Stephen W. Hurt

Suicidal children grow up : rates and psychosocial risk factors for suicide attempts during follow-up

OBJECTIVE Rates and psychosocial risk factors for suicide attempts during a 6 to 8-year follow-up period were compared for 25 predominantly prepubertal inpatient suicide attempters, 28 inpatient suicidal ideators, 16 nonsuicidal inpatients, and 64 nonpatients. METHOD Standard research instruments were used to interview subjects and parents. Cox proportional hazard regression analyses were used to identify risk factors for a suicide attempt in the follow-up. RESULTS No deaths occurred during follow-up. Suicide attempters were six times and suicidal ideators were three times more likely than were nonpatients to attempt suicide during follow-up. Poor social adjustment and mood disorder close to a recurrent suicide attempt were the strongest risk factors. CONCLUSIONS Risk assessment should focus on identifying symptoms of mood disorders and impaired social adjustment in children with histories of suicide attempts and psychiatric hospitalization.

Suicidal Children Grow Up: Demographic and Clinical Risk Factors for Adolescent Suicide Attempts

This longitudinal study reports rates and demographic and clinical risk factors for adolescent suicide attempts during a 6- to 8-year follow-up period of an initial sample of 106 preadolescent and young adolescent psychiatric inpatients and 101 preadolescent and young adolescent nonpatients. Survival analysis was used to evaluate risk for a first suicide attempt in the follow-up period for 133 subjects who were interviewed. No deaths occurred. Suicidal inpatients, compared with nonpatients, had earlier first suicide attempts in the follow-up period. Adolescents who attempted suicide in the follow-up period were seven times more likely to have a mood disorder during the follow-up period than those who did not attempt suicide. Implications for clinical practice and research are discussed.

Discontinuing or Switching Selective Serotonin-Reuptake Inhibitors

OBJECTIVE: To describe reasons for discontinuing or switching selective serotonin-reuptake inhibitors (SSRIs) at 3 and 6 months after starting treatment, and to identify information provided to patients that may help prevent premature discontinuation of medication. METHODS: Telephone surveys were conducted at 3 and 6 months after patients (n = 672) were started on an SSRI for a new or recurrent case of depression. RESULTS: Significantly more patients discontinued or switched their SSRI because of an adverse effect within the first 3 months of starting (43%) compared with the second 3 months (27%; p = 0.023). The adverse effect most frequently reported as the reason for early discontinuation or switching was drowsiness/fatigue (10.2%), followed by anxiety, headache, and nausea — All at just over 5%. The odds ratio for discontinuation was 61% less in patients who recalled being told to take the medication for at least 6 months compared with those who did not (OR 0.39; p < 0.001). Patients who recalled being informed of potential adverse effects increased their reported incidence of mild to moderate adverse effects by 55% (OR 1.55; p < 0.05) without affecting rates of premature discontinuation (OR 1.06; p = 0.77). CONCLUSIONS: Adverse effects are the most frequent reason for discontinuing or switching SSRIs within the first 3 months of treatment. Patients are more likely to continue taking their antidepressant if they fully understand how long to take the medication. Informing patients of potential adverse effects does not appear to prevent premature discontinuation, but may increase the patients awareness and reporting of mild to moderate adverse effects.

The Tridimensional Personality Questionnaire : An exploration of personality traits in eating disorders

The Tridimensional Personality Questionnaire (TPQ) was tested in four subgroups of eating-disorder patients: anorectic-restrictors (AN-R), anorectic-bulimics (AN-B), normal weight bulimics (BN), and bulimics with a past history of anorexia (B-AN). Normal controls and patients were matched for gender and age. All subjects completed the Beck Depression Inventory (BDI) in addition to the TPQ. AN-Rs scored lower on the Novelty Seeking scale than the bulimic groups and controls, and the two normal weight bulimic groups had higher Novelty Seeking scores than the controls. On the Harm Avoidance scale, all eating disorder groups scored significantly higher than the control group. In addition, the AN-Rs scored lower than the AN-Bs and B-ANs. The Harm Avoidance scale and depression scores were positively correlated while the Reward Dependence scale and depression scores were negatively correlated. Differences between diagnostic groups on the Novelty Seeking and Persistence scales remained clearly significant when depression was partialled out. These results are discussed in terms of the Tridimensional Personality Questionnaire as a stable measure of traits with eating disorder subjects.

Behavior and the Menstrual Cycle

Because of the existence of multiple individual and environmental factors influencing a persons behavior, no one study can provide a complete analysis of the complex relationships that exist between behavior and the menstrual cycle. In studying that we must focus on influences on the individual arising from biological, psychological, and sociocultural factors. All three have the capacity to modify an individual womans responses, and some factors may be more important than others in accounting for any one womans behavioral changes. Thus dramatic biological changes, perhaps in nerve-cell receptor response to changing hormone levels, may be of such importance in the case of one individual that personality and sociocultural features may be relatively inconsequential. Alternatively, constellations of psychopathological syndromes may be primarily responsible for magnifying the effects of normal variations in hormone levels or receptor sensitivities. In this review, we will focus on selected research studies that have attempted to explore the relationship between behavior and the menstrual cycle. Our purpose is to give an overview of the spectrum of information available. Further resource material will be noted throughout the text for those readers with a particular interest in any of the topics discussed. In considering each study, we shall devote some attention to the kind of individuals studied, the techniques employed in

The ADAS-cog in Alzheimer's disease clinical trials: psychometric evaluation of the sum and its parts

Background The Alzheimers Disease Assessment Scale Cognitive Behavior Section (ADAS-cog), a measure of cognitive performance, has been used widely in Alzheimers disease trials. Its key role in clinical trials should be supported by evidence that it is both clinically meaningful and scientifically sound. Its conceptual and neuropsychological underpinnings are well-considered, but its performance as an instrument of measurement has received less attention. Objective To examine the traditional psychometric properties of the ADAS-cog in a large sample of people with Alzheimers disease. Methods Data from three clinical trials of donepezil (Aricept) in mild-to-moderate Alzheimers disease (n=1421; MMSE 10–26) were analysed at both the scale and component level. Five psychometric properties were examined using traditional psychometric methods. These methods of examination underpin upcoming Food and Drug Administration recommendations for patient rating scale evaluation. Results At the scale-level, criteria tested for data completeness, scaling assumptions (eg, component total correlations: 0.39–0.67), targeting (no floor or ceiling effects), reliability (eg, Cronbachs α: = 0.84; test-retest intraclass correlations: 0.93) and validity (correlation with MMSE: −0.63) were satisfied. At the component level, 7 of 11 ADAS-cog components had substantial ceiling effects (range 40–64%). Conclusions Performance was satisfactory at the scale level, but most ADAS-cog components were too easy for many patients in this sample and did not reflect the expected depth and range of cognitive performance. The clinical implication of this finding is that the ADAS-cogs estimate of cognitive ability, and its potential ability to detect differences in cognitive performance under treatment, could be improved. However, because of the limitations of traditional psychometric methods, further evaluations would be desirable using additional rating scale analysis techniques to pinpoint specific improvements.

The phenomena and characteristics of self-hypnosis

Abstract Self-hypnosis and hetero-hypnosis were compared, and selfhypnosis was studied longitudinally. Results indicated that absorption and the fading of the general reality orientation are characteristics of both hetero-hypnosis and self-hypnosis. The differentiating characteristics lie in the areas of attention and ego receptivity. Expansive, freefloating attention and ego receptivity to stimuli coming from within are state-specific for self-hypnosis, while concentrative attention and receptivity to stimuli coming from one outside source—the hypnotist on whom the subject concentrates his attention-are state-specific for laboratory defined hetero-hypnosis. Attempts to produce age regression and positive or negative hallucinations are markedly more successful in hetero-hypnosis. Imagery is much richer in self-hypnosis than in hetero-hypnosis. Self-hypnosis requires adaptation to the state: in the beginning of self-hypnosis there is a good deal of anxiety and self-doubt. As the subject feels more comforta...

Suicidal Children Grow Up: Suicidal Episodes and Effects of Treatment during Follow-up

OBJECTIVES This paper describes risk for first recurrent suicidal episodes in follow-up of suicidal child psychiatric inpatients. It identifies relations between suicide attempts in follow-up and psychosocial and psychopharmacological treatments. METHODS First suicidal episodes involving either suicidal ideation or a suicide attempt in a 6 to 8 year follow-up period were rated for 69 child psychiatric inpatients and 64 children selected from the community. Psychiatric treatments were determined from reports from multiple sources. RESULTS Forty-five percent of 133 subjects reported a suicidal episode during follow-up. Children who reported suicidal ideation or a suicide attempt were greater than twice as likely to report a suicidal episode in follow-up than were children from the community. Children treated with antidepressants in follow-up were more likely to attempt suicide than were those not treated with antidepressants. CONCLUSIONS Close follow-up of suicidal children is warranted to identity risk and to intervene to prevent suicidal episodes. Lack of efficacy of naturalistic treatments implies that controlled treatment studies are needed to determine effective intervention for suicidal children.

DSM-III and affective pathology in hospitalized adolescents.

Charts of 76 adolescents, who had been recently discharged from a psychiatric hospital, were reviewed by a research team for evidence of DSM-III axis I and axis II disorders. Research diagnoses were assigned to patients on the basis of documented symptomatology and irrespective of the discharge diagnosis of the clinical staff. Forty-five patients met criteria for an affective disorder. Of these, 15 were diagnosed major depression and 24 dysthymia or atypical depression (i.e., dysthymia of briefer duration than 1 year). Two patients were manic, one was bipolar depressed, one was schizoaffective, and two were atypical depressed with psychotic features. No patient with dysthymia had a past history of major depression as the earliest manifestation of psychiatric disorder. Four patients with major depression, however, had past histories of dysthymia as the earliest manifestation of psychiatric disorder. Forty per cent of patients with major depression had parents with depression. Excepting one schizophrenic, every patient who had ever attempted suicide met criteria for a depressive disorder. Twelve patients fulfilled DSM-III criteria for borderline personality disorder (BPD). Each of these patients manifested a concurrent axis I depressive disorder, and each had a history of attempted suicide. Patients with major depression co-existing with BPD had histories of more frequent and more lethal attempts than other patients. Most depressed borderline patients were female. Sex differences were not found in prevalence of affective disorder occurring alone without the co-existence of BPD. Of the 12 patients with depression plus BPD, all those patients (N = 5) with major depression and BPD had at least one parent who had been treated for depression. In each of these five cases, axis I affective disorder occurred earlier in development than did axis II BPD. Our findings indicate that depression may have an earlier onset in the life cycle than generally appreciated. Dysthymia may in itself be a serious disorder during adolescence and may progress to major depression. The co-existence of a depressive disorder with BPD would appear to be of particular clinical significance during adolescence. More specifically, it appears that adolescents who manifest major depression and BPD actually suffer from a particularly severe variant of affective disorder.

The effects of depression and treatment on the tridimensional personality questionnaire

Given the success of the Tridimensional Personality Questionnaire (TPQ) in delineating personality characteristics of eating disorder patients, the present investigation was designed to evaluate the stability of TPQ scores. This was done by examining the effects of depression on TPQ scores before and after treatment in eating disorder patients and normal controls