Maria I. Zapata-Vega

The safe treatment of the suicidal patient in an adult inpatient setting: a proactive preventive approach

This paper focuses on the work of an inpatient service in an acute care safety net hospital in the prevention of suicide on its inpatient service and during the high-risk period post discharge. The strategy utilized a comprehensive proactive systems approach to the suicidal patient including: a formalized suicide assessment jointly done by medical and nursing staff, accurate diagnosis and best practice treatment, a flexible nursing observation policy, groups on inpatient units focused on suicide and key risk factors and triggers, and a communication tool to the next level of care that describes the strategies learned by the patient to deal with his or her suicidality. Incidents of self-injurious behaviors and special observation hours were monitored.

The Multicultural Quality of Life Index: presentation and validation

RATIONALE AND OBJECTIVES Quality of life has emerged as a crucial concept for the assessment of health and the planning of health care. Desirable features for the evaluation of quality of life include comprehensiveness, self-ratedness, cultural sensitivity, practicality and psychometric soundness. An attempt to meet these challenges led to the development of a brief multicultural quality of life instrument and to the appraisal of its applicability, reliability and validity. METHODS The development of the proposed assessment instrument was based on a wide review of the literature and the engagement of a multicultural mental health scholarly team. Its validation was conducted on samples of psychiatric patients (n = 124) and hospital professionals (n = 53) in New York City. RESULTS A new generic culture-informed and self-rate instrument, the Multicultural Quality of Life Index, has been developed. Its 10 items cover key aspects of the concept, from physical well-being to spiritual fulfilment. Concerning its applicability, mean time for completion was less than 3 minutes and 96% of raters found it easy to use. Test-retest reliability was high (r = 0.87). A Cronbachs α of 0.92 documented its internal consistency and a factor analysis revealed a strong structure. With regard to discriminant validity, a highly significant difference was found between the mean total scores of professionals (x = 8.41) and patients (x = 6.34) presumed to have different levels of quality of life. CONCLUSIONS The Multicultural Quality of Life Index is a brief and culturally informed instrument that appears to be easy to complete, reliable, internally consistent and valid.

Dopamine agonist-induced impulse control disorders in a patient with prolactinoma.

Impulse control disorders (ICDs) involve a set of psychiatric symptoms and disorders (including pathological gambling, compulsive shopping, compulsive eating, and hypersexuality) that have been considered as side effects of dopamine agonist medications. ICDs have been commonly associated with the treatment of Parkinson’s disease. ICDs have also been reported in dopaminergic treatment of other disorders, such as restless leg syndrome, fibromyalgia, multiple system atrophy, and progressive supranuclear palsy. Dopamine agonists are also used to treat prolactinomas in patients with symptomatic prolactin-secreting microor macroadenomas. In these conditions their primary goals are to lower prolactin levels, decrease tumor size, and restore gonadal function. The most commonly used dopamine agonists for the treatment of prolactinomas are bromocriptine and cabergoline. Cabergoline is preferred because of its greater efficacy and higher frequency of pituitary tumor shrinkage. Less commonly used alternatives include quinagolide and pergolide. In 2007, pergolide was withdrawn from the US market after several published studies revealed an increased rate of valvular dysfunction. The goal of this report is to identify potential behavioral manifestations of patients treated with dopamine agonists.

Using a Brief 10–Item Generic Measure of Quality of Life in English and Spanish Speaking Diabetic Patients

Objectives: Validation of the Multicultural Quality of Life Index (MQLI), a 10-item self-rated generic multilingual quality of life (QOL) measure in ethnically-diverse diabetic patients. Methods: Diabetic adult patients (n = 180) in New York City completed the MQLI, English or Spanish version. Its internal consistency, factorial structure, and construct validity were analyzed. Depression screening (PHQ-9) scores were used to divide subjects into two sub-samples with presumed different QOL levels. Results: A Cronbachs alpha of 0.92 demonstrated its internal consistency (English-version = 0.90, Spanish-version = 0.94). A one-single factor structure was documented (all items loadings > 0.64), accounting for 59% of the items variance in the total sample; similar results were found for each language version. Correlation of the MQLI and PHQ-9 scores yielded an r = −0.58. Mild negative correlations with self-disclosed diagnosis of depression or other mental disorders, diabetes duration, and abnormal sensation on foot exam were found, but were non-significant with other diabetes aspects (e.g., HbA1c, retinopathy). A significant difference (p < 0.001) between the scores of two subsamples with presumed different levels of QOL (means = 8.02 vs. 5.84) was found. Conclusions: The MQLI demonstrated coherence around the QOL concept. It correlated significantly with mental health (particularly depression), duration of diabetes, and possible neuropathy, but not with some diabetes-related factors. Its use in diabetic care settings is recommended, possibly supplemented by QOL diabetic-specific instruments.