Environmental risk factors in hospital suicide

Suicide of hospitalized patients is the most common sentinel event reviewed by The Joint Commission on Accreditation of Healthcare Organizations. Shorter lengths of stay, sicker patients, and higher patient to staff ratios challenge the ability of the hospital to maintain safety. Risk factors associated with the physical environment of the inpatient psychiatric unit, cited as the most common root cause of inpatient suicide, may be neglected because evaluation of these factors is generally not included in medical education and training. Minimization of fixtures that can facilitate strangulation and other high risk aspects within the hospital environment is an important element in the prevention of suicide on psychiatric units.     

Normative warrant in diagnostic criteria: the case of DSM-IV-TR personality disorders

This article focuses on the kinds of evaluative judgments made when applying DSM-IV-TR diagnostic criteria within the diagnostic interview between clinician and patient. The authors name these kinds of value judgments in diagnosis "normative warrant" because they involve one or more justifications (warrants) for standard-bearing (normative) elements involved in applying diagnostic criteria to actual patients. Seven types of normative warrant judgments are described (Type 1, Semantic-Phenomenal Matching; Type 2, Solicitation Choice; Type 3, Sociocultural Context; Type 4, Performance-Context Matching; Type 5, Deviance Threshold; Type 6, Threshold Characterization; Type 7, Disvalue characterization) and the typology is illustrated by applying it to various DSM-IV-TR personality disorder criteria. A research and clinical understanding of normative warrant may well contribute to the refinement of criteria sets as well as the refinement of the clinical use of criteria sets.     

A Comparison of Stress Measures in Children and Adolescents: A Self-Report Checklist Versus an Objectively Rated Interview

A self-report checklist assessing the occurrence of stressful life events in children and adolescents' lives was compared to an objectively rated interview to determine whether the checklist would introduce over-reporting of events or over-rating of event severity as a function of child/parent depressive symptoms, cognitive vulnerability, or anxiety. Participants completed the Children's Life Events Scale (CLES), the Life Events Interview (LEI), and questionnaires assessing cognitive vulnerability and symptoms of depression and anxiety. Findings yielded a positive association between the checklist and the interview. Contrary to hypotheses, depressive symptoms, cognitive vulnerability, and anxiety were not associated with over-reporting of events. Anxiety was associated with over-rating of event severity in parents but not children. Findings suggest that the checklist and interview may be equally viable approaches to assessing the occurrence of life events. Findings have mixed implications with regard to assessing event severity, as subjective reports may be systematically influenced by anxiety.

Medication barriers and anti-hypertensive medication adherence: the moderating role of locus of control

Locus of control as a moderator of the relationship between medication barriers (e.g., side-effects, forgetting to take medication, and keeping track of pills) and anti-hypertensive medication adherence was examined. Baseline data were obtained from 588 hypertensive veterans. In general, fewer medication barriers, higher internal locus of control and lower external locus of control was associated with better hypertensive medication adherence. Furthermore, internal locus of control served as a moderator (beta = -.74, p < .01) for the relationship between medication barriers and medication adherence; effect size was large. Decomposition of the interaction revealed that the relationship between medication barriers and medication adherence was strongest when internal control was high (b = -.24, p < .01). Higher internal locus of control was beneficial when barriers to medication adherence are low, but at high perceived barriers, locus of control plays less of a role in medication adherence. Future efforts to improve medication adherence should consider the patient's perceived level of medication barriers in conjunction with their locus of control.     

Mood-induced changes on the Implicit Association Test in recovered depressed patients

A mood induction paradigm was used to examine dysphoria-related changes in two types of cognitive processing in individuals who had previously experienced depression. Formerly depressed patients (n = 23) and never-depressed controls (n = 27) completed the Dysfunctional Attitudes Scale, a self-report measure of effortful processing, and performed the Implicit Association Test, an automatic-reaction time task that measures evaluative bias, before and after a negative-mood induction. The formerly depressed group showed both an increase in endorsement of dysfunctional attitudes and a more negative evaluative bias for self-relevant information after the induction, relative to controls--however, there was no association between the mood-linked changes observed on these two measures. The shift in evaluative bias shown by the formerly depressed group was similar to that seen in a group of 32 currently depressed individuals. These findings suggest that even a mild negative mood in formerly depressed individuals can reinstate some of the cognitive features observed in depression itself.     

Visual statistical learning in infancy: evidence for a domain general learning mechanism

The rapidity with which infants come to understand language and events in their surroundings has prompted speculation concerning innate knowledge structures that guide language acquisition and object knowledge. Recently, however, evidence has emerged that by 8 months, infants can extract statistical patterns in auditory input that are based on transitional probabilities defining the sequencing of the input's components (Science 274 (1996) 1926). This finding suggests powerful learning mechanisms that are functional in infancy, and raises questions about the domain generality of such mechanisms. We habituated 2-, 5-, and 8-month-old infants to sequences of discrete visual stimuli whose ordering followed a statistically predictable pattern. The infants subsequently viewed the familiar pattern alternating with a novel sequence of identical stimulus components, and exhibited significantly greater interest in the novel sequence at all ages. These results provide support for the likelihood of domain general statistical learning in infancy, and imply that mechanisms designed to detect structure inherent in the environment may play an important role in cognitive development.     

Reasons for suicide attempts and nonsuicidal self-injury in women with borderline personality disorder

Self-reported reasons for suicide attempts and nonsuicidal self-injury were examined using the Parasuicide History Interview within a sample of chronically suicidal women meeting criteria for borderline personality disorder (N = 75). Overall, reasons given for suicide attempts differed from reasons for nonsuicidal self-injury. Nonsuicidal acts were more often reported as intended to express anger, punish oneself, generate normal feelings, and distract oneself, whereas suicide attempts were more often reported as intended to make others better off. Almost all participants reported that both types of parasuicide were intended to relieve negative emotions. It is likely that suicidal and nonsuicidal parasuicide have multiple intents and functions.     

The cerebellum and the timing of coordinated eye and hand tracking.

The cerebellum is known to have important functions in motor control, coordination, motor learning, and timing. It may have other "higher" functions as well, up to and including cognitive processing independent of motor behavior. In this article, we will review some of the evidence from functional imaging, lesion studies, electrophysiological recordings, and anatomy which support the theory that the cerebellum provides a "forward model" of the motor system. This forward model would be used for control of movement; it could also underlie a cerebellar role in coordination. In this role, the forward model would generate time-specific signals predicting the motion of each motor effector, essential for predictive control of, for example, eye and hand movements. Data are presented from human eye and hand tracking that support this. Tracking performance is better if eye and hand follow the same spatial trajectory, but better still if the eye leads the hand by about 75 to 100 ms. This suggests that information from the ocular control system feeds into the manual control system to assist its tracking.