The standard of care in suicide risk assessment: An elusive concept

Suicide risk assessment is now a core competency requirement in the residency training of psychiatrists. The purpose of suicide risk assessment is to identify modifiable or treatable acute, high-risk suicide factors, and available protective factors that inform patient treatment and safety management. The standard of care varies according to state statutory definitions. Heretofore, most states adopted an average physician or "ordinarily employed standard." Currently, more states are adopting a "reasonable, prudent physician" standard. No single source or authority defines the standard of care for suicide risk assessment. Evidence-based psychiatry can inform clinicians' suicide risk assessments. Carefully documented risk assessments will assist the courts in evaluating clinicians' decision-making process.     

Confidence intervals and replication: where will the next mean fall?

Confidence intervals (CIs) give information about replication, but many researchers have misconceptions about this information. One problem is that the percentage of future replication means captured by a particular CI varies markedly, depending on where in relation to the population mean that CI falls. The authors investigated the distribution of this percentage for varsigma known and unknown, for various sample sizes, and for robust CIs. The distribution has strong negative skew: Most 95% CIs will capture around 90% or more of replication means, but some will capture a much lower proportion. On average, a 95% CI will include just 83.4% of future replication means. The authors present figures designed to assist understanding of what CIs say about replication, and they also extend the discussion to explain how p values give information about replication.     

A virtual reality scenario for all seasons: the virtual classroom

Treatment and rehabilitation of the cognitive, psychological, and motor sequelae of central nervous system dysfunction often relies on assessment instruments to inform diagnosis and to track changes in clinical status. Typically, these assessments employ paper-and-pencil psychometrics, hands-on analog/computer tests, and rating of behavior within the context of real-world functional environments. Virtual reality offers the option to produce and distribute identical "standard" simulation environments in which performance can be measured and rehabilitated. Within such digital scenarios, normative data can be accumulated for performance comparisons needed for assessment/diagnosis and for treatment/rehabilitation purposes. In this manner, reusable archetypic virtual environments constructed for one purpose can also be applied for applications addressing other clinical targets. This article will provide a review of such a retooling approach using a virtual classroom simulation that was originally developed as a controlled stimulus environment in which attention processes could be systematically assessed in children with attention-deficit/hyperactivity disorder. This system is now being applied to other clinical targets including the development of tests that address other cognitive functions, eye movement under distraction conditions, social anxiety disorder, and the creation of an earthquake safety training application for children with developmental and learning disabilities.     

On the risk of being a cultural chameleon: variations in collective self-esteem across social interactions

In the present study the authors used an event-contingent daily recording strategy, the Rochester Interaction Record, to examine the relation of perceived evaluations of a multicultural person's heritage group to the nature and quality of his or her social interactions. Hierarchical linear modeling showed that having an interaction partner who positively evaluated one's heritage culture was associated with significantly enhanced interaction intimacy, disclosure, and quality, as well as with feelings of personal acceptance. Moderator analyses revealed that individuals who possessed a chameleon-like cultural identity and those who had low public collective self-esteem were particularly reactive to how their heritage group was being evaluated.     

Verified hormone therapy improves episodic memory performance in healthy postmenopausal women

Studies of hormone therapy (HT) and cognition have yielded conflicting results. The aim of this observational study was to examine the effect of estradiol, via serum verified HT (estradiol, estriol, progesterone) and endogenous estradiol, on 108 healthy postmenopausal women's cognitive performance. The results demonstrated that the 43 HT-users performed at a significantly higher level than non-users on episodic memory tasks and on a verbal fluency task, whereas HT-users and non-users did not differ on tasks assessing semantic memory and spatial visualization. In addition, there was a positive relationship between serum estradiol level and episodic memory performance, indicating that postmenopausal HT is associated with enhanced episodic memory and verbal fluency, independent of age and education. These observational results suggest that HT use may be sufficient to exert small, yet positive effects on female sensitive cognitive tasks. Hormone therapy compliance and formulation is discussed as confounding factors in previous research.     

Private-Sector Research Ethics: Marketing or Good Conflicts Management? The 2005 John J. Conley Lecture on Medical Ethics

Pharmaceutical companies are major sponsors of biomedical research. Most scholars and policymakers focus their attention on government and academic oversight activities, however. In this article, I consider the role of pharmaceutical companies’ internal ethics statements in guiding decisions about corporate research and development (R&D). I review materials from drug company websites and contributions from the business and medical ethics literature that address ethical responsibilities of businesses in general and pharmaceutical companies in particular. I discuss positive and negative uses of pharmaceutical companies’ ethics materials and describe shortcomings in the companies’ existing ethics programs. To guide employees and reassure outsiders, companies must add rigor, independence, and transparency to their R&D ethics programs.     

Neural bases of binocular rivalry

During binocular rivalry, conflicting monocular images compete for access to consciousness in a stochastic, dynamical fashion. Recent human neuroimaging and psychophysical studies suggest that rivalry entails competitive interactions at multiple neural sites, including sites that retain eye-selective information. Rivalry greatly suppresses activity in the ventral pathway and attenuates visual adaptation to form and motion; nonetheless, some information about the suppressed stimulus reaches higher brain areas. Although rivalry depends on low-level inhibitory interactions, high-level excitatory influences promoting perceptual grouping and selective attention can extend the local dominance of a stimulus over space and time. Inhibitory and excitatory circuits considered within a hybrid model might account for the paradoxical properties of binocular rivalry and provide insights into the neural bases of visual awareness itself.