Probation staff experiences of managing suicidal and self-harming service users.

The current study sought to explore the impact of suicidal behaviours on probation staff, in relation to their experiences of working with probation service users who have carried out suicide, attempted suicide or self-harm. Thirteen in-depth interviews were carried out with probation staff who had direct contact with probation service users in one probation area, and had varying degrees of experience of managing suicidal or self-injurious service users. These were analysed using thematic analysis and five themes were identified. Findings indicate that staff felt that suicide and self-harm by service users are serious issues which need to be recognized and dealt with in an effective yet compassionate manner. Not attending the suicide prevention training, or lack of experience, were perceived as restricting their ability to know how to deal with these individuals, and offer support. Furthermore, staff were emotionally affected by these incidents and it is recommended that they should continue to be provided with access to appropriate support services after an incident.

Link between increased gut hormones signaling satiety and reduced food reward following gastric bypass surgery for obesity

CONTEXT: Roux-en-Y gastric bypass (RYGB) surgery is an effective long-term intervention for weight loss maintenance, reducing appetite, and also food reward, via unclear mechanisms. OBJECTIVE: To investigate the role of elevated satiety gut hormones after RYGB, we examined food hedonic-reward responses after their acute post-prandial suppression. DESIGN: These were randomized, placebo-controlled, double-blind, crossover experimental medicine studies. PATIENTS: Two groups, more than 5 months after RYGB for obesity (n = 7-11), compared with nonobese controls (n = 10), or patients after gastric banding (BAND) surgery (n = 9) participated in the studies. INTERVENTION: Studies were performed after acute administration of the somatostatin analog octreotide or saline. In one study, patients after RYGB, and nonobese controls, performed a behavioral progressive ratio task for chocolate sweets. In another study, patients after RYGB, and controls after BAND surgery, performed a functional magnetic resonance imaging food picture evaluation task. MAIN OUTCOME MEASURES: Octreotide increased both appetitive food reward (breakpoint) in the progressive ratio task (n = 9), and food appeal (n = 9) and reward system blood oxygen level-dependent signal (n = 7) in the functional magnetic resonance imaging task, in the RYGB group, but not in the control groups. RESULTS: Octreotide suppressed postprandial plasma peptide YY, glucagon-like peptide-1, and fibroblast growth factor-19 after RYGB. The reduction in plasma peptide YY with octreotide positively correlated with the increase in brain reward system blood oxygen level-dependent signal in RYGB/BAND subjects, with a similar trend for glucagon-like peptide-1. CONCLUSIONS: Enhanced satiety gut hormone responses after RYGB may be a causative mechanism by which anatomical alterations of the gut in obesity surgery modify behavioral and brain reward responses to food.