Describing suicidality: an investigation of qualitative SSF responses

Given the incidence and seriousness of suicidality in clinical practice, the need for new and better ways to assess suicide risk is clear. While there are many published assessment instruments in the literature, survey data suggest that these measure are not widely used. One possible explanation is that current quantitatively developed assessment instruments may fail to capture something essential about the suicidal patient's experience. The current exploratory study examined a range of open ended qualitative written responses made by suicidal outpatients to five assessment prompts from the Suicide Status Form (SSF)--psychological pain, press, perturbation, hopelessness, and self-hate. Two different samples of suicidal outpatients seeking treatment, including suicidal college students (n = 119) and active duty U.S. Air Force personnel (n = 33), provided a wide range of written responses to the five SSF prompts. A qualitative coding manual was developed through a step-by-step methodology; two naive coders were trained to use the coding system and were able to sort all the patients' written responses into the content categories with very high interrater reliability (Kappa > .80). Certain written qualitative responses of the patients were more frequent than others, both within and across the five SSF constructs. Among a range of specific exploratory findings, one general finding was that two thirds of the 636 obtained written responses could be reliably categorized under four major content headings: relational (22%), role responsibilities (20%), self (15%), and unpleasant internal states (10%). Theoretical, research, and clinical implications of the methodology and data are discussed.     

Index of suspicion: feeling not believing

Throughout the U.S., state laws require professionals who work with children to report cases of suspected child abuse to child protection services. Both practically and conceptually, however, significant problems arise from a lack of clarity regarding the threshold that has been set for reporting. Specifically, there is no consensus as to what constitutes reasonable suspicion, and little direction for how mandated reporters should gauge their legal and professional responsibilities when they harbor suspicion. In this paper we outline the context of the problem, discuss the nature and scope of its conceptual underpinnings, and offer recommendations for moving towards a concrete, practical solution.     

Memory conjunction errors for autobiographical events: more than just familiarity

Two diary studies investigated the prevalence of memory conjunction errors for real-life events. In both studies, participants completed detailed diary pages over the course of several weeks. Participants in both diary studies committed memory conjunction errors on a later recognition memory test. In the second diary study participants also made remember/know judgements. For a large proportion of their memory conjunction errors participants indicated that they "remembered" the event occurring in that context. These diary studies demonstrate that memory conjunction errors do occur for autobiographical memories, and these errors can seem compelling.     

From sensory processes to conscious perception

In recent years, cognitive neuroscientists have began to explore the process of how sensory information gains access to awareness. To further probe this process, event-related functional magnetic resonance imaging (fMRI) was used while testing subjects with a paradigm known as the "attentional blink." In this paradigm, visually presented information sporadically fails to reach awareness. It was found that the magnitude and time course of activation within the anterior cingulate (BA 32), medial prefrontal cortex (BA 9), and frontopolar cortex (BA 10) predicted whether or not information was consciously perceived during the critical period for the attentional blink. These results are discussed in light of a neural framework for conscious processing.     

Social science as dialogue: narcissism,individualist and collectivist values,and religious interest in iran and the united states

This investigation most importantly sought to illustrate the use of social science to promote cross-cultural dialogue. Fukuyama (1992) explained contemporary cultural trends in terms of a triumphant individualism that would overcome all other forms of social life, including what he described as the “fundamentalist resentment” of Iran. Lasch (1979) more pessimistically diagnosed Western social arrangements in terms of an emerging “culture of narcissism.” In this study, Iranian and American university students responded to measures of narcissism, individualist and collectivist values, religious interest, and psychological adjustment (identity, self-actualization, and self-consciousness). Variables related to a sense of community (collectivist values, religious interest, and identity) correlated negatively with narcissism in both societies, as did self-actualization. These data supported a moderate position between the polarized extremes of Fukuyama and Lasch and more importantly demonstrated how social scientific methods might be useful in creating a “space” for conducting a “dialogue between civilizations.”     

Analyzing the Process and Content of Genetic Counseling in Familial Breast Cancer Consultations

A detailed examination of the process of genetic counseling has been identified as a priority area for research by previous authors. This multicenter longitudinal study examined the process and content of genetic counseling in initial consultations with women from high-risk breast cancer families. One hundred and fifty-eight consultations with women unaffected and affected with breast cancer were audio taped and transcribed verbatim. A detailed coding system was developed. Clinical geneticists and genetic counselors demonstrated consistently good practice in giving detailed information on essential aspects related to familial breast cancer such as screening and management, genetic testing, breast cancer genetics, and prophylactic surgery. Eliciting emotional concerns and facilitating communication were found to be inconsistently present. As clinical practice guidelines and the general communication literature emphasize the importance of these factors, this is an area where training in or self-monitoring of such behaviors may assist consultants to further develop these skills.     

The clinical efficacy and safety of galantamine in the treatment of Alzheimer's disease

Alzheimer's disease is a progressive, neurodegenerative condition characterized by deficits in cognition, inability to perform activities of daily living, and alterations in behavior. Galantamine hydrobromide is the newest acetylcholinesterase inhibitor (AChEI) approved in the United States for the treatment of mild-to-moderate AD. The safety and efficacy of galantamine has been demonstrated in multiple randomized, Phase III trials of >2,600 patients with mild-to-moderate AD. Studies have found that galantamine improved or maintained performance in all domains of AD (cognition, function, behavior, and caregiver burden) in the short term and slowed the decline in performance or maintained baseline performance through 12 months. The dual mechanism of action may make galantamine a reasonable treatment option for both newly diagnosed patients and patients who have not benefitted from or have poorly tolerated current therapy.     

Rising and surviving: a conceptual model of active coping among Black lesbians

This study tested a conceptual model of active coping among a predominantly middle-class sample (N = 92) of Black lesbians (ages 18 to 68) attending a Black lesbian retreat. F. B. Tyler's (1978) active coping dimension of psychosocial competence and L. P. Anderson, C. L. Eaddy, and E. A. Williams's (1990) psychosocial competence model for Black Americans emphasizing the role of individual and environmental factors provided the theoretical framework for the study. A theoretical model was developed to examine whether internal (self-esteem, race and lesbian identification) and external (social support, perceived available lesbian, gay, bisexual, and transgendered resources) factors predicted active coping. Results confirmed that the model of internal and external factors was a statistically significant predictor of active coping.