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.     

Probabilistic inference in human semantic memory

The idea of viewing human cognition as a rational solution to computational problems posed by the environment has influenced several recent theories of human memory. The first rational models of memory demonstrated that human memory seems to be remarkably well adapted to environmental statistics but made only minimal assumptions about the form of the environmental information represented in memory. Recently, several probabilistic methods for representing the latent semantic structure of language have been developed, drawing on research in computer science, statistics and computational linguistics. These methods provide a means of extending rational models of memory retrieval to linguistic stimuli, and a way to explore the influence of the statistics of language on human memory.     

Psychological management and body image issues in facial transplantation

Facial transplantation, although controversial, is proposed as a major advance in facial reconstructive surgery, with the first partial transplant having taken place in France in November 2005. Although the psychological impact of facial transplantation will not be understood until several procedures have been carried out, this article examines the psychological issues likely to arise with particular reference to body image. A detailed framework for anticipation and management of psychological change is proposed. Pre-operative preparation must include thorough psychological preparation for the patient and their family. The immediate post-operative period is likely to be challenging, and a detailed management plan is proposed emphasising early return to function; subsequent psychological issues including altered body image, anxiety, shame, depression, communication and behavioural avoidance are discussed and a management strategy based on cognitive behavioural principles is proposed for the first post-operative year. Previous discussion frames psychological outcome in terms of complication and risk, tending to downplay the potential advantages of a successful procedure; the focus of this paper is on ensuring psychological adjustment as an inevitable consequence of change.     

Binocular coordination of the eyes during reading: word frequency and case alternation affect fixation duration but not fixation disparity

This experiment investigated whether properties of the text being read affect binocular coordination of the eyes during reading. Readers' binocular eye movements were recorded while they read sentences that contained high- and low-frequency words. In addition, half of the sentences were presented in normal case, and half were presented in alternating case (i.e., AlTeRnAtInG cAsE). Past research has suggested that the visual system tolerates less binocular fixation disparity with alternating than with normal case (Heller & Radach, 1999). While both word frequency and alternating case produced large effects on fixation durations on the target word, neither manipulation affected the magnitude of fixation disparity. It is concluded that linguistic and visual properties of the text being read do not influence binocular coordination of the eyes during reading. Additional analyses also showed no difference in fixation disparity between reading and a nonlinguistic task. Implications of these results for split-fovea models of reading are discussed.     

The heart of the matter: a proposal for placing the self of the therapist at the center of family therapy research and training

As it faces the transition marked by the death or retirement of most of its first-generation founders, the field of family therapy finds itself still unable to answer the critical question of what it is that makes family therapy work. The two dominant approaches to answering this question, the common-factors perspective and the model-specific factors perspective, remain divided at this juncture by a fundamental difference of emphasis between the two. This article proposes a way of integrating the two perspectives via the hypothesis that therapists achieve maximum effectiveness by committing themselves to a family therapy model of proven efficacy whose underlying worldview closely matches their own personal worldview. The implications of this hypothesis for the training of family therapists are examined.     

Finding a face in the crowd: testing the anger superiority effect in Asperger Syndrome

Social threat captures attention and is processed rapidly and efficiently, with many lines of research showing involvement of the amygdala. Visual search paradigms looking at social threat have shown angry faces 'pop-out' in a crowd, compared to happy faces. Autism and Asperger Syndrome (AS) are neurodevelopmental conditions characterised by social deficits, abnormal face processing, and amygdala dysfunction. We tested adults with high-functioning autism (HFA) and AS using a facial visual search paradigm with schematic neutral and emotional faces. We found, contrary to predictions, that people with HFA/AS performed similarly to controls in many conditions. However, the effect was reduced in the HFA/AS group when using widely varying crowd sizes and when faces were inverted, suggesting a difference in face-processing style may be evident even with simple schematic faces. We conclude there are intact threat detection mechanisms in AS, under simple and predictable conditions, but that like other face-perception tasks, the visual search of threat faces task reveals atypical face-processing in HFA/AS.     

fMRI of parents of children with Asperger Syndrome: a pilot study

BACKGROUND: People with autism or Asperger Syndrome (AS) show altered patterns of brain activity during visual search and emotion recognition tasks. Autism and AS are genetic conditions and parents may show the 'broader autism phenotype.' AIMS: (1) To test if parents of children with AS show atypical brain activity during a visual search and an empathy task; (2) to test for sex differences during these tasks at the neural level; (3) to test if parents of children with autism are hyper-masculinized, as might be predicted by the 'extreme male brain' theory. METHOD: We used fMRI during a visual search task (the Embedded Figures Test (EFT)) and an emotion recognition test (the 'Reading the Mind in the Eyes' (or Eyes) test). SAMPLE: Twelve parents of children with AS, vs. 12 sex-matched controls. DESIGN: Factorial analysis was used to map main effects of sex, group (parents vs. controls), and sexxgroup interaction on brain function. An ordinal ANOVA also tested for regions of brain activity where females>males>fathers=mothers, to test for parental hyper-masculinization. RESULTS ON EFT TASK: Female controls showed more activity in extrastriate cortex than male controls, and both mothers and fathers showed even less activity in this area than sex-matched controls. There were no differences in group activation between mothers and fathers of children with AS. The ordinal ANOVA identified two specific regions in visual cortex (right and left, respectively) that showed the pattern Females>Males>Fathers=Mothers, both in BA 19. RESULTS ON EYES TASK: Male controls showed more activity in the left inferior frontal gyrus than female controls, and both mothers and fathers showed even more activity in this area compared to sex-matched controls. Female controls showed greater bilateral inferior frontal activation than males. This was not seen when comparing mothers to males, or mothers to fathers. The ordinal ANOVA identified two specific regions that showed the pattern Females>Males>Mothers=Fathers: left medial temporal gyrus (BA 21) and left dorsolateral prefrontal cortex (BA 44). CONCLUSIONS: Parents of children with AS show atypical brain function during both visual search and emotion recognition, in the direction of hyper-masculinization of the brain. Because of the small sample size, and lack of age-matching between parents and controls, such results constitute a pilot study that needs replicating with larger samples.     

Anxiety and sensitivity to eye gaze in emotional faces

This paper reports three studies in which stronger orienting to perceived eye gaze direction was revealed when observers viewed faces showing fearful or angry, compared with happy or neutral, emotional expressions. Gaze-related spatial cueing effects to laterally presented fearful faces and centrally presented angry faces were also modulated by the anxiety level of participants, with high- but not low-state anxious individuals revealing enhanced shifts of attention. In contrast, both high- and low-state anxious individuals demonstrated enhanced orienting to averted gaze when viewing laterally presented angry faces. These results provide novel evidence for the rapid integration of facial expression and gaze direction information, and for the regulation of gaze-cued attention by both the emotion conveyed in the perceived face and the degree of anxiety experienced by the observer.     

The effects of undergarment type on the urinary continence of toddlers

There is a growing trend toward later toilet training of typically developing children. This trend is a problem for caregivers and professionals who work with young children, because it is associated with a number of costs and health risks in child-care settings. Results of a recent study (Tarbox, Williams, & Friman, 2004) suggest that wearing underwear may facilitate the development of toileting skills. Based on these findings, we examined the effects of wearing disposable diapers, disposable pull-on training pants, and underwear on urinary continence of 5 typically developing toddlers in a child-care setting. Underwear decreased incontinence and increased continent urinations for 2 of the 5 participants, produced no improvement in 2 participants, and when combined with increased fluid intake and longer sitting periods, produced some favorable trends for the 5th participant.