Documenting suicide risk assessments and proportionate clinical actions to improve patient safety and mitigate legal risk

Few clinical practices are as important for simultaneously augmenting patient safety and mitigating legal risk as the judicious evaluation and stratification of a patient's risk for suicide, proportionate clinical actions based thereon taken by the healthcare provider, and contemporaneous documentation of the foregoing. In this article, we draw from our combined decades of multidisciplinary experience as a clinical psychologist, forensic psychiatrist, medical malpractice attorney, and clinical psychology trainee to discuss the documentation of suicide risk assessment and management as a conduit to patient safety and legal risk mitigation. We additionally highlight documentation as a core clinical competency across disciplines and note areas of improvement, such as increased training, to bolster documentation practices.     

Mom Matters: Maternal Influence on the Choice of Academic Major

Using High School and Beyond data and multinomial logit modeling, this analysis explores the parental impact on a student's choice of academic major. Family measures that have traditionally been used in status attainment models have focused primarily on father. This analysis includes measures for both the mother and the father to gauge their individual impact. Results indicate that mothers influence students' choice of academic major most readily through emotional and normative channels. In addition, mothers generally encourage the pursuit of nontechnical majors, whereas fathers encourage the pursuit of technical majors. The implications of this analysis are that mothers ought to be included more systematicly in status attainment models.     

Chronic fatigue syndrome/myalgicencephalomyelitis as a twentieth-century disease: analytic challenges

The challenges of chronic fatigue syndrome (often called myalgic encephalomyelitis, especially in the UK) (CFS/ME) to analytical and medical approaches are connected with our inability to understand its distressing somatic symptoms in terms of a single identifiable and understandable disease entity. The evidence for the roles of viral aetiologies remains inconclusive, as does our understanding of the involvement of the immune system. The history and social context of CFS/ME, and its relation to neurasthenia and psychasthenia are sketched. A symbolic attitude to the condition may need to be rooted in an awareness of psychoid levels of operation, and the expression and spread of CFS/ME may sometimes be aided by the ravages of projective identification. Psychic denial, sometimes violent, in sufferers (especially children and adolescents) and their families may be important in the aetiology of CFS/ME. We draw out common threads from psychodynamic work with five cases, four showing some symptomatic improvement, analytic discussions of three cases being presented elsewhere in this issue of JAP.     

Strategic reliance on phonological mediation in lexical access

The present study investigated strategic variation in reliance on phonological mediation in visual word recognition. In Experiment 1, semantically related or unrelated word primes preceded word, pseudohomophone (e.g.,trane), or nonpseudohomophone (e.g.,trank) targets in a lexical decision task. Semantic priming effects were found for words, and response latencies to pseudohomophones were longer in related than in unrelated prime conditions. In Experiment 2, related or unrelated word primes preceded word or pseudohomophone targets. A relatedness effect was found for words, although it was significant at a 600-msec prime-target stimulus onset asynchrony (SOA) and not at a 200-msec SOA. There was no relatedness effect for pseudohomophones. Experiment 3 was a replication of Experiment 2, except that pseudohomophones were replaced by nonpseudohomophonic orthographic controls. Facilitation effects for related target words were greater in Experiment 3 than in Experiment 2. The results reflect apparent variations in the expectation that a related prime reliably indicates that a target is a word. Although reliance on phonological mediation might be strategically contingent, there could be a brief time period in which phonologically mediated lexical access occurs automatically. Whether phonological information is maintained or suppressed subsequently depends on its overall usefulness for the task.     

Differential accuracy in person perception across traits: examination of a functional hypothesis.

Although strangers can assess certain traits of unacquainted others with moderate validity, overall validity is low. Differential validity across traits may be due to (a) the extent to which targets display valid cues or (b) the extent to which perceivers validly use cues. A functionalist perspective suggests that valid cue utilization should vary with how important the consequences of accurate trait assessment are. It was predicted from this perspective that perceivers would judge strangers' sociosexuality more accurately than 3 other traits--social potency, social closeness, and stress reaction. Perceivers viewed 1-min videotaped segments of targets being interviewed and rated them on the 4 traits. Ratings were correlated with target-reported trait measures. As predicted, perceivers' ratings of male sociosexuality agreed relatively well with self-reports. This effect was moderated by sex of target and sex of perceiver.     

Employee substance use and on-the-job behaviors.

Substance use and job behaviors were assessed in a sample of municipal employees from a large city in the southwestern United States. Job behaviors included psychological and physical withdrawal, positive work behaviors, and antagonistic work behaviors. Employees who reported substance use at or away from work were found to more frequently engage in withdrawal activities and antagonistic work behaviors than did nonusers, although users and nonusers did not differ on positive work behaviors. We tested hierarchical regression models to determine whether substance use contributed unique variance to the prediction of job behaviors after we controlled for variance associated with personal and job background domains. Substance use added unique variance to the prediction of psychological and physical withdrawal behaviors but not to positive or antagonistic work behaviors.     

Learning models for a continuum of sensory states reexamined

Dorfman and Biderman evaluated an additive-operator learning model and some special cases of this model on data from a signal-detection experiment. They found that Kac's pure error-correction model gave the poorest fit of the special models when the predictions were generated from the maximum likelihood estimates and the initial cutoffs were set at an a priori value rather than estimated. First, this paper presents tests of an asymptotic theorem by Norman, which provide strong support for Kac's model. On the final 100 trials, every subject but one gave probability matching, and the response propcrtions appropriately normed were approximately normally distributed with variance π(1 ? π). Further analyses of the Dorfman-Biderman data based upon maximum likelihood and likelihood-ratio tests suggest that Kac's model gives a relatively good, but imperfect fit to the data. Some possible explanations for the apparent contradiction between the results of these new analyses and the original findings of Dorfman and Biderman were explored. The investigations led to the proposal that there may be nonsystematic, random drifts in the decision criterion after correct responses as well as after errors. The hypothesis gives a minor modification of the conclusions from Norman's theorem for Kac's model. It gives asymptotic probability matching for every subject, but a larger asymptotic variance than π(1 ? π), which agrees with the data. The paper also presents good Monte Carlo justification for the use of maximum likelihood and likelihood-ratio tests with these additive learning models. Results from Thomas' nonparametric test of error correction are presented, which are inconclusive. Computation of Thomas' p statistic on the Monte Carlo simulations showed that it is quite variable and insensitive to small deviations from error correction.     

Effect of snap and thoughtful judgments on person impressions

Judgment type (snap and thoughtful) and valence of stimulus person (from likable to unlikable) were varied as within-subjects factors in four studies to test whether situational and motivational variables (as opposed to the perceptual variable of unit formation) would interfere with integrative activity in forming first impressions. If such variables are influential, both the averaging and meaning shift formulations would expect that snap judgments should produce less extreme impression ratings than more thoughtful judgments. None of three indices of integrative activity (impression ratings, component ratings and variance of impression ratings) detected a difference between the snap and thoughtful response conditions for early and late judgments in a series, for moderate or extreme traits, or for between- or within-subjects designs. These findings suggest that certain boundary conditions need to be placed on the assumptions underlying the averaging and meaning shift formulations.