Brief Cognitive-Behavioral Therapy for Suicidal Inpatients

Suicide risk is elevated in psychiatric patients following discharge from inpatient care. Despite this vulnerability, there has been limited research investigating suicide prevention protocols that take into account the unique system characteristics of this setting (e.g., short lengths of stay, crisis stabilization treatment model, multidisciplinary team coordination). Cognitive-behavioral therapy (CBT) has demonstrated efficacy for improving suicide risk in outpatients, but has not been validated with inpatients. The current study was a treatment development and pilot feasibility open trial that modified brief cognitive-behavioral therapy (BCBT) for an inpatient setting (BCBT-I). Key treatment modifications included administering up to 10 sessions (depending on patient length of stay), daily, and in a standardized order, with core crisis management skills introduced during the first three sessions. In addition, coordination with the inpatient treatment team was included in BCBT-I implementation. Six adult inpatients with a recent suicide attempt enrolled and completed an average of 4.67 BCBT-I sessions (SD = 1.36). The treatment was highly acceptable (Client Satisfaction Questionnaire total score M = 3.49, SD = 0.73). Pre- to posttreatment effect sizes demonstrated improvements in suicidal ideation (d = 0.97), depression (d = 1.33), and suicidal implicit associations (d = 1.28). All but one of the participants (83%) completed follow-up assessments 1-, 2-, and 3-months postdischarge. Over follow-up, two participants reported suicidal ideation (both without intent), and none reported suicide attempts, preparatory acts or behaviors, or nonsuicidal self-injury. This study provided preliminary evidence supporting the feasibility of CBT to treat suicidal inpatients. Future research is needed to validate BCBT-I in a larger, randomized controlled trial to determine whether BCBT-I reduces suicide risk beyond that afforded by inpatient treatment alone.     

Vigilance and control

Philosophical Studies - We sometimes fail unwittingly to do things that we ought to do. And we are, from time to time, culpable for these unwitting omissions. We provide an outline of a theory of...     

The dissolution of “classical ethnoscience”

„Ethnoscience”︁ in the early 1960s provides a prototypical case of an elite specialty. With easy access to recognition, there was only a loose confederation, not at all the kind of tightly knit social network with a garrison worldview typifying revolutionary groups. Elite specialities both grow and dissolve more rapidly than revolutionary groups; they require less commitment, and concomitantly offer less resistance to competitors. Ethnoscience lacked a single leader and was never monolithic.     

The interactive effects of conscientiousness and agreeableness on job performance

The authors hypothesized that the relationship between conscientiousness and job performance would be stronger for persons high in agreeableness than for those low in agreeableness. Results of hierarchical moderated regression analyses for 7 independent samples of employees across diverse occupations provided support for the hypothesis in 5 of the samples. In samples supporting the hypothesis, among the highly conscientious workers, those low in agreeableness were found to receive lower ratings of job performance than workers high in agreeableness. One explanation for lack of an interaction between conscientiousness and agreeableness in the other 2 samples is that those jobs were not characterized by frequent, cooperative interactions with others. Overall, the results show that highly conscientious workers who lack interpersonal sensitivity may be ineffective, particularly in jobs requiring cooperative interchange with others.     

Regularities of source recognition: ROC analysis

Source memory has become the focus of a growing number of investigations in a variety of fields. An appropriate model for source memory is, therefore, of increasing importance. A simple 2-dimensional signal-detection model of source recognition is presented. The receiver operating characteristics (ROCs) obtained from 3 experiments are then used to test the model. The data demonstrate 3 regularities: convex ROCs, z-ROCs with linear slopes of 1.00, and slightly concave z-ROCs. Two of these regularities support the model. The 3rd requires a revision of the model. This revised model is fitted to the data. The implications of these regularities for other theories are also discussed.     

When rejection stings: how self-esteem constrains relationship-enhancement processes

Three experiments examined how needs for acceptance might constrain low versus high self-esteem people's capacity to protect their relationships in the face of difficulties. The authors led participants to believe that their partner perceived a problem in their relationship. They then measured perceptions of the partner's acceptance, partner enhancement, and closeness. Low but not high self-esteem participants read too much into problems, seeing them as a sign that their partner's affections and commitment might be waning. They then derogated their partner and reduced closeness. Being less sensitive to rejection, however, high self-esteem participants affirmed their partner in the face of threat. Ironically, chronic needs for acceptance may result in low self-esteem people seeing signs of rejection where none exist, needlessly weakening attachments.     

Sentence processing strategies in healthy seniors with poor comprehension: an fMRI study

We used fMRI to examine patterns of brain recruitment in 22 healthy seniors, half of whom had selective comprehension difficulty for grammatically complex sentences. We found significantly reduced recruitment of left posterolateral temporal [Brodmann area (BA) 22/21] and left inferior frontal (BA 44/6) cortex in poor comprehenders compared to the healthy seniors with good sentence comprehension, cortical regions previously associated with language comprehension and verbal working memory, respectively. The poor comprehenders demonstrated increased activation of left prefrontal (BA 9/46), right dorsal inferior frontal (BA 44/6), and left posterior cingulate (BA 31/23) cortices for the grammatically simpler sentences that they understood. We hypothesize that these brain regions support an alternate, nongrammatical strategy for processing complex configurations of symbolic information. Moreover, these observations emphasize the crucial role of the left perisylvian network for grammatically guided sentence processing in subjects with good comprehension.     

Effects of methylphenidate on sensitivity to reinforcement in children diagnosed with attention deficit hyperactivity disorder: an application of the matching law

The behavior of children diagnosed with attention deficit hyperactivity disorder (ADHD) has been hypothesized to be the result of decreased sensitivity to consequences compared to typical children. The present study examined sensitivity to reinforcement in 2 boys diagnosed with ADHD using the matching law to provide more precise and quantitative measurement of this construct. This experiment also evaluated the effects of methylphenidate (MPH) on sensitivity to reinforcement of children with ADHD. Subjects completed math problems to earn tokens under four different variable-interval (VI) schedules of reinforcement presented in random order under both medicated and nonmedicated conditions. Results showed that, in the medicated condition, the matching functions for both subjects resulted in higher asymptotic values, indicating an overall elevation of behavior rate under these conditions. The variance accounted for by the matching law was also higher under the medicated conditions, suggesting that their behavior more closely tracked the changing rates of reinforcement while taking MPH compared to placebo. Under medicated conditions, the reinforcing efficacy of response-contingent tokens decreased. Results are discussed with respect to quantifying behavioral changes and the extent to which the drug interacts with prevailing contingencies (i.e., schedule values) to influence behavioral variability.     

Cardiac disorders and antidepressant medications

Tricyclic antidepressants (TCAs) and monoamine oxidase inhibitors (MAOIs) have been associated with an increase in cardiovascular disorders, especially in depressed patients who have pre-existing cardiac disease. These disorders are less likely to occur when a therapeutic dosage is administered. Injuries because of falls are more likely in elderly depressed patients, and orthostatic hypotension occurs with the use of TCAs. Selective serotonin reuptake inhibitor (SSRI) antidepressants differ structurally and in side effects from TCAs and MAOIs. They appear to be effective for treatment of depression, and their side-effect profiles appear safer than those of earlier approved antidepressants used by depressed patients with cardiovascular disorders.