Accuracy of Clinician Predictions of Future Self‐Harm: A Systematic Review and Meta‐Analysis of Predictive Studies

Assessment of a patient after hospital‐treated self‐harm or psychiatric hospitalization often includes a risk assessment, resulting in a classification of high risk versus low risk for a future episode of self‐harm. Through systematic review and a series of meta‐analyses looking at unassisted clinician risk classification (eight studies; N = 22,499), we found pooled estimates for sensitivity 0.31 (95% CI: 0.18–0.50), specificity 0.85 (0.75–0.92), positive predictive value 0.22 (0.21–0.23), and negative predictive value 0.89 (0.86–0.92). Clinician classification was too inaccurate to be clinically useful. After‐care should therefore be allocated on the basis of a needs rather than risk assessment.     

Poisoning Severity Associated with a Range of Medications in Suicide Attempts by Ingestion

There are limited data on the medical severity of suicide attempts by intentional self‐poisoning (ISP) associated with ingestion of differing classes of medications and meager data on specific agents. The purpose of the study was to address these gaps. This was an analysis of a consecutive series of ISP cases ages 13 to 65 treated at a U.S. university medical center (N = 671). The outcome, poisoning severity, was dichotomized as “moderate‐severe” and “low” (reference) based on a standard measure. Class of medication (e.g., opiate) and specific agents ingested were the predictors of interest. Covariates were age, sex, and the ingestion of multiple classes of medications. Data were analyzed using multivariate logistic regression models. At the class level, ingestion of opiate was uniquely associated with increased risk for moderate‐severe ISP at a statistically significant level, adjusted odds ratio (95% CI) = 2.97 (1.69, 5.21), p = .0002. Several specific agents were also associated with moderate‐severe ISP. Along with the key role of opiate medications in unintentional overdose morbidity and mortality, opiate medications may also play an important and largely unrecognized role in medically serious suicidal behavior. Results also underscore the variability in toxicity of specific agents within drug classes.     

Hasidism and the Habsburg Empire, 1788–1867

This article discusses the attitude of the Habsburg empire towards hasidim in Galicia during the years 1788–1867. It is based on a range of laws regarding hasidim, including the private minyanim (prayer groups) laws. The main argument of the article is that hasidim, like all other Jews, enjoyed the Austrian policy of religious toleration, and could perform all their religious rituals and customs so long as they did not contravene civil law. The examples cited in the article, almost all based on newly discovered archival documents, demonstrate the failure of efforts, such as that of the maskil Yehudah Leib Mieses, to define Hasidism as Religionsschwärmerei (religious enthusiasm), and thus to prohibit hasidim from petitioning for a license to set up private minyanim. Other examples show that the Austrian imperial authorities rebuked some district authorities for wrongly detaining hasidic leaders, finding it necessary to explain the correct interpretation of the law to local officials who had misapplied it. Hasidim in Galicia were familiar with the law and quickly learned to protest when their rights had been violated. Contrary to Raphael Mahler’s claim, the story of government treatment of hasidim in Galicia was not one of persecution, but one that involved enforcement of civil law on the one hand, and the policy of religious toleration on the other.     

Odor memory: Review and analysis

We critically review the cognitive literature on olfactory memory and identify the similarities and differences between odor memory and visual-verbal memory. We then analyze this literature using criteria from a multiple memory systems approach to determine whether olfactory memory can be considered to be a separate memory system. We conclude that olfactory memory has a variety of important distinguishing characteristics, but that more data are needed to confer this distinction. We suggest methods for the study of olfactory memory that should make a resolution on the separate memory system hypothesis possible while simultaneously advancing a synthetic understanding of olfaction and cognition.     

The Effects of Selective Cholinergic Basal Forebrain Lesions and Aging upon Expectancy in the Rat

The effects of selective cholinergic cell loss within the basal forebrain (BF) were determined using a task that requires shifting of attention between two visual stimuli. Discriminability between two stimuli and response bias were determined in young and old F-344 rats given BF injections of IgG-192 saporin (100 ng). The lesion reduced ChAT activity in the frontal and parietal cortices, hippocampus, and olfactory bulbs. The lesion did not significantly alter Na⁺/K⁺-ATPase activity in cortex, hippocampus, or olfactory bulbs, or endogenous levels of neuropeptide Y and neurokinin B within the BF. The BF lesions impaired both stimulus discriminability and response bias in young and old rats. The BF lesions had a significantly greater effect upon stimulus discriminability and response bias in aged rats, compared to young rats, only when the stimulus duration was very brief, i.e., when the task was most difficult to solve. At longer stimulus durations, aging and lesions showed no interaction. The results suggest that the selective loss of cholinergic cells in the BF, but not normal aging, impairs the ability to discriminate between independent sensory stimuli. The loss of these cells confers a response bias in simple operant tasks involving motor responses to reward-related visual stimuli.     

Peer Group and Family Relationships in Early Adolescence

This study explored the possible interface between family and peer group systems in early adolescence. Sixth-graders who were identified as group members were interviewed and given questions regarding their attitudes toward the group and group dynamics. Family atmosphere and parent-adolescent relationships were evaluated from the parents' perspective. The results show two different linkages of peer and family processes: On the one hand, family relationships are related to the perception of the peer group as a source of support, especially when individual growth is respected within an atmosphere of acceptance and support in the family. On the other hand, family life characterized by conflict and lack of support for individual development is related to an increased involvement with groups and more conformity to group pressure. Results are discussed in line with theories dealing with the role of the family in adolescent development.     

TOWARD THE DEVELOPMENT OF STRUCTURED CRITERIA FOR INTERPRETATION OF FUNCTIONAL ANALYSIS DATA

Using functional analysis results to prescribe treatments is the preferred method for developing behavioral interventions. Little is known, however, about the reliability and validity of visual inspection for the interpretation of functional analysis data. The purpose of this investigation was to develop a set of structured criteria for visual inspection of multielement functional analyses that, when applied correctly, would increase interrater agreement and agreement with interpretations reached by expert consensus. In Study 1, 3 predoctoral interns interpreted functional analysis graphs, and interrater agreement was low (M = .46). In Study 2, 64 functional analysis graphs were interpreted by a panel of experts, and then a set of structured criteria were developed that yielded interpretive results similar to those of the panel (exact agreement = .94). In Study 3, the 3 predoctoral interns from Study 1 were trained to use the structured criteria, and the mean interrater agreement coefficient increased to .81. The results suggest that (a) the interpretation of functional analysis data may be less reliable than is generally assumed, (b) decision-making rules used by experts in the interpretation of functional analysis data can be operationalized, and (c) individuals can be trained to apply these rules accurately to increase interrater agreement. Potential uses of the criteria are discussed.     

Young people's theories of anorexia nervosa and obesity

One hundred and forty-seven participants completed a 108-item questionnaire, based on that used by Fumham and Hume-Wright in 1992 aournal of Clinical Psychology, 48, 20-36) that looked at their beliefs about the causes and cures of anorexia neruosa and obesity. The four parts of the questionnaire were individually factor analysed and an intevretable factor structure emerged for each. while age and knowing someone with anorexia neruosa or obesity did not correlate with the factors obtained, sex, actual body size, estimated body size and having experience of an eating disorder were found to correlate significantly with a number of factors. Factors of cause and cure were not correlated regarding anorexia neruosa, but were for obesity. Several correlations within cause and cure, across both disorders, were also significant. The implications of these jindings and how they relate to the theories described in the Introduction are considered in the Discussion.