Environmental factors in suicide in long-term care facilities.

One major purpose of this study was to identify environmental factors related to suicide in long-term care facilities. Questionnaires were mailed to a random sample of administrators at 1,080 facilities. Information was collected on facility characteristics, overt suicide, and intentional life-threatening behavior. Chi-square analyses revealed 4 environmental characteristics related to suicidal behavior and deaths from suicide: staff turnover, size, auspices, and per diem cost. More suicides occurred in larger facilities and facilities with higher staff turnover. Religious or "other" facilities experienced more suicidal deaths than public or private facilities; facilities charging less experienced more deaths.     

Representation by counsel: Right or obligation?

Since the Supreme Court's decision in Faretta v. California (1975), courts have generally permitted defendants to represent themselves, as long as they are competent to do so. The problem lies in the definition of competency to waive counsel, which has been vaguely defined by the courts. Little is known about the frequency of, or reasons for, attempts to waive counsel, about the process of forensic evaluation of such competency, and about the success of such attempts. The authors briefly review the case law on competency to waive representation, report on a longitudinal prospective study of these issues in a population of defendants referred to an inpatient forensic facility for evaluation of all types of competency related to their criminal prosecutions, and discuss the significance of the issue for forensic clinicians. A key question for courts, lawyers, and clinicians is whether a competency evaluation can be invoked to overcome a defendant's constitutional rights to self-representation and bail.     

The Predicament-Problem Continuum: Dealing With Stressors Outside Our Control

The author developed a practical, effective way of teaching people how to refocus their energy from predicaments to problems and thereby reduce their stress levels. Feedback about using the technique was positive. Benefits and limitations are discussed.     

Factors related to sleep quality in healthy elderly women.

Elderly women in subjectively good health--free of acute illness and major sleep pathologies--who were self-identified as good (n = 22) and poor (n = 16) sleepers were compared on measures of physical health, psychological symptoms, psychosocial status, and life-style. Poor sleepers reported longer sleep latencies, less total sleep time, more nonrestorative sleep, and more daytime fatigue than did good sleepers. Sleep recordings confirmed subjective reports, with shorter total sleep times and trends for lower sleep efficiency, longer sleep latencies, and more wake-after-sleep onset among women with subjective poor sleep. Poor sleepers also were more frequent users of sedative-hypnotic medications in the past. Current medication use, alcohol and caffeine use, daytime napping, and exercise were equivalent in both groups. Psychosocial status failed to discriminate groups. Poor sleepers reported significantly more psychological symptoms than did good sleepers. The levels of both psychological symptoms and sleep disturbance were mild.     

The Counseling Process as Defined by Relationship Types: A Test of Helms's Interactional Model

Helms (1984) presented a model to explain the influence of Black and White racial identity development on counseling interactions. The purpose of this study was to examine her hypothesis that specific combinations of racial identity attitudes contribute to qualitatively different counseling process and outcome or relationship types.     

Evaluation of a comprehensive inpatient rational-emotive therapy program: Some preliminary data

Mental health practitioners are faced with a profound challenge surrounding the prevalence of adult mental disorders, the need for inpatient treatment programs, and the costs of such programs. This paper describes the development of an adult inpatient psychiatric program based on Rational-Emotive Therapy. Specific elements of this program are described briefly, and preliminary outcome data presented on 372 patients. Concerns and future directions are also discussed. Development of adult inpatient psychiatric programs based on Rational-Emotive Therapy would appear to be one method of providing effective and cost-efficient treatment within the current cost-containment atmosphere of psychiatric treatment.Dr. Nottingham is an Associate Fellow and Approved Supervisor of the Institute for Rational-Emotive Therapy. He is in independent practice with Germantown Psychological Associates, P.C. and is Director of Psychology at Parkwood Hospital, Olive Branch, MS. Dr. Neimeyer is an Associate Professor and Director of Clinical Training in the Department of Psychology of Memphis State University. He has written extensively in the areas of cognitive and constructivist psychotherapy, and is co-editor of the International Journal of Personal Construct Psychology.The authors would like to thank Kat Bagley, Joe Grillo, Ivey Bright, Brooke Bensen, Cathy Michas, Brad Barris, Lori Passmore, David Wilkins, and Dee Conrad for their help with data collection. Additionally, without the assistance and support of the Parkwood Hospital administration and staff, neither this treatment program nor this paper could have been developed.Portions of this paper based on earlier data analyses were presented at the Mississippi Psychological Association Convention, September, 1990. This research was conducted at Parkwood Hospital.     

Diathesis-stress models of psychopathology: A quantitative genetic perspective

When genetics is considered in diathesis-stress models of psychopathology, it is often assumed that heredity provides the diathesis and environmental factors are responsible for the stressor. We discuss two quantitative genetic models relevant to the diathesis-stress construct. One model focuses on genotype-environment interaction, which is the usual way in which genetic influence is represented in diathesis-stress models. A second model—genotype-environment correlation—provides an alternative that represents both genetic and environmental influences relevant to the development of psychopathology. Implications of these models for clinical research are discussed.     

WHEN PREDICTIONS CREATE REALITY:

Abstract —Nelson and Dunlosky (Psychological Science, July 1991) reported that subjects making judgments of learning (JOLs) can be extremely ac curate at predicting subsequent recall performance on a paired-associate task when the JOL task is delayed for a short while after study They argued that this result Is surprising given the results of earlier research, as well as their own current experiment, indicating that JOLs are quite inaccurate when made immediately after study We note that the delayed-JOL procedure used by Nelson and Dunlosky invited covert recall practice (which was reported by their subjects) Retrieval practice is a welt-known determinant of subsequent recall Accordingly, Nelson and Dunlosky s findings can be explained by the simple assumption that people base delayed JOLs on an assessment of retrieval success which in turn influences their retrieval success on the subsequent recall test