John A. Chiles

Interpersonal problem solving and parasuicide

This study examined the relationship between interpersonal problem solving and suicidal behavior among psychiatric patients. Subjects were 123 psychiatric inpatients, admitted for current parasuicide, serious suicide ideation, or non-suicide-related complaints. A group of 16 orthopedic surgery patients was included to control for hospitalization trauma and current stress. All subjects completed a revised version of the Means-End Problem Solving Procedure, the Rathus Assertiveness Schedule, and a suicide expectancy measure. Psychiatric patients scored lower than the medical control group on the assertive schedule, but no differences were noted as a function of suicidal behavior status. Psychiatric patients expected suicide to solve problems more than did controls. Suicidal patients had higher expectancies than did nonsuicidal patients. Active interpersonal problem solving did not distinguish suicidal and nonsuicidal psychiatric patients but did separate parasuicides from suicide ideators. Among patients without a parasuicide history, less active and greater passive problem solving discriminated first-time parasuicides from suicide ideators and nonsuicidals. Results suggest that assertion deficits may characterize the psychiatric population in general, but suicidal behavior within psychiatric patients may be related to lower active problem solving.

Brief Psychiatric Rating Scale Expanded Version: How do new items affect factor structure?

Our goal was to suggest a factor structure for the Brief Psychiatric Rating Scale Expanded Version (BPRS-E) based upon a large and diverse sample and to determine which of the new items improved the factors derived from the 18-item version of the scale that have been used in clinical research for decades. We investigated the consistency of our proposed model over time and across demographic groups. As part of the Texas Medication Algorithm Project, the BPRS-E was administered to a total of 1440 psychiatric outpatients in three different diagnostic groups on multiple occasions. The sample was randomly split so that exploratory factor analysis could be done with the first half, and the model could be confirmed on the second half. A four-factor structure including factors assessing depression/anxiety, psychosis, negative symptoms, and activation was found. For each factor, we specify items in the expanded version that added to the breadth of the commonly used clinical factors while improving or maintaining goodness of fit and reliability. The final model proposed was consistent over time and across diagnosis, phase of illness, age, gender, ethnicity, and level of education. The BPRS-E has a stable four-factor structure, making it useful as a clinical outcome measure.

Prediction of suicide intent in hospitalized parasuicides: reasons for living, hopelessness, and depression.

This study examined the risk prediction efficiency of the Reasons for Living Inventory Survival and Coping Beliefs Scale, Beck Hopelessness Scale, Beck Depression Inventory, and the Life Experiences Survey with a sample of 51 newly hospitalized parasuicides. The index of suicidal potential chosen for this study was suicide intent as measured by Becks Suicide Intent Scale. Regression analyses indicated that the Survival and Coping Beliefs Scale emerged as the single most important predictor of suicide intent. Hopelessness and depression made secondary and nonsignificant contributions. Hopelessness was a significant predictor of suicide intent when analyzed apart from Survival and Coping Beliefs, but not among a subsample of 43 repeat parasuicides. Classification analyses showed that neither hopelessness nor survival and coping beliefs were accurate at classifying low- or high-intent parasuicides. Factors contributing to the efficacy of survival and coping beliefs as a risk prediction index are discussed, as is the false-negative dilemma in suicide risk assessment and prediction.

ECT in medication resistant schizoaffective disorder.

Abstract For the clinician, schizoaffective patients are a formidable challenge. They are usually the most disturbed, agitated, and difficult to control on the ward. Because they are often young, retain affect (though it may be bizarre) and may have functioned relatively well between episodes and/or prior to hospitalization, ECT is often considered a last resort or may not be given at all. This is unfortunate given the excellent response to ECT and Tsuangs 3 finding that schizoaffective patients not treated with ECT had higher suicide and mortality rates compared with those who had received ECT. The present study and review concludes that: (1) ECT is a very effective acute treatment in schizoaffective disorder; (2) whether called schizoaffective or affective disorder with psychosis there appears to be a subgroup of young patients with prominent confusion and lack of response to medications for whom ECT is particularly effective; (3) lithium should be considered as a prophylactic treatment with these patients; and (4) patients with schizoaffective disorder (as described) should be considered as a separate group in future ECT and/or lithium treatment response studies.

Family history as a diagnostic aid in two samples of adolescents.

Psychiatric diagnostic patterns were examined in two different samples of adolescents, one a group of psychiatric inpatients and the second youth apprehended by the law for alcohol-related difficulties. Affective disorder in parents was most closely correlated with a similar patient diagnosis or constellation of depressive-type symptoms in both samples of youth. Parental antisocial personalities, alcohol abuse, or drug problems correlated most closely with high levels of similar difficulties in individuals in the two studied groups. However, antisocial, alcohol, or drug problems of a mild degree were present in all subgroups of the two samples, perhaps representing a nonspecific reaction to parental illness or the occurrence of a broken home. A follow-up of future problems in both samples will be carried out to determine the importance of the family history and clinical picture in predicting the future course of problems.

Hyperactivity: Diagnostic Confusion.

Histories of hyperactive symptoms were evaluated for two samples of young men and women under treatment for drug or psychiatric disorders. More than one in five had shown hyperactivity but almost all of these developed pictures of other psychiatric problems, frequently the antisocial personality, by late adolescence. This picture is felt to reflect inaccurate use of hyperactive labels in difficult-to-handle children. The potential consequences of these practices are discussed.

Modeling effects on suicidal behavior.

Knowledge of suicidal behavior, i.e., psychiatric patients indicating that they have an acquaintance or relative who has attempted or committed suicide, has been cited as a risk factor in the assessment of suicide potential. The authors evaluated psychiatric patients hospitalized for a suicide attempt (N = 30), serious suicidal ideation (N = 26), or other non-suicide-related reasons (N = 20) and also a control group of 18 patients admitted for orthopaedic surgery. Information derived from a structured clinical interview revealed that suicide attempters have fewer suicidal models than individuals in the other patient groups, and they are more interpersonally distant from the models they do know. Depression level was not positively related to the recall and reporting of suicidal models. Measures assessing suicide-related beliefs revealed that suicide attempters rated suicide as an effective solution for problems to a greater extent that did patients in the remaining three groups. The implications of these results for social learning models of suicidal behavior are discussed.

Who smokes? Why?: Psychiatric aspects of continued cigarette usage among lawyers in Washington State

Eight-hundred two lawyers, a random sample of the Washington State Bar, were surveyed to determine the prevalence of medical and psychological distress. Approximately 15% of this group reported current cigarette use. Greater levels of dysphoric symptoms and greater misuse of alcohol differentiated male smokers from male nonsmokers, whereas no differences were found for females. The implications of these findings for pharmacologic and counseling strategies to further promote smoking cessation are discussed.

Single case study. Pseudodementia and mania.

This case report extends the discussion of pseudodementia into the area of manic behavior. An elderly patient whose manic symptoms are considered to be an early sign of an organic brain syndrome should be given timely repeat evaluations before this diagnosis is allowed to guide treatment. Our case presentation emphasized the paucity of the data base we have to diagnose cognitive and emotional disturbances of the elderly. It is difficult to identify the essential features of cognitive dysfunction associated with primary neuronal degeneration especially in the early stages of the disease. A careful differential diagnostic evaluation is important to eliminate variables such as affective disorders and underlying physical conditions as causes of confusion and cognitive dysfunction in the elderly patient.