Recognizing suicide risk in a pediatric emergency department: a change in nursing care.
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Adolescent↗
Biomedical subjects
L M Horowitz
Publications and source records attributed to L M Horowitz.
Detecting suicide risk in a pediatric emergency department: development of a brief screening tool.
OBJECTIVE: To develop a brief screening tool that will allow emergency department (ED) staff to rapidly and accurately detect suicide risk in child and adolescent patients. DESIGN: Cross-sectional survey. Participants. One hundred forty-four children and adolescents, mean age of 13.6 years, presenting to an urban university teaching hospital pediatric ED for primarily psychiatric reasons. Data Collection. As part of a quality improvement initiative, we developed a 14-item screening survey (the Risk of Suicide Questionnaire [RSQ]) that was administered by a triage nurse to all pediatric mental health patients on admission to the ED. All patients were subsequently administered the 30-item Suicide Ideation Questionnaire (SIQ) by a mental health clinician, which served as the criterion standard assessment of suicidality. Other information collected included demographic and clinical characteristics. MAIN OUTCOME MEASURES: Sensitivity, specificity, positive predictive value, negative predictive value (NPV), and area under the receiver operating characteristic curve for responses to individual and combinations of RSQ items, relative to determinations of suicidality by the criterion standard SIQ. RESULTS: Four of the items from the RSQ had a predictive c statistic of 0.87, a sensitivity of 0.98, and a NPV of 0.97. Little improvement in predictive ability was obtained by including other RSQ items (c statistic for the most predictive 4-item model = 0.87; c statistic for the model containing all 14 items = 0.90). Among all possible combinations of 4 RSQ items, the combination of items inquiring about current suicidal behavior, past suicidal ideation, past self-destructive behavior, and current stressors yielded the highest sensitivity (0.98), NPV (0.97), and c statistic (0.87), as assessed by the criterion standard SIQ. CONCLUSIONS: A brief 4-item screening tool can be used by nonmental health clinicians to accurately detect suicidality in children and adolescents who visit an ED. Early and accurate identification of suicidality is a critical first step that could lead to better treatment and improved health outcomes for children and adolescents with mental health concerns.
Adolescent↗
[Validation of the Inventory for Interpersonal Problems (IIP). Results of a representative study in East and West Germany].
The Inventory of Interpersonal Problems (IIP) was developed in the USA in the late 1970s and in the mean time has become a well-established instrument applied in numerous clinical studies in German speaking countries under the name "Inventar zur Erfassung interpersonaler Probleme". The test manual was published in German in 1994, but without the corresponding standardisation for a German-speaking population. The present study fills this gap. In a representative study the IIP was completed by 2025 West Germans and 1022 East Germans aged 14-92 years. The representative norms are given and the psychometric dimensions of the questionnaire adjusted for this sample. As a contribution to testing validity the results were also related to the scores of a number of other tests completed by the same sample (Giessen Test--GT; Giessener Beschwerdebogen--GBB; Fragebogen zur Lebenszufriedenheit--FLZ; Angstbewältigungsinventar--ABI and the Fragebogen zum erinnerten elterlichen Erziehungsverhalten [FEE]). The relevant results will be reported.
Adolescent↗
Patterns of interpersonal problems associated with binge eating disorder.
OBJECTIVE: To determine if interpersonal problems reported by individuals with binge eating disorder (BED) are distinct from psychiatric norms, and whether specific types of interpersonal problems are predictive of BED treatment outcome. METHOD: Subjects were 88 females with BED who completed a treatment trial for binge eating and weight loss. Pretreatment data on the Inventory of Interpersonal Problems (IIP) was compared (1) to that of psychiatric and nonpsychiatric norms and (2) for individuals with good versus poor outcome for eating disorder symptoms and weight loss. RESULTS: BED patients reported less distress for problems with being too vindictive (hostile dominance) than psychiatric norms. Patients with good eating disorder outcome reported less distress for problems with social avoidance; patients with good weight loss outcome reported greater distress over problems with vindictiveness. DISCUSSION: BED treatment may be enhanced by an initial focus on specific interpersonal difficulties.
Adult↗
The study of interpersonal problems: a Leary legacy.
The Inventory of Interpersonal Problems (IIP) is an instrument based on Leary's original theory that has been used to identify dysfunctional patterns in a person's interpersonal interactions. Interpersonal problems can be organized in 2 dimensions, and the 2-dimensional space can be divided into 8 equal sectors (octants). Subscales of the IIP describe problems in each of these octants. The instrument has been used to identify interpersonal problems that are discussed most often in a brief dynamic psychotherapy and problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. We have also examined people's attachment styles in adulthood (following a model proposed by Bowlby) and found that different attachment styles correspond to different types of interpersonal problems.
Adult↗
A priming methodology for studying self-representation in major depressive disorder.
The authors investigated processing of self-descriptive emotional information in depression using a modified Stroop color-naming task. Depressed (n = 58) and nondepressed control (n = 44) participants were required to name the color in which positive and negative adjectives, differing in the degree to which they described the person, were presented. These target adjectives were primed by emotional phrases that also varied according to degree of self-reference. Analyses indicated that depressed participants showed slower color-naming latencies for self-descriptive negative targets primed by self-descriptive negative phrases than for any other prime-target condition. No effect of prime-target relation was found for positive material with depressed participants, and nondepressed controls showed no effect of prime-target relation for material in either valence. These results support the hypothesis that negative information about the self is highly interconnected in the cognitive system of depressed patients.
Adolescent↗
Interpersonal problems, attachment styles, and outcome in brief dynamic psychotherapy.
The Inventory of Interpersonal Problems (IIP) has been used to identify dysfunctional patterns in interpersonal interactions. Interpersonal problems can be organized in two dimensions, and the two-dimensional space can be divided into eight equal sectors (octants). Subscales of the IIP describe each of these octants. The instrument has been used to identify (a) interpersonal problems that are discussed most often in a brief dynamic psychotherapy and (b) problems that are treated most easily. The results show that problems in the "exploitable" octant improve most frequently, whereas problems in the "dominating," "vindictive," and "cold" octants do not improve as readily. Attachment styles in adulthood were examined (following a model proposed by Bowlby), and different attachment styles were found to correspond to different types of interpersonal problems. Finally, these variables were related to the ability to describe other people clearly. The article also discusses implications for brief dynamic psychotherapy.
Adult↗
Schematic and situational determinants of depressed and nondepressed students' interpretation of feedback.
We examined whether depressed persons' social skill deficits contribute to their negative cognitions and whether this contribution is independent of their negative schemata. Depressed (n = 60) and nondepressed (n = 60) subjects engaged in group discussions. We assessed subjects' social competence schemata with a questionnaire and subjects' actual level of social competence in the discussion through objective ratings made by codiscussants and outside observers. We found that independently of their negative schemata, depressed subjects' social skill deficits explained a significant portion of the variance in their more negative interpretation of feedback (relative to nondepressed subjects'). This suggests that real deficits in depressed persons' performance compound the effects of their negative schemata and further contribute to their negative cognitions. We also further explored findings by Dykman et al. (1989) and Lewinsohn et al. (1980).
Cognition↗
Self-derogations and the interpersonal theory.
The interpersonal theory of personality has been applied to explain depressed people's dilemma: The depressed person's submissive behavior invites dominating reactions from other people, and those reactions sustain the depressed person's depression. Experiments 1 and 2 showed that self-derogations connote submissiveness but are generally judged to be neutral in affiliation. Experiment 3 tested implications for the behavior of dysphoric and nondysphoric Ss as they interacted with a self-derogating, other-derogating, or nonderogating confederate partner. Ss selected a topic from a list and talked about it for 1 min: the confederate's script was fixed. The S's judgments of the confederate, choice of topics, satisfaction with the interaction, and actual responses were analyzed. Self-derogators were judged to be submissive, elicited dominating reactions, and selected more topics with negative content.
Adult↗
Attachment styles among young adults: a test of a four-category model.
A new 4-group model of attachment styles in adulthood is proposed. Four prototypic attachment patterns are defined using combinations of a person's self-image (positive or negative) and image of others (positive or negative). In Study 1, an interview was developed to yield continuous and categorical ratings of the 4 attachment styles. Intercorrelations of the attachment ratings were consistent with the proposed model. Attachment ratings were validated by self-report measures of self-concept and interpersonal functioning. Each style was associated with a distinct profile of interpersonal problems, according to both self- and friend-reports. In Study 2, attachment styles within the family of origin and with peers were assessed independently. Results of Study 1 were replicated. The proposed model was shown to be applicable to representations of family relations; Ss' attachment styles with peers were correlated with family attachment ratings.
Adolescent↗
Satisfaction in interpersonal interactions as a function of similarity in level of dysphoria.
This study compared dysphoric and nondysphoric male and female undergraduates as they conversed with dysphoric or nondysphoric undergraduates of the same sex. Subjects rated their satisfaction with the conversation after each turn. The results showed that people in homogeneous dyads (i.e., both partners were dysphoric or both partners were nondysphoric) were more satisfied with the interaction, and their satisfaction increased as the conversation proceeded. People in mixed dyads were less satisfied, perceived each other as colder, and spoke about increasingly negative topics. Thus, in accord with other research showing that similarity leads to liking, the crucial determinant of interactional satisfaction was neither the mood of the subject nor the mood of the partner, but their similarity in mood.
Adaptation, Psychological↗
Psychodynamic formulation, consensual response method, and interpersonal problems.
We describe a new method for aggregating psychodynamic formulations of independent clinicians. 15 patients (10 female and 5 male, aged 23-41) were interviewed before they began brief dynamic psychotherapy. Different panels of 8 formulators (drawn from a pool of 72 psychodynamic clinicians with 10-38 years of clinical experience) observed each videotaped interview and wrote individual formulations. The text of each formulation was divided into thought-units, and thought-units that occurred 3 or more times were combined into a final consensual formulation. (One case was formulated twice to demonstrate the replicability of the method). Other clinical raters then read each consensual formulation and judged, for a list of interpersonal problems, whether each problem was apt to be distressing for that patient. The raters were very successful in predicting which problems were later discussed in treatment. Predictions were best for formulations with a high proportion of interpersonal content.
Adult↗
Inventory of interpersonal problems: psychometric properties and clinical applications.
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Adult↗
Poor social performance of lonely people: lacking a skill or adopting a role?
A substantial literature has shown that lonely people differ from nonlonely people on a variety of measures of social performance. These differences have usually been conceptualized as a social skills deficit, which implies that lonely people lack the ability to perform appropriate and effective social behavior. Rather than a lack of this ability, the authors hypothesize that the adoption of passive interpersonal roles predisposes lonely people to exhibit inadequate performance. In order to test this hypothesis, lonely and nonlonely subjects were assigned to one of two roles: They either listened (Condition Li) to an interaction partner describe a personal problem or they themselves described a personal problem (Condition Pr) to their partner. The subjects' interpersonal role produced a substantial effect on their social behavior. Subjects who listened to their partner describe a problem generated more solutions to a set of hypothetical situations, attended to their partners more adequately, and conversed longer than did subjects who described a personal problem. In contrast, lonely subjects did not differ from nonlonely subjects in their social performance within each particular role. Lonely and nonlonely subjects did differ, however, in their subjective evaluations of themselves and of their performance. These results illustrate the need for research to address both the interpersonal and the intrapersonal bases of social performance.
Adult↗
Combined oculopneumoplethysmography and duplex scan. Use in the noninvasive cerebrovascular laboratory examination.
To determine the relative merits of oculopneumoplethysmography (OPG) (Gee) and duplex scanning of the carotid arteries, a retrospective analysis was made of 93 patients in a 12-month period who underwent noninvasive carotid studies followed by carotid angiography. The results for the duplex scan were 91% sensitivity, 86% specificity, and 89% overall accuracy in evaluation of 184 arteries. The OPG results were 59% sensitivity, 90% specificity, and 74% accuracy when applied to individual arteries. The sensitivity of OPG increased to 77% when applied to disease in the patient rather than in individual arteries. Analysis of cases in which the duplex scan and OPG were in agreement and disagreement suggested an important role for the OPG test despite its inferior accuracy compared with the duplex scan alone. The predictive value of an abnormal duplex scan result was 98% when the OPG was also abnormal, whereas it was 81% when the OPG was normal. The predictive value of a normal duplex scan result was 93% when the OPG was also normal, whereas it was 60% in those cases where the OPG was abnormal. We believe that the duplex scan should be the basic noninvasive evaluation of cerebrovascular disease, although the OPG continues to provide important information.
Arterial Occlusive Diseases↗
Noninvasive penile arterial evaluation in 120 males with erectile dysfunction.
One hundred twenty males referred to a hospital-based Medical Sexology Program for evaluation of erectile dysfunction had, as part of that workup, a noninvasive penile arterial assessment which included determination of (1) blood pressure in each of the six penile arteries, (2) patency of each cavernosal artery, and (3) brachial blood pressure. The systolic pressures in each of the six penile arteries were averaged and divided by the brachial systolic pressure to determine the penile brachial index (PBI). When a PBI of 0.75 or less was correlated with a history of myocardial infarction, coronary artery bypass, or cerebral vascular accident, a P value of 0.069 resulted, certainly suggesting that each is a manifestation of arterial disease.
Adult↗
Attributional style of lonely and depressed people.
This article examines the attributional style of lonely and depressed people. Previous studies have suggested that both lonely and depressed individuals ascribe failure to characterological defects in themselves. However, the prototype of a lonely person and the prototype of a depressed person suggest that this characteristic attributional style should mainly hold for interpersonal failures. A questionnaire was formed, consisting of 20 hypothetical situations. Half of the situations were interpersonal, and half were not; half described successful outcomes, and half described failures. The subject selected an attributional alternative that best explained the outcome. The questionnaire was administered to 304 students, along with the Beck Depression Inventory and the UCLA Loneliness Scale. The results showed that lonely and depressed people ascribe interpersonal failures to unchangeable characterological defects in themselves (e.g., a lack of ability). Because the prototype of a lonely person is more singularly interpersonal than is the prototype of a depressed person, we hypothesized that loneliness would show higher correlations with the attributional style. This hypothesis was also confirmed. The findings were replicated using a modified version of the questionnaire.
Depression↗
Assessing peripheral vascular disease. Noninvasive testing.
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Carotid Artery Diseases↗