuman; optimal drug dose; paranoia; perception; personal experience; personality; personality disorder; priority journal; psychiatric treatment; psychomotor activity; psychotherapy; publication; pulse rate; religion; schizophrenia; smelling; suicide attempt; synaptic transmission; thinking; touch; vasoconstriction; visual hallucination; visual stimulation

HOMOSEXUAL PANIC WITH HALLUCINATIONS--A CASE STUDY. - London, L.S. (Medical times, 1964)
Keywords: anxiety; article; dream; hallucination; homosexuality; mental disease; narcotherapy; psychoanalysis; suicide

A clinical appraisal of some sexually promiscuous females - McBroom, M.S.W. (Journal of the National Medical Association, 1963)
Description of the promiscuous sexual behaviour of a number of women has been presented. The patterns have been shown to have both sociological as well as psychological roots. In this context, on a clinical level, sociologically several of these women used sex to escape from economic insecurities. Psychologically, these women are the prototypes of many women in the United States today suffering from feelings of not being wanted, that they are unlovable, despised and isolated. In a word, they suffer from a severe unresolved Oedipus complex. In the main, they suffer from a breakdown in the fusing process, the inability as children to accept their parents as both 'heroes' (fathers) or 'angels' (Virgin mothers) - the good (or God) and as sexual beings (having or enjoying sex, 'dirty-bad-Devil') plus over-abundance of dehumanizing and deadening influences from the culture. All suffered from total or partial frigidity occasioned by incestuous fantasies that plagued them from their days of masturbation. Several were bi-sexual. Their homosexuality was revealed to be related to 'castration anxiety'. One woman who played the aggressive (male) role imagines herself capable of introjecting the passive partner (female) role. One patient having lost the parent object upon which she depended for narcissistic supplies, felt totally rejected. She regressed to the oral stage and incorporated the object (lover). The sadism, which was originally directed against the 'deserting father', with the resultant guilt, was taken up by the patient's super-ego and she committed suicide. This occurred not so much as an attempt on the ego's part to escape the inexorable demands of the super-ego, but as an enraged attack on the incorporated parent, in retaliation for having deserted the parent in the first place. All the women were depressives. Only one of these women had had the strong secure protectiveness that each girl needs from her father.
Keywords: buphenine; castration anxiety; child; ego; fantasy; father; female; frigidity; girl; guilt; homosexuality; imago; male; masturbation; mother; nymphomania; Oedipus complex; parent; patient; psychosexual development; sadism; sexual behavior; suicide; superego; United States

The existence of a man placed in a limit-situation. an anthropological analysis of a paranoid case in a leprosarium - Kamiya, M. (Confin. Psychiat., 1963)
While conducting a series of psychiatric investigations in Aisei-en, the largest national leprosarium in Japan, the author met a leper patient who had religious delusions based on auditory hallucinations that awoke him every night from his sleep for the last 5 years. The patient, however, was well adapted to the life in the leper community and was liked and respected by all around him as a 'queer but noble personality'. His psychotic symptoms had appeared for the first time before his entrance to the leprosarium after a few years spent with his family in continuous and ever growing anxiety due to a relapse of his illness which seemed to deprive him of all hope and all his 'raison d'être'. The sudden appearance of his mystical hallucinations saved him from despair and suicide giving him a new world-view and a new mission to fulfill in life and led him to an altruistic way of life that seemed almost superhuman in the eye of his fellow patients. Nevertheless these 'voices' also led him to refuse obstinately almost all medical treatment and food, a fact which was virtually the cause of his death, which occurred a little after the author's interview in April 1957. The life of this patient was studied here mainly from the phenomenological-anthropological point of view as a striking example of one of the ways in which man may surmount a limit-situation by changing his mode of existence, an example which seems to reveal to us 'the sources of human potentialities', as K. Jaspers says.
Keywords: anxiety; auditory hallucination; community; death; delusion; eye; food; general aspects of disease; hallucination; hope; hopelessness; human; interview; Japan; night; paranoia; patient; personality; psychosis; relapse; sleep; suicide; therapy; voice

Psychiatric illness and crime with particular reference to alcoholism: A study of 223 criminals - Guze, S.B.; Tuason, V.B.; Gatfield, P.D.; Stewart, M.A.; Peckens, B. (Journal of Nervous and Mental Disease, 1962)
Systematic, structured psychiatric interviews were carried out with 223 consecutive male criminals. No psychiatric diagnosis, apart from possessing a sociopathic personality, was established in 48% of the men. Fifty-two per cent were found to have some other psychiatric disorder. The prevalence figures for individual psychiatric disorders were as follows: alcoholism, 43%; drug addiction, 5%; anxiety neurosis, 12%; homosexuality, schizophrenia and epilepsy, 1% each; mental deficiency, dementia and undiagnosed psychiatric illness, less than 1% each. Alcoholism was shown to be associated with a stronger family history of alcoholism and suicide, and a more pronounced personal history of attempted suicide, wander-lust, military service difficulties, fighting, employment difficulties and arrests.
Keywords: alanine; alcohol; alcoholism; anxiety neurosis; crime; criminal behavior; dementia; drug dependence; employment; epilepsy; family history; homosexuality; interview; male; mental deficiency; mental disease; military service; neuropathy; neurophysiology; offender; prevalence; psychiatric diagnosis; psychopathy; schizophrenia; suicide; suicide attempt

Plastic-bag asphyxia in adults - Johnstone, J.M.; Hunt, A.C.; Ward, E.M. (British medical Journal (1857), 1960)
Death from asphyxia in 4 adult males is described: in 3 instances a plastic bag was placed over the head and in the 4th plastic and rubber sheeting covered the face. Two were transvestites, and the psychological make-up of the other two may have been similar. The evidence suggests that all may have had some desire to be enclosed, and an unconscious desire to return to the womb may have been the motivating factor.
Keywords: asparagine; plastic; rubber; adult; asphyxia; death; ego development; male; spinal cord transverse lesion; suicide; cross-dressing

A syndrome of serious suicidal intent - Stone, A.A. (Archives of General Psychiatry, 1960)
The author notes that hitherto little attempt has been made to correlate the psychodynamics contributing to suicide with seriousness of suicidal attempt. Analysis of the psychiatric history of 7 males all of whom made serious yet unsuccessful attempts at suicide revealed several common psychological features. These are interpreted in a psychoanalytic framework and described as a syndrome: (1) an obsessive compulsive character with latent passive homosexual features; (2) possible symptomatic alcoholism; (3) history of poor father-relationship; (4) interest in a sexually discredited woman about whom are created jealous fantasies and paranoid ruminations; (5) threatened or actual rupture with or rejection by this woman. The resulting attempt at suicide is regarded as a defence against the feelings of helplessness, inadequacy and passive hopelessness arising from such rejection: it is an impulsive grasping for the active, aggressive masculine role, but also holds promise of the ultimate masochistic gratification in the form of death. The author believes that recognition of such a syndrome merits careful consideration as a serious suicidal risk.
Keywords: alcoholism; death; fantasy; father; female; helplessness; homosexuality; hopelessness; male; paranoia; psychodynamics; risk; rumination; rupture; suicide; suicide attempt

The recruit prisoner - Pierre, C.M. (Military Medicine, 1959)
A recruit who arrives in the brig is a recidivist. Only about 2 of every 1,000 recruits are confined at any one time. Most have a marginal pre-service adjustment. Only in highly exceptional circumstances should a recruit be retained in the service once he has been sent to the brig. In 100 consecutive consultations carried out at a brig, 17 men were judged to be psychotic; half of them were recruits; thus, the importance of early diagnosis is evident. Over a 4th of the prisoners had entered the Navy without 5th grade education. Suicide often represents an effort to manoeuver others and to gain attention on the part of immature or latent homosexual prisoners. Psychopaths should not be permitted to remain in the services once they have had a trial at duty which has shown an inability to adapt. Absence without leave (AWOL) accounts for 90% of all brig admissions; the AWOL-offender possesses major and lifelong lacunae in submission-dominance patterns, and shows petulance at conformity and routine. Morale and administrative considerations make an early and exact diagnosis of homosexuality in the service imperative. Recommendations are made for research which could result in economic and morale assets to the armed forces. These recommendations include: use of group listing of prisoners; the setting-up of boards to find methods of reducing delay in trial; correlation of brig research data by all armed forces; and necessary work on special investigative projects.
Keywords: army; consultation; diagnosis; early diagnosis; education; homosexuality; morality; navy; offender; prisoner; psychosis; recidivism; suicide

Community reactions to a horrifying event - Arndt, G.W. (Bulletin of the Menninger Clinic, 1959)
The response mechanisms of members of the community in the State of Wisconsin were studied in relation to the exposure of a series of horrifying and bizarre activities of a 51-year-old bachelor recluse, in November, 1957. One victim was shot with a 0.22 rifle, decapitated, eviscerated, and hung by the heels from a rafter in his 'summer kitchen'. During the questioning, he confessed to the 1955 murder of a female tavern keeper in a nearby town, and to robbing fresh graves (only female bodies) in the local cemetery over a period of several years. One of the corpses was removed from a grave adjacent to his mother's burial plot. Portions of viscera, sections of human skin, a box of noses and remains of extremities were found in the trash-littered, dingy rooms of his home. Ten human skulls neatly arranged in a row, books on anatomy, embalming equipment, pulp magazines, furniture up-hostered with skin, and dirty kerosene lamps completed the macabre scene. He also stated he made belts and purses from skin sections. The largest piece of skin found, neatly rolled, was from an anterior chest, including the mam maries. An immaculate portion of the house, his mother's bedroom and sitting room, had been sealed off by nailed doors and windows after her death in 1945. When the final crime was uncovered, the body found hanging and dressed as if it were a deer, neighbours recalled that he had frequently given them portions of 'venison', although he remarked, while under psychiatric observation, 'I've never shot a deer'. The immediate response within the community itself was of horror, but also of profound indignation at the publicity suddenly poured upon the area. Beyond a ten to twenty mile perimeter of the afflicted town, the response to the crime was far different. Instead of anger or denial, the situation was dealt with through the media of grim humour, as though the unconscious was aware of what had happened. The joking was so common that it could be considered a mass repetition compulsion, with all ages participating. The humour was of 3 types: cannibalism, sexual perversion and combinations of these. Children communicated the jokes freely to their parents as well as among themselves, causing consternation and indignation. The event with its grief and horror was felt by the unconscious and conscious of all who learned of the activities. Through the mechanism of humour, the horror was repressed, then released by the people who were near but not personally involved in the grim situation. Important theoretical references were made to works of Eysenck, Grotjahn, Bergler, Kris, Obrdlik, Reik, Freud, and Brill.
Keywords: kerosene; cannibalism; child; city; community; compulsion; crime; death; deer; ego development; exposure; female; furniture; grief; heel; homicide; homosexuality; human; humor; kitchen; mass medium; mother; nose; parent; perimeter; posthumous care; sexual deviation; sitting; skin; skull; summer; thorax; United States; victim; viscera

Homosexuality among Oxford undergraduates - Spencer, S.J.G. (Journal of Mental Science, 1959)
A report concerning homosexual tendencies and practices of 100 students under psychiatric observation, and a control group of 100 freshmen. The well-tabulated results show that 51% of the psychiatric patients and 35% in the control group displayed homosexuality in its different forms. The majority of the persistent homosexuals came from a lower social class and were mostly day-students, i.e., they did not board at the school. Further comparisons of the homosexual students (psychiatric patients) and the freshmen group revealed data concerning parent relationship, heredity, number and sex of siblings, nervous break-downs and suicides, and, particularly, constitutional somatic factors.
Keywords: control group; hemiplegia; heredity; homosexuality; mental patient; parent; school; sibling; social class; stereotaxic surgery; student; suicide

Somatometrical studies of the feet of inhabitants of Kamoto-gun in the Higo prefecture - Otsuka, M. (J. Kumamoto Med. Soc., 1959)
The feet of 385 boys and 372 girls aged 6 to 15 years were measured as to length, breadth, height and two circumferences, and several ratios among these measurements were calculated. (1) After 10 or 11 years of age, boys' measurements exceeded girls' in all mean values, especially in length, so that the boys' feet became longer and more slender than the girls'. (2) The feet grew rapidly from 11 to 13 years of age in boys and from 10 to 12 years of age in girls. The ratio of length to breadth, 'foot index', remained almost the same in the same sex, but other ratios changed somewhat. (3) The foot length was about 30% of the body length at 6 years of age. It increased to ca. 80% at 8 years of age, then again showed a gradual decrease to ca. 60% at 15 years of age.
Keywords: aged; body height; boy; girl; height; Japan

The call girl: A social and psychoanalytic study - Greenwald, H. (Psychoanalysis, 1958)
The family background of 20 call girls investigated showed great similarities. Inter-parental relationship was maladjusted in all and none had a happy home. In 75% the home was broken before they reached adolescence. Divorce rates among their parents were high; in 2 cases there were 3, and in 3 cases 6 divorces. Six mothers lived with a lover. Absence of warmth made it impossible for the girls to form family attachments, leading to their incapacity of absorbing values of society. Children in these homes meant an additional burden and were mostly rejected by both parents. This double rejection led to severe feelings of unworthiness. But they discovered early in life that sex was a commodity which they could barter for some measure of affection, and that by giving sexual gratification they could escape their loneliness and feelings of worthlessness. All 20 call girls suffered from anxiety in form of social discomfort, fear of insanity, of bodily decay, and felt lonely to the extreme. All were addicted either to alcohol, marijuana or other narcotics in an attempt to cope with this anxiety. Their self-image was vague, since because of rejection and their ensuing hatred, they could not incorporate either parent as model upon whom to mould. This led to confusion in their sexual role. Fifteen girls admitted to homosexual acts, but were undecided whether they preferred a masculine or feminine role in their lesbian acts. Some had lesbian 'pimps' to whom they gave their money. They had difficulty in establishing human relationships and though they rejected the norms of society, they tried hard to conform. Their incapacity to conform caused them to hate those who did conform. They lacked in interest, had poor appreciation of reality and had no life goal. Their defence mechanisms consisted in projection and they argued that all women behaved like themselves. They rationalized that prostitution was a business like any other. Over 50% were frigid, and more than 75% made one or more suicidal attempts. None of the girls gave economic pressure as the reason for taking up prostitution. Many had a chance of marrying or co-habiting with wealthy men, but found the existence too monotonous. Psychoanalysis conceives prostitution as an attempt to act out incest phantasies. Promiscuity is often caused by an underlying fear of homosexuality.
Keywords: alcohol; cannabis; narcotic agent; adolescence; anxiety; blood; child; commercial phenomena; defense mechanism; divorce; fear; female; girl; hate; homosexuality; human relation; incest; homosexual female; loneliness; mental disease; model; money; mother; parent; prostitution; psychoanalysis; self concept; society; suicide attempt

Uxoricide and infanticide in a setting of oedipal jealousy - Karpman, B. (Arch. Crim. Psychodyn., 1957)
The first portion of the investigation of a patient who killed his wife and smothered his infant child. He was always closely attached to the mother and frequently discussed with her his intimate sexual activities. He was hostile toward his father from the age of 11. The father was an inadequate provider who persistently evaded his responsibilities and duties. The boy invariably took his mother's part in quarrels between the parents. He was sexually promiscuous from age 19, frequently with prostitutes. He obtained great satisfaction from measuring women's bodies, especially busts and hips. He was addicted to voyeurism and he was a member of a nudist colony for 8 yr. Both heterosexual and homosexual phantasies were indulged in frequently. He experienced feelings of inferiority and desire for privacy and seclusion. He would suffer from feelings of indecision. Frequently, he contemplated suicide.
Keywords: boy; child; father; female; heterosexuality; hip; homosexuality; infant; infanticide; jealousy; mother; neurosurgery; parent; patient; privacy; prostitution; responsibility; satisfaction; sexual behavior; sexual deviation; suicide

A case of narcissism with auto-fellatio - Gorham, D.R. (Psychiat. Quart., 1954)
A case of auto-fellatio is reported, with a brief review of 2 previously reported cases. The patient was 23 yr. old, was seen far 76 sessions of psychotherapy. The patient had had homosexual panic states leading to suicidal attemptss There were marked similarities to two cases referred to. The auto-fellatio did not seem particularly significant in terms of the patient's personality maladjustments but rather as a symbol of the narcissistic aspects of his personality.
Keywords: homosexuality; maladjustment; narcissism; patient; personality; psychotherapy

Schreber's prepsychotic phase - Katan, M. (International Journal of Psycho-analysis, 1953)
It is pointed out that among the advantages afforded by a study of the prepsychotic phase are the gaining of a clear insight into the differences between neurotic and prepsychotic reactions and also insight into the structure of the delusion and hallucination. It is suggested that Schreber's insomnia, anxiety, his suspicion of Flechsig and his suicidal thoughts all possessed the common elements of serving as a defence against the breaking through of homosexual orgastic feelings. This was the central conflict in the prepsychotic period. Among the decisive factors in the development of the psychotic phase was the occurrence one light of a quite extraordinary number of emissions and the departure of his wife to visit her father, thus making the patient feel he was no longer protected by her against the homosexual influence of the men surrounding him.
Keywords: anxiety; delusion; father; hallucination; homosexuality; insomnia; patient; psychosis

Research in genetics and psychiatry (New York State Psychiatric Inst. Columbia Univ.) - Hurst, L.A. (Eugenics review, 1952)
A Department of Medical Genetics has been established (1937) at the New York State Psychiatric Institute, Columbia University under the leadership of Dr. Franz Kallmann. This organization has been instrumental in studying a large number of mental conditions by the twin study and investigation of blood relations. The fact was established that schizophrenia was probably inherited as a recessive, and that manic-depressive psychosis is an irregular dominant with a high degree of penetrance. Other conditions in which a genetic basis has been determined by twin studies are aging, longevity, senile disorders, suicide and homosexuality, tuberculosis. These studies have established a 'genetically oriented organic view' in the 2 major psychoses, which is in reality an optimistic view, for it will lead us to focus attention to the physiological and anatomical substratum of disease, and will point the way to research procedure in the direction of fundamental cure.
Keywords: aging; blood; Colombia; genetics; homosexuality; leadership; longevity; bipolar disorder; medical genetics; mental health; penetrance; psychiatry; psychosis; schizophrenia; suicide; tuberculosis; twins; United States; university

A citizen's handbook of sexual abnormalities and the mental hygiene approach to their prevention. a report of the Covernor's study Commission on sex deviates - Hartwell, S.W. (Pub. Hoirs Press, 1951)
The review of the problem of sexual behaviour which in present-day western-Christian culture is considered abnormal is written in order better to acquaint the layman with the medical, social and legal aspects of the problem. Dr. Hartwell, psychiatrist of the Michigan Governor's Study Commission on sex deviates, has written the first 3 of the 4 sections of the report, and D.M.D. Thurber, executive director of the Commission, has written the final section. Part I lists and explains the modern psychiatric concepts of sexual deviation and defines and explains differences of object or of direction of sex drives as found in the clinic and in courts. Emphasizing the importance of homosexuality, Dr Hartwell states: Because of the human unhappiness, discouragement, and neurotic anxiety that homosexual tendencies and acts cause; because of the very large number of broken homes divorces, and suicides resulting from homosexuality; and because of the large number of individuals who lose faith in God and men, and finally drift into t life of worthlessness as a result of it, homosexuality far exceeds, in its social importance, all the crimes that are committed by sexual deviates. His claim that modern psychiatry and psychology have fully established that much can be done by the proper rearing of young children from babyhood to puberty that tends strongly to prevent any great likelihood of the child becoming an adult homosexual, however, is overstating the case, for full proof that we know of ways of decreasing the incidence of persistence of childhood and adolescent homosexuality into adult life is not yet available. Part II reviews many common fallacies about sexual deviates entertained by the law and the laity and emphasizes the great lack of proved facts in this field. Among the important points stressed are: (1) When young people are subjected to very strong pressures to control their biological needs, especially those needs which will become sexual, they develop a particularly dangerous type of anxiety ;(2) when the child is made to believe that perhaps his very life is threatened by sexual criminals it is difficult for him to avoid being afraid of his own normal developing feelings; too strong warnings by parents may be harmful;(3) many young adolescents often try various sexual acts considered deviate, yet, unless they have a strong predisposition, toward sexual deviation determined earlier in their childhood, they will not usually fail to mature to normal heterosexual adjustment even if they have extensive deviate experience in adolescence ;( 4) there is no way of predicting with any certainty by examination and psychiatric study of a child or adolescent that he or she will have a marked adult sexual deviation;(5) there is no psychotherapy for adult or adolescent sexual deviates which has been proved to be effective except in a small percentage of cases;(o) the most serious mistake in legislation has been that all sexually deviated acts have been considered as one group making no distinction as to the prescribed punishment or treatment whether the deviated acts consisted of injurious aggressive sadism or non-aggressive voluntary acts which harmed no one; harmless voyeurs may be prosecuted and punished under the same laws as sadistic attackers. Part III presents a review of the changing patterns of instinctive emotional gratifications during the growth and development of the child followed by a brief presentation of the psychoanalytical theory of psychosexual development and a description of the stages in development referable to the hypotheses of this theory. There is a discussion of normal adolescent homosexuality and the environmental factors which seem to contribute to a failure to progress from this stage to a satisfactory heterosexual adjustment. There is finally a lengthy discussion of sexual instruction, emphasizing that by 8 yr. of age most children in public schools have obtained much sex information and misinformation in spite of the refusal of many parents to accept this obvious observation. The fallacy of waiting until children ask questions before giving them any sex instruction is stressed, and reasons are presented to explain why group instruction in schools and elsewhere is no adequate substitute for individual discussion with the child by someone whom he trusts and who knows him. There is a list of suggestions concerning such discussions. The language of the report is simple and clear so that any intelligent adult can fully follow the rather complete outline of psychosexual aspects of infancy, childhood, and adolescence. Theories are stated conservatively with brief explanations of the observations on which they are based and adequate reservations in their acceptance. Part IV summarizes the social problems and the difficulty of the legal problem wherein the would-be law-maker swings from severity to leniency in his desire to punish the offending criminal and his interest in protecting the unjustly accused and the socially well-adjusted but blackmailed deviate. The only prophylactic approach which is suggested is that of utilizing the general mental hygiene concepts we now have; training parents to try to avoid conflicts, feel ing s of shame, inadequacy, self-rejection or fears in their children. That the entire matter is closely bound up with religious, ethical and moral concepts of the community is pertinently re-emphasized. The suggestion that teach-, ers should be trained to recognize Obvious sexual deviations' in adolescents is hardly consistent with the previous admissions that accurate childhood and adolescent prognostication is impossible; the inaccurate guessing with which we are left may well do far more harm than good. The report should interest all pediatricians and child psychiatrists for it focuses clearly on the inadequacy of our understanding of how to deal with the problem of sexual deviation, a condition developing in childhood the consequences of which are usually first recognized in late adolescence or adult life. The problem lies in the province of the pediatrician who with our present knowledge can neither diagnose it with certainty nor recommend any form of proved therapy. That the problem is inextricably interwoven with the pattern of culture in which it is viewed and which may even play a fundamental aetiological rôle perhaps accounts for much of the difficulty.
Keywords: adolescence; adolescent; adult; anxiety; child; child psychiatry; childhood; Christian; community; congenital malformation; crime; disease predisposition; divorce; environmental factor; error; examination; fear; growth, development and aging; heterosexuality; homosexuality; human; hygiene; hypothesis; infancy; language; law; legal aspect; libido; manager; morality; offender; outpatient department; parent; pediatrician; prevention; psychiatrist; psychiatry; psychology; psychosexual development; psychotherapy; puberty; punishment; rearing; sadism; school; sexual behavior; sexual deviation; sexual education; shame; social problem; social status; suicide; therapy; United States

Hypnotherapy in a case of amnesia with suicide attempt - Zeckel, A. (Psychiat. Quart., 1951)
A 24-year-oid girl unsuccessfully tried to commit suicide. History showed there were no problems or difficulties admitted or known to justify such an act, but she did admit on questioning what might be considered fugues and amnesias. As a result her physician felt hypnotherapy was indicated. Family history of importance showed the parents were involved in divorce proceedings, which did not worry her; the health of her mother to whom she was attached and who was suffering from glaucoma was of primary concern. She felt that her alcoholic father had not treated her mother well, although she and her father were on fairly good terms. She even knew his prospective wife and liked her. The nomadic life of her parents always impressed her as the family had moved no less than 15 times to her knowledge. The Rorschach test reflected that she was greatly handicapped by a severe depression, feelings of hopelessness and despair, a great amount of guilt frustration, repressed hostility, and confabulative thinking. Great concern about her father was also observed. Frustration and depression were of such magnitude that suicide seemed quite possible. The picture was considered, not one of psychosis, but rather of a psychoneurosis compulsive in nature. The patient was hypnotized several times until she became refractory to it so that the last few sessions yielded little material. Barbiturate addiction was discovered and no less, homosexual attachment to her mother. Incestuous relations in relation to a brother were observed. The disadvantages of hypnotic approach in this case were stressed. The author expressed the opinion that the diagnosis could not be restricted to hysteria with fugues and amnesia attacks. In addition, he cites other features as confabulation and addiction to barbiturates as features suggestive of mild psychopathic traits. The author raises the issue as to whether post-hypnotic amnesia may not be malingering and expresses the belief that both hysterical and malingering features might have been present.
Keywords: barbituric acid derivative; hypnotic agent; addiction; alcoholism; amnesia; confabulation; diagnosis; disabled person; divorce; family history; father; frustration; girl; glaucoma; guilt; health; homosexuality; hopelessness; hostility; hypnosis; hysteria; malingering; mother; neurosis; parent; patient; personality test; physician; psychosis; suicide; suicide attempt

The Rorschach findings in a case of suicide - Ulett, G.A.; Martin, D.W.; McBride, J.R. (American journal of orthopsychiatry, 1950)
Case history and Rorschach protocol of a 21-year-old soldier who committed suicide 6 months after the Rorschach test had been taken and 4 months after he had been discharged from hospital to full duty. Retrospective analysis shows that Becks' 'formula for suicide' is definitely found in the Rorschach protocol, while he was successful in masking his homosexual and suicidal character disorder during clinical observation. Pertinent Rorschach data and literature complete this important study.
Keywords: isoprenaline; character disorder; clinical observation; homosexuality; hospital; personality test; military personnel; suicide

Functional vasospasm - Woolley, L.F.; Maholick, L.T. (Southern medical journal, 1948)
The case reported illustrates that acute prolonged vasomotor spasm can result from psychic stimuli and that reliance on physical examination and sympathetic blocks may be misleading. The patient was a man aged 39, who complained of aching and weakness in the right leg of one week's duration. The only physical signs found were slight cyanosis of the right foot, coldness of the right leg and foot as compared with the left, and absence of voluntary movement in the right foot with tenderness of the calf. The arterial pulses were equal and strong and the tendon reflexes normal. Bilateral lumbar sympathetic blocks with 1% procaine failed to relieve the condition. Mental exploration in the waking state and under sodium amytal revealed a continually frustrated emotional life since childhood and persistent homosexual trends. He then found himself living and working to keep parents for whom he had no affection. Psychoneurotic symptoms developed as a means of a face-saving escape from an intolerable situation. Following 'emotional catharsis', his leg condition recovered, but was followed by severe depression with suicidal tendencies. For this he was treated with electro-convulsive therapy with excellent results.
Keywords: amobarbital; procaine; aged; childhood; cold; convulsive therapy; cyanosis; homosexuality; human; leg; muscle spasm; parent; patient; physical examination; psychotherapy; pulse wave; stimulation; sympathetic blocking; tendon reflex; vasospasm; voluntary movement; wakefulness; weakness