Clinical rating scales in suicide risk assessment.

This study explores the usefulness of clinical rating scales in the assessment of suicidal risk in an urban psychiatric teaching hospital. Admission for clinically evaluated suicide risk was the outcome variable because actual suicide occurs rarely. Six clinical scales identified high-risk patients: the Modified SAD PERSONS scale, revised Beck Depression Inventory, Beck Anxiety Inventory, Beck Hopelessness Scale, Beck Scale for Suicidal Ideation (BSS), and the High-Risk Construct Scale (NEW). It was hypothesized that patients who scored highly on the clinical scales were more likely to be admitted. Five of the scales had previously established psychometric properties, while one was new and untested. For our patient population, the established scales had 100% sensitivity and negative predictive value, but lower specificity and positive predictive value (range = 38-90% & 28-71%). We performed a correlation matrix and regression analysis to determine which scale(s) best predicted admission based upon suicidal concerns. The previously untested NEW scale was the best predictor followed by the BSS. Clinical rating scales cannot predict suicide in the individual and strict cut-off scores should not be used to dictate admission to hospital. However, the information provided can be a valuable adjunct to suicide risk assessment in psychiatric and non-psychiatric emergency settings

Evaluating psychiatric clinical clerks with a mini-objective structured clinical examination.

Although objective structured clinical examinations (OSCEs) are well-accepted performance-based assessments with good reliability, psychiatric educators have been slow to adopt this evaluation method, opting for oral exams that often have inferior psychometric properties. A 4-station "mini-OSCE" was developed and used to test 42 clinical clerks in psychiatry. The examination mean score and standard deviation were 74% and 8.08, respectively, while individual scores ranged from 56% to 86%. Interstation reliability was 0.61. Student and faculty satisfaction was high. A "mini-OSCE" for psychiatric clinical clerks confers the benefits of acceptable reliability and a high degree of acceptance without incurring the high costs usually associated with OSCE evaluation.

Is there a role for selective monoamine oxidase inhibitor therapy in bulimia nervosa? A placebo-controlled trial of brofaromine.

Pharmacologic and cognitive behavioral therapies have been advocated in the treatment of bulimia nervosa (BN). Brofaromine, a selective and reversible inhibitor of monoamine oxidase-A was selected for a double-blind, placebo-controlled evaluation because of previous demonstrated monoamine oxidase inhibitor efficacy in BN and because of its safer adverse reaction profile. Thirty-six female patients who met DSM-III-R criteria for BN were randomly assigned to the drug group (N = 19) or to the placebo group (N = 17) for an 8-week outpatient trial. Brofaromine produced a significant effect in decreasing episodes of vomiting throughout the trial, although comparable reductions in episodes of binge eating were found in both groups. Also, there were no advantages of drug over placebo on improvements in attitudinal measures and shape or on self-report ratings of depression and anxiety. However, a significant proportion of the subjects on brofaromine lost weight when compared with the placebo group. Methodologic issues including subjective assessment measures, placebo response rates, and the elucidation of responder subgroups are discussed.