Endocrinology and suicide

The data accumulated so far suggest several tentative conclusions. First, thyroid and adrenal gland disease unquestionably can produce severe mental disturbances. Most of these are "organic" in nature, but depressive symptoms are common as well. A connection between these diseases and suicide has not been established, however. Research cannot really address this possibility adequately, since these studies are difficult, if not impossible, to do in the postmortem state at this time. Ways should continue to be sought to overcome this problem. Clinically, it seems advisable to treat all depressed, suicidal persons with the same caution, whether they have diseases of these endocrine systems or not. The differences in responsiveness of the thyroid and adrenocortical systems among depressed and perhaps truly suicidal persons are of greater theoretical as well as practical clinical interest. The TRH-TSH test and the DST may not be as specific as once thought. Nonetheless, the abnormalities do occur with regularity in specific subgroups of depressed patients. It is far too early to stop research on the DST or the TRH-TSH test. Clinically, however, it is premature to make important management decisions about suicidal patients based on these test results. At this time, we really have no means of pinpointing the persons who will eventually suicide. The hope that they may someday provide valid data for assessing real suicide potential is there, and clinicians should stay informed in this arena. Until that day comes, though, we must continue to exercise caution regarding our clinical judgments and to live with their uncertainties.     

A delay timer for presenting auditory and visual probes

A circuit designed to present auditory or visual probes is described. The circuit allows the probes to be delayed by a specified amount of time, and the volume (for auditory probes) or intensity (for visual probes) may also be adjusted. The circuit may be triggered by any device capable of emitting an electronic pulse-such as a computer or a tachistoscope.     

Pragmatics in the measurement of family functioning: an interpretive framework for methodology

The issue of the cross-method comparison of concepts that describe family functioning is addressed by means of an empirical investigation of two methods of family assessment. The examination focuses on a consideration of the functional, or pragmatic, aspects of subjects' responses through a comparison of a self-report and an observational method whose associated concepts appear to be similar. Little predicted association based on conceptual similarity is noted. An interpretive framework is developed suggesting that the outcomes of empirical method comparisons may be usefully considered in terms of the pragmatic aspects of subjects' responses or the way in which subjects may be using their responses, based on their inferences regarding the interpersonal context associated with each method.     

San Diego Suicide Study: the adolescents

The San Diego Suicide Study involved psychological autopsy and toxicological examination of 283 suicides. Of the 133 consecutive cases under age 30, 14 were under age 20. In this paper, detailed data on the 14 adolescent cases are presented and the findings compared to other studies.     

Developing an efficient clinical information system for a comprehensive psychiatric institute: II. Initial evaluation form

This paper describes the objectives, design, organization, content, evaluation, and implementation of the initial evaluation form, first component of a comprehensive psychiatric institute’s clinical information system. Major features of this effort are the involvement of a large number of clinicians in the form’s development, the use of complementary narrative and standardized components, the use of an expanded DSM-III multiaxial diagnostic format, pilot testing with over 1,000 patients, the evaluation of the form’s usefulness and interrater reliability, the form’s computerization, facilitating data retrieval and coordination with other institutional data bases, and the form’s monitoring.     

Cognitive tuning,encoding, and the attribution of causality

Subjects were given a transmission or reception set before or after viewing a videotape of an event which involved an extreme outcome. The results indicated that transmitters made relatively extreme attributions to plausible causal agents when the set was given prior but not subsequent to viewing the event. The results also showed that subjects who had been given a transmission set before viewing the videotape exhibited relatively high recognition of aspects of the event they observed. It is suggested that the data provide support for an encoding interpretation of transmission-reception differences in the attribution of causality.     

Christian Churches and Immigrant Support in Canada: An Organizational Ecology Perspective

Canada receives roughly 250,000 immigrants each year, and the government spends considerable resources on assisting them to settle and integrate into Canadian society through the agencies they support. Most of these new immigrants settle in Canada’s largest cities, where churches meet specific needs that extend beyond the capacities of government agencies. In smaller centers, churches cover a wide range of services because few government supports are available. Little is known about the work of churches in Canada in spite of their importance to immigrant settlement and integration. In this study, we examine the services offered to immigrants by Canadian Christian churches. We show how the service provision of Christian churches is constrained by other organizations and groups in their environment, in ways consonant with the organizational ecology framework. Specifically, churches service the needs of immigrants by adapting to specific niche needs and by filling in gaps left by other service providers.     

Obsessive-Compulsive Disorder: The Process of Parental Adaptation and Implications for Genetic Counseling

Obsessive-compulsive disorder (OCD) has primarily pediatric onset and well-documented unique impacts on family functioning. Limited research has assessed the understanding that parents of children with OCD have of the etiology of the condition, and there are no data regarding potential applications of genetic counseling for this population. We recruited 13 parents of 13 children diagnosed with OCD from the OCD Registry at British Columbia Children’s Hospital, and conducted qualitative semi-structured telephone interviews to explore participants’ experiences with their child’s OCD, causal attributions of OCD, and perceptions of two genetic counseling vignettes. Interviews were audio-recorded, transcribed, and analyzed using elements of grounded theory qualitative methodology. Analysis revealed key components and contextual elements of the process through which parents adapt to their child’s OCD. This adaptation process involved conceptualizing the meaning of OCD, navigating its impact on family dynamics, and developing effective illness management strategies. Adaptation took place against a backdrop of stigmatization and was shaped by participants’ family history of mental illness and their child’s specific manifestations of OCD. Parents perceived genetic counseling, as described in the vignettes, as being empowering, alleviating guilt and blame, and positively impacting treatment orientation. These data provide insight into the process of parental adaptation to pediatric OCD, and suggest that genetic counseling services for families affected by OCD may help facilitate adaptation to this illness.     

Academic Guidance in Medical Student Research: How Well Do Supervisors and Students Understand the Ethics of Human Research?

Research is increasingly recognised as a key component of medical curricula, offering a range of benefits including development of skills in evidence-based medicine. The literature indicates that experienced academic supervision or mentoring is important in any research activity and positively influences research output. The aim of this project was to investigate the human research ethics experiences and knowledge of three groups: medical students, and university academic staff and clinicians eligible to supervise medical student research projects; at two Australian universities. Training in research ethics was low amongst academic staff and clinicians eligible to supervise medical student research. Only two-thirds of academic staff (67.9 %) and students (65.7 %) and less than half of clinicians surveyed (47.1 %; p?=?0.014) indicated that specific patient consent was required for a doctor to include patient medical records within a research publication. There was limited awareness of requirements for participant information and consent forms amongst all groups. In the case of clinical trials, fewer clinicians (88.4 %) and students (83.3 %) than academics (100 %) indicated there was a requirement to obtain consent (p?=?0.009). Awareness of the ethics committee focus on respect was low across all groups. This project has identified significant gaps in human research ethics understanding among medical students, and university academic staff and clinicians. The incorporation of research within medical curricula provides the impetus for medical schools and their institutions to ensure that academic staff and clinicians who are eligible and qualified to supervise students’ research projects are appropriately trained in human research ethics.