Reducing aversion to side effects in preventive medical treatment decisions

Laypeople tend to be overly sensitive to side effects of treatments that prevent illness, possibly leading them to refuse beneficial therapies. This Internet-based study attempted to reduce such side effect aversion by adding graphic displays to the numerical risk probabilities. It also explored whether graphics reduce side effect aversion by making it easier for respondents to determine how the treatment might change their net cancer risk. Participants (N=4,248) were presented with a hypothetical preventive treatment situation that was or was not accompanied by a small side effect. In both conditions, the net absolute risk reduction was 12%. Adding an array of stick figures to risk probabilities reduced side effect aversion substantially, but adding a bar graph was not beneficial. The ability of arrays to reduce side effect aversion was not attributable to greater accuracy in evaluating the treatment's net benefit.     

Acting on persecutory delusions: the importance of safety seeking

OBJECTIVE: Acting on delusions is a significant clinical issue. The concept of safety behaviours--actions carried out with the intention of reducing perceived threat--provides a new way of understanding acting on delusions. A study was conducted with the aim of examining the prevalence and correlates of safety behaviours related to persecutory delusions. METHOD: One hundred patients with persecutory delusions were assessed for safety behaviours, acting on delusions, anxiety, depression, and psychotic symptoms. Case note data were collected on instances of serious violence or suicide attempts. RESULTS: Ninety-six patients had used safety behaviours in the last month. Greater use of safety behaviours was associated with higher levels of distress. A history of violence or suicide attempts was associated with greater use of safety behaviours. Safety behaviours were significantly associated with acting on delusions, but not with the negative symptoms of psychosis. CONCLUSION: Safety behaviours are a common form of acting on persecutory delusions. These behaviours have the consequence that they are likely to prevent the processing of disconfirmatory evidence and will therefore contribute to delusion persistence.     

A randomised controlled trial to assess the effectiveness of providing self-help information to people with symptoms of acute stress disorder following a traumatic injury

BACKGROUND: Patients attending accident and emergency (A&E) may develop long-term psychological difficulties. Psycho-education has been suggested to reduce the risk of post-injury disorders. AIMS: We tested the efficacy of providing self-help information to a high-risk sample. METHODS: A&E attenders were screened for acute stress disorder and randomised to two groups: patients (n=116) receiving a self-help booklet and those who did not (n=111). A sample of 'low' scorers was also included (n=120); they did not receive a booklet. Psychological assessments were completed at baseline (within 1 month post-injury) and 3 and 6 months post-injury. RESULTS: Post-traumatic stress disorder (PTSD), anxiety and depression decreased (p<0.001) across time but there were no group differences in these measures or quality of life. However, subjective ratings of the usefulness of the self-help booklet were very high. CONCLUSIONS: This trial failed to support the efficacy of providing self-help information, as a preventative strategy to ameliorate PTSD.     

The superego, narcissism and Great Expectations

The author notes that the concepts of the superego and narcissism were linked at conception and that superego pathology may be seen as a determining factor in the formation of a narcissistic disorder; thus an examination of the superego can function as a 'biopsy', indicating the condition of the personality as a whole. Charles Dickens's novel Great Expectations is presented as a penetrating exploration of these themes and it is argued that in Pip, the central character, Dickens provides a perceptive study of the history of a narcissistic condition. Other key figures in the book are understood as superego representations and, as such, integral to the vicissitudes of Pip's development. In particular, the lawyer Jaggers is considered as an illustration of Bion's notion of the 'ego-destructive superego'. In the course of the paper, the author suggests that Great Expectations affirms the psychoanalytic understanding that emotional growth and some recovery from narcissistic difficulties necessarily take place alongside modification of the superego, allowing for responsible knowledge of the state of the object and the possibility of realistic reparation.     

Change blindness and eyewitness testimony

The authors explored the relevance of research on change blindness to eyewitness identification and testimony under intentional and incidental memory conditions. Participants (N = 80, 40 men and 40 women) viewed a video enactment of a burglary in which the identity of the burglar changed at the halfway point of the film. Half of participants were briefed to remember the content, and the other half were not. All were tested for the recall of the content, awareness of the change, and ability to identify either or both of the burglars. Some 61% of participants did not notice the identity change. Rates of detection were significantly higher in participants in the intentional condition, who also recalled significantly more detail from the film. Awareness of change was also significantly related to content recall scores and accuracy of identification of both burglars. The results illustrate the interrelation between the eyewitness and change blindness literatures.     

Desire for euthanasia or physician-assisted suicide in palliative cancer care.

OBJECTIVE: To investigate the attitudes of terminally ill individuals toward the legalization of euthanasia or physician-assisted suicide (PAS) and to identify those who would personally desire such a death. DESIGN: In the Canadian National Palliative Care Survey, semistructured interviews were administered to 379 patients who were receiving palliative care for cancer. Patients who expressed a desire for physician-hastened death were followed prospectively. MAIN OUTCOME MEASURES: Attitudes toward the legalization of euthanasia or PAS were determined, as was the personal interest in receiving a hastened death. Demographic and clinical characteristics were also recorded, including a 22-item structured interview of symptoms and concerns. RESULTS: There were 238 participants (62.8%) who believed that euthanasia and/or PAS should be legalized, and 151 (39.8%) who would consider making a future request for a physician-hastened death. However, only 22 (5.8%) reported that, if legally permissible, they would initiate such a request right away, in their current situations. This desire for hastened death was associated with lower religiosity (p=.010), reduced functional status (p=.024), a diagnosis of major depression (p<.001), and greater distress on 12 of 22 individual symptoms and concerns (p<.025). In follow-up interviews with 17 participants, 2 (11.8%) showed instability in their expressed desire. CONCLUSION: Among patients receiving palliative care for cancer, the desire to receive euthanasia or PAS is associated with religious beliefs; functional status; and physical, social, and psychological symptoms and concerns. Although this desire is sometimes transitory, once firmly established, it can be enduring.     

Ethnocultural aspects of suicide in young people: a systematic literature review part 2: Risk factors, precipitating agents, and attitudes toward suicide

Different scholars have expressed the same regret for the lack of research on ethnocultural differences in youth suicide behavior and the need to conduct more comparative studies, necessary to develop culturally responsive prevention and intervention strategies. The authors reviewed 82 publications on youth suicide that have considered, to different degrees, the ethnicity/culture of the population studied. Part 1 of this article explored youth suicide rates and methods (SLTB, this issue), while the present paper examines risk and precipitating factors and attitudes toward suicide in young people from a cross-cultural perspective.