An expanded etiological model for suicide behavior in adolescents: Evidence for its specificity relative to depression

This study tests both the stress/social support and the stress/problem-solving etiological models for suicidality while controlling for depression. To this end, a depressed, high-suicide-ideating sample (N=68) was compared to a depressed, low-suicide-ideating sample (N=64). Hierarchical multiple regression analyses were used to test the unique contributions of stress, problem-solving orientation, problem-solving skills, and perceived level of social support in predicting level of suicidality. Hierarchical regression analyses were also used to test the interactive contributions of problem-solving × stress and social support × stress in predicting level of suicidality. Regression models were generated separately for men, women, and the entire sample using all factors. The results clearly support the importance of social support as an independent predictor of suicidality for men, women, and the entire sample. Ability to generate alternatives to identified problems predicted suicidality, but only for women and the entire sample. Problem-solving orientation was not uniquely predictive of suicidality and may affect suicidal behavior via its relationship to depression.     

Ethical principles and cultural integrity in health care delivery: Asian ethnocultural perspectives in genetic services

The tradition of Western thought is not always ubiquitous when working within the context of different ethnocultural populations, particularly that of Asian culture, and often poses ethical quandaries for health care professionals engaged in genetic services. For example, understanding the Asian ethnocultural perspective of patient autonomy, informed consent, and nondirective counseling from the Western perspective may be inappropriate and compromise cultural integrity and the delivery of effective genetic services because: (1) A distinction exists between the role of Asian (collective) autonomy vs. Western (individual) autonomy in the decision-making process. (2) The medical model is complementary to Asian expectations and respect of authority and may result in an uninformed consent to genetic professional's recommendations. (3) Misinterpretations of the normative decision-making process, misconceptions of normalcy, and the limits of tolerance of nondirective counseling may result in less effective treatment and compliance. Therefore, we suggest that acknowledging the impact of ethnicity and culture on ethical principles as applied in genetic services is essential in the assessment and delivery of ethically and culturally appropriate health care.     

The challenge of “Healthy People 2000”

The federal Office of Disease Prevention and Health Promotion (U.S. Public Health Service) has again prepared a compilation of goals and objectives for the health of the Nation's people, applicable to anticipated achievements within the decade ending in the year 2000. This effort involved work groups from numerous federal agencies, testimony in regional hearings from 800 citizens, and enrollment of a consortium of 300 national organizations. The final product, Healthy People 2000, was released in September 1990, and contains 298 measurable objectives. Content regarding children, genetic disorders, developmental disabilities, and disabilities in general is less featured and less specific than was hoped for. Ten objectives of relatively direct concern to geneticists are discussed, plus 23 others of interest in the maternal and child health field. On balance, it is suggested that the Healthy People 2000 objectives can be useful and stimulating for workers in genetics, child health care, and disabilities' services. Regrettably, there was no simultaneous proposal of legislation that would provide new federal programs, funding, or assistance to states.     

Diffuse Lewy Body Disease: Clinical,Pathological, and Neuropsychological Review

The pathophysiological etiologies and clinical presentations of neurodegenerative dementias have been found to be complex and heterogeneous. Recently, Lewy body inclusions have been identified as an etiological factor in 20–34% of autopsied dementia cases. The term diffuse Lewy body disease (DLBD) is generally accepted as the diagnostic term representative of this currently under-reported and under-recognized disease. This article reviews the literature on the clinical, pathological, and neuropsychological features of this disorder. Differential diagnostic issues are discussed as well as current pharmacological treatment. Nine confirmed cases of DLBD are presented to demonstrate the various features of this disorder. The diagnostic implications of neuropsychological examination results are discussed in relation to other common dementing neurologic diseases.     

Understanding Chest Pain: What Every Psychologist Should Know

Chest pain is one of the most frequent presenting complaints in Emergency Rooms and other medical settings. A considerable number of these patients do not have significant coronary artery disease. This led to plausible alternative explanations for these presenting symptoms and these patients tend to have unremarkable cardiac outcomes. Nevertheless, many studies have also documented that symptoms and related disability persist in the face of reassurances about benign cardiac status. Given the implied threat of chest pain (e.g., myocardial infarction) and the presence of chest pain symptoms in other noncardiac conditions (including anxiety and panic), it is not surprising that many of these patients present with considerable emotional distress. Consequently, chest pain symptoms represent diagnostic and treatment dilemmas for physicians and psychologists alike. The extent to which cardiac and noncardiac factors contribute to all forms of chest pain remains unknown. The function of this review is to provide mental health professionals with a primer on relevant clinical issues in chronic chest pain. We examine several common medical and psychiatric causes of chronic chest pain and selectively review (1) the relevant medical and psychiatric diagnostic and treatment considerations for chest pain and (2) the hypothetical biobehavioral mechanisms relevant to psychological intervention, (3) while expanding on existing conceptual models for understanding chest pain, and (4) offering some suggestions for future research.     

The Concept of Abnormality in Medical Genetics

This paper explores usage of the concept ofabnormality in medical genetics and proposesdirectives for more careful usage of this concept.The conceptual difficulties are first explored, thena model is developed to assess actual usage, followedby analysis of a sample of genetic textbooks andgenetics literature. It appears that fact andvaluation are often intermingled, that referencestandards used to define 'genetic abnormalities' areoften not clear and that the concept of abnormality isoften used independent of the degree of certainty withwhich the altered genetype develops into a (seriously)harmful phenotype. On the basis of these findings itis argued that more restraint and more careful use ofthe concept of genetic abnormality of medical geneticsis appropriate as well as more agreement on the use ofreference standards.     

Nosology and Causal Necessity; The Relation BetweenDefining a Disease and Discovering its Necessary Cause

The problem of disease definition is related to theproblem of proving that a certain agent is thenecessary cause of a certain disease. Natural kindterms like rheumatoid arthritis and AIDS refer toessences which are discoverable rather thanpredeterminate. No statement about such diseases isa priori necessarily true. Because theories onnecessary causes involve natural kind semantics,Koch's postulates cannot be used to falsify or verifysuch theories. Instead of proving that agent A is thenecessary cause of disease D, we include A in atheoretical definition of D, take this to representthe real meaning of D, and discard thepretheoretical definition. This is illustrated byKoch's own attempt to prove he had discovered thenecessary cause of tuberculosis. Methodologicalarguments about disease causation require a clear viewof our use of diagnostic terms. Medical lexicographersshould do more to provide such a view.     

Logic or rhetoric in law?

One of the most crucial questions in the philosophy of law deals with the very nature of legal reasoning. Does this reasoning belong to logic or to rhetoric? This debate, increasingly centered on rhetoric, is not merely a question of language use; it covers and indicates a more basic choice between formal legalism — focusing on rational deduction from the law — and pragmatic judiciarism — focusing on reasonable debate in the court. Today, it is necessary to circumscribe the respective fields of logic and rhetoric in the language of law, while showing how they are sometimes complementary in the resolution of legal problems. But, even when we have acknowledged the need for a rhetoric accompanied by logic, we have to define that rhetoric cautiously. I confront a narrow rhetoric, often called argumentation, with a wider one of interrogative nature. There are two conceptions of rationality at stake. Their comparison enables us to raise the question of the foundation of law, as a locus to use arguments, as well as to solve social problems.     

Neuropsychological findings and depressive symptoms in patients with Huntington''s disease

Twenty patients with Huntington's disease (HD) and a comparison group were studied by a depression scale (MADRS) and a neuropsychological test-battery assessing central areas of cognitive function. The main purpose was to analyze the consistency of findings across patients and focus on the role of specific factors in the impairments. The HD-patients are impaired relative to norms and the comparison-group in all areas but verbal conceptual function. We further divided the HD-patients into subgroups according to severity of neuropsychological impairment. The groups generally show a pattern of increasing deficits. Early changes are found in tests of cognitive efficiency, memory and sensomotor function, but the pattern of impairment is variable. The more severely affected subgroups show an increased decline in performance and progressive involvement of a broader range of functions. The pattern of depressive symptoms in HD-patients indicates that cognitive symptoms of concentration difficulties and lassitude are prominent in all subgroups.     

A note on keats' generalization of the rasch model

An alternative derivation is given for a simple test model which incorporates anability parameter for the subject anddifficulty level andguessing parameters for the problem. The probability of a correct response to the problem is a projective transformation of the problem difficulty. The ability and difficulty parameters separate into additive components.