Impact of the Abbreviated Suicide Crisis Syndrome Checklist on Clinical Decision Making in the Emergency Department.

Objective: The suicide crisis syndrome (SCS), an acute negative affect state predictive of near-term suicidal behavior, is currently under review for inclusion as a suicide-specific diagnosis in the Diagnostic and Statistical Manual of Mental Disorders (DSM). While the predictive validity of the SCS for near-term suicidal behavior is well documented, its real-world clinical utility has yet to be evaluated. As such, this study evaluated how implementation of a novel assessment tool, the Abbreviated SCS Checklist (A-SCS-C), into the electronic medical records (EMRs) influenced disposition decisions in the emergency departments (EDs) of a large urban health system.Methods: Logistic regression analyses evaluated the impact of SCS diagnosis on 212 admission/discharge decisions after accounting for chief complaints of suicidal ideation (SI), suicidal behavior (SB), and psychosis/agitation.Results: The A-SCS-C was concordant with 86.9% of all non-psychotic disposition decisions. In multivariable analysis, the A-SCS-C had an adjusted odds ratio (AOR) of 65.9 (95% confidence interval: 18.79-231.07) for inpatient admission, whereas neither suicidal ideation nor behavior was a significant predictor. The effect size remained very high in 3 sensitivity analyses, the first using information from a different section of the EMR, the second in patients younger than 18 years, and the third in males and females separately (AORs > 30).Conclusions: SCS diagnosis, when implemented in ED EMRs alongside SI and SB, was strongly predictive of clinician decision making with regard to admission/discharge, particularly in non-psychotic patients, while SI and SB were noncontributory. Overall, our results show that the SCS, as a diagnostic entity, demonstrates robust clinical utility and may reduce the limitations of relying on self-reported SI as a primary basis of suicide risk assessment.

Blame, shame, and contamination: the impact of mental illness and drug dependence stigma on family members.

Family members of relatives with mental illness or drug dependence or both report that they are frequently harmed by public stigma. No population-based survey, however, has assessed how members of the general public actually view family members. Hence, the authors examined ways that family role and psychiatric disorder influence family stigma. A national sample (N = 968) was recruited for this study. A vignette design describing a person with a health condition and a family member was used. Family stigma related to mental illnesses, such as schizophrenia, is not highly endorsed. Family stigma related to drug dependence, however, is worse than for other health conditions, with family members being blamed for both the onset and offset of a relative's disorder and likely to be socially shunned.

Adolescent attitudes toward serious mental illness.

While there is a growing literature on mental illness stigma and strategies for reducing stigma among adults, less is known about how children and adolescents view persons with mental illness. In this paper, we describe the Attitudes Toward Serious Mental Illness Scale-Adolescent Version (ATSMI-AV) and our initial examinations of its factor structure and variations among subgroups of adolescents. Findings suggest that strategies aimed at reducing stigma in this age group would be wise to specifically target categorical thinking about mental health and mental illness and perceptions of persons with mental illness being violent and out of control.

Strategies for the rapid treatment of depression.

The purpose of this article is to review current literature relating to the determination of the time course of antidepressant effects. Further, this work explores studies examining the safety and effectiveness of pharmacological techniques for accelerating the therapeutic effects of antidepressant medication. A review of the literature pertaining to strategies for accelerating antidepressant medication effects was accomplished using the MEDLINE database, employing the key title words, antidepressant, rapid, and accelerating. A preponderance of evidence suggests that there is a multiple week latency for the onset of action of antidepressant medications. This latency appears to apply to virtually all standard antidepressants and may reflect slow adaptive changes to the inciting event of increased monoamine levels. Several strategies have received attention as potential strategies with which to accelerate the therapeutic effects of antidepressant medications. These include the use of high initial doses of some agents and also the use of initial augmentation strategies. Specifically, studies exist suggesting the acceleration of antidepressant effects using high initial doses of tricyclic antidepressants or venlafaxine, as well as the potential for acceleration by using initial augmentation with psychostimulants, lithium, or pindolol. Considering the morbidity and mortality associated with severe depression, a critical need exist for the exploration of ways in which to achieve antidepressant effects more quickly. A number of preliminary studies suggest strategies for the rapid treatment of depression, each with an apparent high degree of safety. Further investigations in more carefully defined patient populations and utilizing advances in the techniques for assessing antidepressant onset are needed. Copyright 2001 John Wiley & Sons, Ltd.