Personality types and suicidal behavior: an exploratory study.

This study used cluster analysis to explore prominent personality traits among a sample of suicidal psychiatric patients (n = 86), with a goal of identifying distinct clusters based on descriptive personality traits as measured by the Millon Clinical Multiaxial Inventory-II (MCMI-II). Three clusters were identified, accounting for 97% of study participants with available data. Additional analyses were conducted to explore differences and similarities among the three groups. The three clusters were comparable with respect to symptomatology (i.e., depression, anxiety, hopelessness), psychiatric diagnoses, and negative life stress, suggesting that cluster differences were not due to severity of disturbance (i.e., symptom severity) or diagnosis. Although all three clusters evidenced prominent negativistic and avoidant traits and two of the clusters showed prominent borderline traits, each was characterized by a distinct trait with implications for interpersonal functioning. Results are discussed in terms of implications for treatment and future research, particularly the importance of the therapeutic relationship with suicidal patients.

A multidisciplinary TBI inpatient rehabilitation programme for active duty service members as part of a randomized clinical trial.

OBJECTIVE: To design and describe an effective rehabilitation programme for use in an ongoing trial on the efficacy of multidisciplinary brain injury rehabilitation for moderately head injury military service members. DESIGN: Treatment arm of a randomized control trial. SETTING: US military tertiary care hospital inpatient rehabilitation programme. PATIENTS: Sixty seven active duty military with moderate to severe TBI who were randomized to the treatment arm of the protocol. INTERVENTION: Eight week rehabilitation programme combining group and individual therapies with an inpatient milieu-oriented neuropsychological focus. Group therapies included fitness, planning and organization, cognitive skills, work skills, medication, and milieu groups, and community re-entry outings. Individual therapy included neuropsychology, work therapy, occupational therapy, and speech and language pathology. MAIN OUTCOME MEASURES: Successful return to work and return to duty. RESULTS: At 1 year follow-up, 64 patients returned to work (96%) and 66% (44/67) returned to duty. CONCLUSION: The described rehabilitation programme demonstrates one successful effort to rehabilitate active duty military service members with TBI who have the potential to return to duty.

Patient suicide in psychiatry residency programs : a national survey of training and postvention practices.

Patient suicide, which has been shown to have great emotional impact upon trainees, is experienced by as many as one in three psychiatry residents. The authors report the results of a national survey of psychiatry residency training programs (N=166) that asked about 1) current training practices in the area of suicide and 2) required or recommended procedures in the event of suicide by a resident's patient. Results show that programs commonly offer training in the assessment and treatment of suicidal patients, but the question remains as to whether the training is adequate to meet the challenges of working with suicidal individuals. Results also reflect considerable variability in "postvention" practices among programs and training settings, especially in terms of what steps should be taken when a trainee's patient commits suicide. Implications of the survey for residency training programs are discussed.

Cluster analysis of MCMI scores of suicidal psychiatric patients: four personality profiles.

Millon Clinical Multiaxial Inventory (MCMI) scores from 299 suicidal psychiatric outpatients were cluster analyzed in hopes of identifying clinical subgroups and deriving specific treatment indications. The analysis revealed four personality profiles: Negativistic/Avoidant/Schizoid, Avoidant/Dependent/ Negativistic, Antisocial, and Histrionic/Narcissistic. This grouping was validated by examining demographics, diagnoses, and scores on several psychometric scales. Results showed few differences in demographics, diagnosis, or intelligence, but significant differences in depression severity, hopelessness, anxiety, problem-solving self-appraisal, and alcohol abuse. Implications for tailoring interventions for subtypes of suicidal patients are discussed.

Neuropsychological performance and suicidal behavior in adult psychiatric inpatients.

Although various studies have shown that suicidal persons exhibit greater cognitive deficiencies than both normals and other psychiatric patients, researchers as yet have been unable to account for the source(s) of the differences. Some of these differences (e.g., cognitive rigidity and impaired problem solving) hint of possible organic involvement. This study explored the relationship of neuropsychological functioning to suicidal behavior by comparing 20 suicidal and 27 nonsuicidal psychiatric inpatients on several tests of neuropsychological functioning. Although results showed no significant differences between the two groups on most measures, both groups showed evidence of notably high levels of cortical dysfunction relative to test norms. Thirty-five percent of suicidal patients and 44% of nonsuicidal patients scored in the impaired range. Implications of this high frequency of impairment for the treatment of suicidal and nonsuicidal psychiatric patients are discussed.

A cross-sectional study to show Eperythrozoon ovis infection is prevalent in Western Australian sheep farms.

A serological survey and risk factor study was conducted to estimate the prevalence of Eperythrozoon ovis infection in Western Australian weaner sheep, the prevalence of farms with infected sheep, and to identify factors affecting initiation and maintenance of infection on the farm. The study was conducted on 91 farms, purposively chosen from 41 randomly selected regional shires stratified by sheep number and rainfall zones. Twenty sheep were selected systematically from a mixed-sex flock on each farm and tested for serum antibody to E ovis using an enzyme-linked immunosorbent assay. Information on putative risk factors was collected using an interview questionnaire. Antibody to E ovis was detected in 4.5% of sheep on 47% of the farms sampled. The prevalence of E ovis infection in sheep was estimated at the 95% confidence level to be between 3.6 and 5.5%, and the prevalence of farms with infected sheep was estimated to be between 37.5 and 56.5%. Most farms with serological evidence of infection occurred in the Great Southern agricultural region (79.5%), south-east of Perth through to Albany (latitude 32 to 34 degrees S, longitude 116 to 120 degrees E), and in the Northern region (12.8%) surrounding Geraldton (latitude 29 degrees S, longitude 114 degrees E). There were significantly more farms (P less than 0.05) with evidence of infection in the Great Southern region compared to the Central region between Geraldton and Perth, and on farms in the region south compared to north of latitude 32 degrees S. None of the putative risk factors examined in the questionnaire were associated with serological evidence of infection on the farm.(ABSTRACT TRUNCATED AT 250 WORDS)

Classification of suicidal behavior: a review and step toward integration.

The many forms of suicidal phenomena, including contemplated, attempted, and completed suicide, present significant problems to both researchers and practitioners. Although many attempts have been made to develop categories, agreement among the proposed systems has been more the exception than the rule. This article reviews theoretical and empirical efforts to define types of suicidal individuals and attempts to integrate them by means of higher-order categories of variables. These categories or "dimensions" are as follows: (1) descriptive, (2) situational, (3) psychological/behavioral, and (4) teleological. Implications for research and practice are discussed.

The Hopelessness Scale and social desirability: more data and a contribution from the irrational beliefs test.

This paper presents findings with regard to social desirability confounding on Beck's Hopelessness Scale (Beck, Weissman, Lester, & Trexler, 1974). Data from 60 suicidal and nonsuicidal psychiatric inpatients were examined in terms of the correlations between hopelessness scores and suicidality. Controlling for social desirability, as measured by the Marlowe-Crowne Scale (Crowne & Marlowe, 1964), did not affect this correlation substantially, nor did use of SD scores in a discriminant analysis improve accuracy of classification into severely suicidal and nonsuicidal groups. These results are in contrast with similar studies (e.g., Linehan & Nielsen, 1981) that used the Edwards SD scale. However, regression analysis of the MCSD scale using subscales of the Irrational Beliefs Test (Jones, 1969) raises the question as to whether the MCSD scale indeed is measuring SD, as opposed to some aspect or aspects of psychological adjustment.

Staff training through collaboration: the training resources center.

As fiscal resources for mental health programs dwindle, it is becoming increasingly important to preserve non-direct-service priorities such as staff development. The West Virginia Training Resources Center, a collaborative program operated by the West Virginia Department of Health and the West Virginia University department of behavioral medicine and psychiatry, addresses problems of staff training in the state mental health service system. The authors discuss the development of the center and its functions as provider of training programs, sponsor of statewide training conferences, and clearinghouse of information and expertise. They also discuss problems stemming from the increased need for continuing education for paraprofessionals, the use of outside consultants, and the relationship between academia and the health service sector.