Eleanor Liu

Assessment and Emergency Management of Suicidality in Personality Disorders

This article examines the association between suicidal behavior and personality disorders. It updates the review of epidemiological evidence for the association between suicidal behavior and suicide in individuals who have a personality disorder diagnosis, particularly in borderline personality disorder (BPD). The second part of the article presents new empirical evidence that characterizes suicidal behavior in patients who have BPD, specifically examining patient characteristics that differentiate patients who have BPD with a history of high versus low lethality suicide attempts. Finally, the article discusses the approach to a patient who has BPD and presents to the emergency department because of an increased risk of suicide.

Family Medicine Residents' Performance with Detected Versus Undetected Simulated Patients Posing as Problem Drinkers

Abstract: Background: Simulated patients are commonly used to evaluate medical trainees. Unannounced simulated patients provide an accurate measure of physician performance. Purpose: To determine the effects of detection of SPs on physician performance, and identify factors leading to detection. Methods: Fixty-six family medicine residents were each visited by two unannounced simulated patients presenting with alcohol-induced hypertension or insomnia. Residents were then surveyed on their detection of SPs. Results: SPs were detected on 45 out of 104 visits. Inner city clinics had higher detection rates than middle class clinics. Residents’ checklist and global rating scores were substantially higher on detected than undetected visits, for both between-subject and within-subject comparisons. The most common reasons for detection concerned SP demographics and behaviour; the SP “did not act like a drinker” and was of a different social class than the typical clinic patient. Conclusions: Multi-clinic studies involving residents experienced with SPs should ensure that the SP role and behavior conform to physician expectations and the demographics of the clinic. SP station testing does not accurately reflect physicians’ actual clinical behavior and should not be relied on as the primary method of evaluation. The study also suggests that physicians’ poor performance in identifying and managing alcohol problems is not entirely due to lack of skill, as they demonstrated greater clinical skills when they became aware that they were being evaluated. Physicians’ clinical priorities, sense of responsibility and other attitudinal determinants of their behavior should be addressed when training physicians on the management of alcohol problems.

Interpersonal Group Psychotherapy for Comorbid Alcohol Dependence and Non-Psychotic Psychiatric Disorders

Alcohol-dependent patients (N = 15) with comorbid non-psychotic psychiatric disorders were treated with Modified Interpersonal Group Therapy (MIGT) for eight weeks, 16 sessions, in a pilot intervention trial. Analysis of the group participants demonstrated that they achieved statistically significant improvements at post-treatment in four of five self-report outcome measures: number of drinking days, number of heavy drinking days, the Brief Symptom Inventory, and the Beck Depression Inventory. Furthermore, the improvements in heavy drinking days and the Brief Symptom Inventory were maintained at two and eight months post-treatment. This study yields preliminary evidence in support of MIGT as a useful treatment approach for an alcohol-dependent population with psychiatric comorbidity.

Centre for Addiction and Mental Health Inventory of Gambling Situations: Evaluation of the Factor Structure, Reliability, and External Correlations

The development and evaluation of the Centre for Addiction and Mental Health Inventory of Gambling Situations (CAMH-IGS) is described. The CAMH-IGS is based on a cognitive-behavioural approach to addiction that sees excessive gambling as a pattern of behaviour which is learned, and which can be changed. The CAMH-IGS is designed to determine the patterns of behaviour, thoughts or feelings which may trigger problematic gambling, with the goal of developing tailored treatment and relapse-prevention approaches for clients. The information can be used in treatment planning. A sample of 524 gamblers that included 323 problem and probable pathological gamblers was used to evaluate the factor structure, reliability, and external correlations of the CAMH-IGS. The results show that the CAMH-IGS consists of 10 internally reliable subscales that can identify individual differences between clients.

Faculty Rating of Learning Objectives for an Undergraduate Medical Curriculum in Substance Abuse

The purpose of this study is to describe medical facultys ratings of learning objectives related to substance abuse. A comprehensive set of learning objectives was drafted. The Associate Dean at each of Ontarios five medical schools was asked to select two faculty members from each clinical discipline who were involved in undergraduate medical education. The selected faculty were sent a survey asking them to rate 282 objectives according to their importance for undergraduate education in their discipline, using a 5-point scale. Sixty-eight out of 90 surveys were returned. For statistical analysis, disciplines were placed into two groups, Group 1 (internal medicine, surgery, emergency medicine, and anesthesia) and Group 2 (family medicine, psychiatry, and pediatrics). The mean ratings of Group 1 were significantly higher than Group 2 (p < 0.001) for five sets of objectives: attitudes, epidemiology, screening and assessment, nonmedical interventions, and specific populations (women, the elderly, and adolescents). Group 1 gave mean ratings above 4 to all themes except epidemiology, inpatient care, and medical complications. In contrast, Group 2 gave mean ratings above 4 to only three themes: physician substance abuse problems, withdrawal, and medical complications. The marked differences in learning objectives between disciplines suggest that a discipline-specific approach is needed for curricular development in substance abuse.

What Does a Random Line Look Like: An Experimental Study

The study examined the perception of random lines by people with gambling problems compared to people without gambling problems. The sample consisted of 67 probable pathological gamblers and 46 people without gambling problems. Participants completed a number of questionnaires about their gambling and were then presented with a series of random and non-random lines. The participants rated lines as random if the pattern stayed near zero (the middle of the screen) and did not form anything that resembled waves. The probable pathological gamblers rated 2 of the patterns (jumps, and multi-wave) as significantly less random than non-problem gamblers. They also rated random lines significantly less random than the non-problem gamblers. That is, they seem to be able to find patterns both when they are really there and when they only appear to be there as in the case of random drift.