Prevalence of traumatic brain injury in an inpatient psychiatric population

This study investigated the prevalence of traumatic brain injury (TBI) in an inpatient psychiatric population. We hypothesized increased prevalence of TBI relative to the general population due to a variety of risk factors observed in psychiatric patients. One hundred (mean age = 34) psychiatric inpatients completed the revised Head Injury Questionnaire. Chart review of 17 subjects reporting injuries established whether injuries were documented in medical records. Sixty-eight percent of this psychiatric population reported one or more injuries in which they were unconscious or dazed. This number is higher than the prevalence in the general population. Injuries were generally of mild to moderate severity; multiple injuries were common. Chart review of 17 subjects reporting TBI indicated that histories of TBI had not been noted in the medical record. Finally, 63% of TBI subjects reported that their injury predated the onset of their psychiatric symptoms. These results suggest a possible role of TBI in psychiatric symptomatology and have implications for psychiatric treatment in this population.     

The relationship between arousal and positive self-presentation

Investigated the validity of the hypothesis that subjects would experience arousal if they received information suggesting that they were presenting themselves to others in a negative manner. Twenty-seven subjects were randomly assigned to a control, evaluation apprehension, or negative feedback group. Subjects' heart-rate was continuously monitored as subjects' rated a series of photographs. Subjects in the evaluation apprehension group were given a cue as to how to present themselves positively whereas subjects in the negative feedback group were told, following their response to the 15th photograph, that their responses suggested maladjustment. Heart-rate change above a baseline measure revealed that an increase in heart-rate occurred only when subjects were informed that they were transmitting negative information. Such a finding supports a positive self-presentation explanation of subject motives in the psychological experiment.     

Who drops-out? Do measures of risk to self and to others predict unplanned endings in primary care counselling?

Aims: Unplanned endings, where clients unilaterally end therapy, are of concern for psychological therapy services generally as they raise questions about the appropriateness of the treatment and it's delivery for some clients. Limited available data indicates that those who drop-out often have more severe symptoms at entry, and have poorer clinical outcomes. This raises further questions about risk to self and others for those clients who leave therapy prematurely and how these clients might be identified and kept engaged. Method: This paper uses a large dataset of CORE data collected routinely in a primary care counselling service between 2000 and 2003. Logistic regression was utilised to consider different measures of risk and other client characteristics recorded at assessment to predict drop-out from the service. Results: These indicate that younger age, greater psychological distress at assessment, an addiction problem and greater risk to others, are associated with an unplanned ending. However, no reliable logistic regression model could be produced. This may be partly due to data quality issues or important characteristics not being available in the data. Implications for practice: The paper concludes that counsellors should actively seek to minimise unplanned endings, as amongst them may be represented the more distressed and risky clients referred to primary care counselling.     

A Safety and Coping Planning Intervention for Suicidal Adolescents in Acute Psychiatric Care

Transitioning from an acute psychiatric care setting to a less restrictive environment after a suicidal event is arguably the most critical period of suicide risk for adolescents, making comprehensive safety and coping plans for this population ever more critical. In this paper we provide theoretical and empirical rationale for the need for developmental adaptations to current safety planning procedures for suicidal adolescents, as well as the standardization of pediatric safety plans for broader use across settings that provide acute psychiatric care to adolescents. We describe how we developed the Adolescent Safety and Coping Plan (ASCP) using qualitative in-depth interviews with 20 adolescents and their parents, explain the specific components of the ASCP, and give a case example of the ASCP being used with a young adolescent and her parents. Finally, we conclude with a discussion of the barriers and facilitators of the use of the ASCP in settings that provide acute psychiatric care, as well as the need for future research to test the ASCP with diverse adolescent and family populations and settings.