Black suicide attempters in 1980: A preventive focus

A retrospective chart review of black suicide attempters was completed to describe the sample in comparison to prior studies and to develop preventive strategies. This sample of 56 black suicide attempters was composed of 17 males and 39 females, a ratio of 1:2.3. Female attempters were younger, 54% had made a prior attempt and had a diagnosis of either affective illness (33%) or an adjustment reaction with depressive features (31%). Male attempters were older, 76% had a prior psychiatric history, and 59% had a psychotic diagnosis. The potential for life-threatening behavior in psychotic black male patients was noted. The necessity of monitoring the access to medication by stressed impulsive youth was emphasized. As significant others involved in the stressers that precipitated the attempt accompanied the patient to the emergency room (ER), crisis intervention in the ER with the signficant other and/or family members was identified as an important strategy.     

The role of meta-analysis in the evaluation of psychotherapy

Meta-analysis has been widely adopted as a quantitative approach toward reviewing and evaluating a body of literature. The present article discusses the utility of metaanalysis in the context of the evaluation of psychotherapy. Benefits and limitations of metaanalysis are highlighted to identify essential characteristics of the approach as a methodological tool. The major focus is discussing meta-analysis in relation to alternative design and data evaluation strategies within clinical psychology. The unique contributions of meta-analysis are discussed. Fundamental issues and assumptions about psychotherapy research are identified to point to the need for critical (and qualitative) evaluation of existing meta-analyses.     

Do old age psychiatrists miss physical illnesses?

We studied the ability of old age psychiatrists to accurately diagnose physical disorders in elderly patients. A group of 24 psychogeriatric patients who died in hospital were matched for age and sex with 24 elderly patients who died under the care of other specialists in the same hospital. Postmortem findings and premortem diagnoses were compared retrospectively and the two groups showed high but similar levels of diagnostic discrepancies, despite the greater prevalence of dementia in the psychogeriatric group. The results show that old age psychiatrists are as successful as other specialists in identifying physical illnesses in their elderly patients.     

Endocrine responses to thyrotropin-releasing hormone in major depressive disorders

The endocrine response to thyrotropin-releasing hormone (TRH) was studied in severely endogenously depressed patients during illness (n = 21) and after recovery (n = 18). The thyroid-stimulating hormone (TSH) response to TRH was blunted (deltaTSH less than 5 microIU/ml) in over one third of depressives during illness and remained blunted in most even after recovery. There was no correlation between multiple measures of cortisol secretion (the mean 24-hour plasma cortisol, dexamethasone suppression test, and plasma cortisol during the TRH procedure) and the TSH response during illness and after recovery. The TSH and prolactin (PRL) responses to TRH, as well as the baseline PRL, were significantly lower during illness. The role of possible abnormalities in dopamine and/or serotonin in depression contributing to these endocrine disturbances is discussed.     

Differential effects of cognitive therapy and pharmacotherapy on depressive symptoms

Patterns of symptom change were examined in 35 unipolar depressed outpatients treated with either cognitive therapy or pharmacotherapy (imipramine HCI). Cross-lagged panel analyses were used to evaluate the temporal relationships among changes in views of the self, hopelessness, mood, motivation and vegetative symptoms during treatment weeks 1–4.During cognitive therapy improvements in hopelessness, views of the self and mood generally preceded changes in vegetative and motivational symptoms. On the other hand, no consistent pattern of change was associated with pharmacotherapy. While these results are compatible with the notion that cognitive therapy initially alters negative thinking and mood, which secondarily leads to improvements in vegetative and motivational symptoms, further studies with a placebo or wait-list group are needed to determine if this is a unique effect of cognitive therapy.     

Competing role demands of therapists' professional and marital lives

This review evaluates current knowledge regarding the multilevel and reciprocal relations between psychotherapists' professional and marital lives. Because few articles pertain specifically to psychotherapists, the review incorporates pertinent literature concerned with other health service professionals. A model of reciprocal influence is proposed which conceptualizes interactive effects among the professional's personal history, vocational life, and marital life. Conflicted nurturing in the professional's family of origin may cultivate a need for control over interpersonal relations, which is fulfilled by professional training and practice. Empirical research supports the notion that professional intimacy serves a defensive function against conflict over marital intimacy. However, residual conflicts over intimacy surface in the marriage, and both the therapist and spouse may develop psychological symptoms.     

An oral examination of the psychiatric knowledge of medical housestaff: Assessment of needs and evaluation baseline

To assess the psychiatric knowledge of medical housestaff, the authors devised an oral examination based on two simulated clinical encounters and administered it to 26 medical residents. The case material embodied those psychiatric problems known to be common in medical populations, namely depression, delirium, dementia, and “psychogenic” pain. The stan-dardized simulations were punctuated by standardized “open” questions with followup probes. A panel of experienced clinicians developed rating criteria for each question such that responses could be categorized as “good,” “adequate,” “inadequate,” or “poor,” in terms of “what an internist needs to know,” Blind raters of the exam achieved an interrater reliability of 0.88. The results indicated major deficits in the knowledge needed for assessment and treatment of these common problems. Only 16% of answers were “good,” whereas 42% were “inadequate” or “poor.” For example, 88% of the doctors could not name three factors that help distinguish organic from “functional” psychosis, and 88% could not list three side-effects of tricyclic antidepressants. The doctors' level of experience was not correlated with test scores, either overall or question by question. These results, together with measures of attitude and skill, have been used to develop a needs-based liaison psychiatry curriculum and to evaluate the effectiveness of that curriculum.