A qualitative analysis of strategies for managing suicide-related events during deployment from the perspective of Army behavioral health providers,chaplains, and leaders

The purpose of this qualitative study was to investigate the use of strategies for managing suicide-related events (SREs; i.e., suicide deaths, suicide attempts, and suicidal ideation with a plan and intent to die) during deployment from the perspective of Army decision makers: behavioral health providers (BHPs), chaplains, and leaders. A total of 76 Army personnel participated in individual interviews or focus groups. Participants identified unit watch, weapon removal, medical evacuations, and debriefings as common strategies used to manage SREs in deployed settings. Many of these strategies were highlighted as short-term solutions only. Participants also underscored the importance of unit cohesion and communication among leaders, BHPs, and chaplains to effectively manage SREs. The need for structured guidelines for successfully managing SREs in deployed settings is discussed.     

A Randomized, Double-Blind, Crossover Comparison of MK-0929 and Placebo in the Treatment of Adults With ADHD

Objective: Preclinical models, receptor localization, and genetic linkage data support the role of D4 receptors in the etiology of ADHD. This proof-of-concept study was designed to evaluate MK-0929, a selective D4 receptor antagonist as treatment for adult ADHD. Method: A randomized, double-blind, placebo-controlled, crossover study was conducted in adults with primary ADHD. The primary end point was changed from baseline in total score on the Adult ADHD Investigator Symptom Rating Scale following a 4-week treatment regimen. Additional measures included Clinical Global Impression-Severity Scale, Hospital Anxiety and Depression Scale, and Brown Attention Deficit Disorder Scale and D4 genotype analysis. Results: No statistically significant treatment differences were found between MK-0929 and placebo in any of the primary or secondary assessments. Conclusion: Results from this study suggest that blockade of the D4 receptor alone is not efficacious in the treatment of adult ADHD.     

The Role of Effort–Reward Imbalance for Reservists on a Military Deployment

The present study extended the effort–reward imbalance (ERI) model (Siegrist, 1996b Siegrist, J. 1996b. “Soziale Krisen und Gesundheit [Social crises and health]”. In Gesundheitspsychologie [Health psychology] Edited by: Krohne, H. W., Schmidt, L., Netter, P. and Schwarzer, R. Vol. 5, Göttingen, , Germany: Hogrefe.  [Google Scholar]), first by differentiating between separate reward components, second by including intrinsic reward, and third by additionally predicting a non-health outcome (i.e., turnover intention) in a military context. Regression analyses of 789 reservists found financial and esteem reward to moderate the impact of extrinsic effort on depressive symptoms, whereas only financial reward moderated the effort turnover intentions relationship. Results supported the usefulness of the extended ERI model in the military context. Relevant areas for future research on the military effort–reward perspective are discussed.     

THE SECOND SPHERE AND THE STORY OF NO STORY

The author discusses Roy Schafer's ideas of the second self and second reality, as well as his consistent theme of storyteller and story. The latter theme is also explored in the context of more recent psychoanalytic influences, such as Bionian thought, trauma theory, the French approach, and the interpersonal perspective. To illustrate the idea of the nonstory in today's clinical encounters, the author presents two clinical vignettes.     

Thoughts Associated with Unprotected Anal Intercourse Among Men at High Risk in San Francisco 1997-1999

Men who had high-risk sex with men in the previous year ( N = 124) were asked to recall their thought processes at the time they last had unprotected anal sex with a man who was HIV-positive or of unknown serostatus. Self-justifications for non-condom use were examined individually and in internally validated scales. The most common single self-justification was I want to have unprotected sex because it feels good , endorsed by 76%. Other common thoughts included the notion that it is only human to slip up occasionally (59%) and the resolution to withdraw before ejaculation (59%). For scaled items, the most strongly endorsed themes were: (1) that condoms reduce sexual pleasure (any of 6 items endorsed at least slightly by 90%); (2) fatalism or leaving it to chance (11 items, 81%); and (3) loss of control (9 items, 77%). The thoughts and themes identified may be useful in planning individual and community prevention messages.     

Is the Generality Problem too General?

Reliabilism holds that knowledge is true belief reliably caused. Reliabilists should say something about individuating processes; critics deny that the right degree of generality can be specified without arbitrariness. It is argued that this criticism applies as well to processes mentioned in scientific explanations. The gratuitous puzzles created thereby show that the "generality problem" is illusory.