Developing and Validating a Big-Store Multiple Errands Test.

The Multiple Errands Test (MET) is an ecologically valid assessment that characterizes how executive dysfunction manifests in everyday activities. Due to the naturalistic nature of this assessment, clinicians and researchers have had to develop site-specific versions resulting in numerous published versions and making it difficult to establish standard psychometric properties. The aim of this study was to develop a standardized, community version of the MET designed to be used in large department stores meeting set criteria that would not require site specific modifications. This paper reports on the development, content validity, feasibility, and inter-rater reliability of a Big-Store MET, and the performance of healthy participants on this test. Items were selected to match previously published versions in relation to quantity and complexity. Content validity was established by having experts (n = 4) on the MET review the proposed Big-Store version and evaluate the task consistency with previously published versions. To assess feasibility of administration, and inter-rater reliability, a convenience sample of 14 community dwelling adults, self-reporting as healthy, were assessed by two trained raters. We found the Big-Store MET to be feasible to deliver (completed within 30 min, scores show variability, acceptable to participants in community environment) and inter-rater reliability to be very high (ICCs = 0.92-0.99) with the exception of frequency of strategy use. This study introduces the Big-Store MET to the literature, establishes its preliminary validity and reliability thus laying the foundation for a standardized, community-based version of the MET.

Relationship between Bullying and Suicidal Behaviour in Youth presenting to the Emergency Department.

OBJECTIVE: Increasing numbers of adolescents are visiting emergency departments with suicidal ideation. This study examines the relationship between bullying and suicidal ideation in emergency department settings. METHOD: A chart review was conducted for all patients under 18 years of age presenting with a mental health complaint to the emergency departments at Kingston General or Hotel Dieu Hospitals in Kingston, Canada, between January 2011 and January 2015. Factors such as age, gender, history of abuse, history of bullying, type and time of bullying, and diagnoses were documented. RESULTS: 77% of the adolescents had experienced bullying, while 68.9% had suicide ideation at presentation. While controlling for age, gender, grade, psychiatric diagnosis, and abuse, a history of bullying was the most significant predictor of suicidal ideation. Individuals in this study who reported cyber bullying were 11.5 times more likely to have suicidal ideation documented on presentation, while individuals reporting verbal bullying were 8.4 times more likely. CONCLUSIONS: The prevalence of bullying in adolescent patients presenting to emergency departments is high. The relationship found between suicidal ideation and bullying demonstrates that clinicians should ask questions about bullying as a risk factor for suicide ideation during the assessment of children and adolescents.

OBJECTIF: Un nombre croissant d'adolescents se rend aux services d'urgence avec une idéation suicidaire. Cette étude examine la relation entre l'intimidation et l'idéation suicidaire dans le contexte des services d'urgence. MÉTHODE: Un examen des dossiers a été mené pour tous les patients de moins de 18 ans qui se sont présentés avec une plainte de santé mentale aux services d'urgence du Kingston General ou de l'Hôtel Dieu de Kingston, Canada, entre janvier 2011 et janvier 2015. Les facteurs comme l'âge, le sexe, les antécédents d'abus, les antécédents d'intimidation, le type et le moment de l'intimidation, et les diagnostics ont été documentés. RÉSULTATS: Soixante-dix-sept pour cent des adolescents avaient connu l'intimidation, tandis que 68,9 % avaient une idéation de suicide en se présentant. En contrôlant pour l'âge, le sexe, l'année de scolarité, le diagnostic psychiatrique et l'abus, des antécédents d'intimidation étaient le prédicteur le plus significatif de l'idéation suicidaire. Les sujets de cette étude qui ont déclaré une cyberintimidation étaient 11,5 fois plus susceptibles d'avoir une idéation suicidaire documentée lorsqu'ils se présentent, alors que les sujets déclarant une intimidation verbale en étaient 8,4 fois plus susceptibles. CONCLUSIONS: La prévalence de l'intimidation chez les patients adolescents qui se présentent aux services d'urgence est élevée. La relation observée entre l'idéation suicidaire et l'intimidation démontre que les cliniciens devraient poser des questions sur l'intimidation comme facteur de risque de l'idéation suicidaire durant l'évaluation des enfants et des adolescents.

Assessing Suicide Risk: What is Commonly Missed in the Emergency Room?

OBJECTIVE: Although risk assessment for suicide has been extensively studied, it is still an inexact process. The current study determined how busy emergency clinicians actually assessed and documented suicide risk, while also examining the differences between psychiatric and emergency medicine opinions on the importance of various suicide predictors. METHOD: Phase 1 of the study involved the administration of a survey on the relative importance of various suicide predictors for the specialties of psychiatry and emergency medicine. In phase 2 of the study, a chart review of psychiatric emergency room patients was conducted to determine the actual documentation rates of the suicide predictors. RESULTS: Several predictors that were deemed to be important, including suicidal plan, intent for suicide, having means available for suicide, and practicing suicide (taking different steps leading up to suicide but not actually attempting suicide), had low documentation rates. CONCLUSIONS: Medical specialties have different opinions on the importance of various suicide predictors. Also, some predictors deemed important had low documentation rates. Educational interventions and simple assessment tools may help to increase documentation rates of several suicide predictors in busy clinical settings.

Effects of the GluN2B-NMDA receptor antagonist Ro 25-6981 on two types of behavioral flexibility in rats.

Recent evidence has implicated N-methyl-d-aspartate receptors (NMDARs) in several aspects of learning and behavioral flexibility in rodents. Here, we examined the effects of treatment with Ro 25-6981, a selective antagonist of NMDARs containing GluN2B subunits, on two types of behavioral flexibility in rats, spatial reversal learning and set-shifting (spatial vs. motor strategy). To examine spatial reversal learning, rats were trained to swim to a hidden platform in a water maze over four days. On the following day, the platform was moved to a new location in the maze. Administration of Ro 25-6981 (10mg/kg) selectively impaired the early phase of reversal learning, but all rats learned to navigate to the new platform location over 12 trials. To examine set-shifting, independent groups of rats were trained to either swim to a fixed location (spatial strategy) or use a motor response (e.g., "turn left"; motor strategy) to find a hidden escape platform in a cross-shaped water maze apparatus; after task acquisition, rats were trained on the second, novel strategy (set-shift) following treatment with either Ro 25-6981 (10mg/kg) or saline. Administration of Ro 25-6981 had no effect on the ability of rats to perform the set-shift and use the new strategy to locate the escape platform. These results suggest that, in rats, spatial reversal learning, but not set-shifting, is sensitive to Ro-25-6981 treatment. Thus, NMDARs-GluN2B signaling may play a selective role in some forms of behavioral plasticity, particularly for situations involving the updating of information in the spatial domain.