The use and impact of repeated questions in diagnostic child abuse assessment interviews.

There is limited research regarding the use of repeated questions and the subsequent response from children in real-world forensic contexts. We analysed 71 transcripts of diagnostic assessments in which 3- to 6-year-olds were assessed for suspected abuse experiences. On average, 6% of interviewer questions were repeated, and 47% of the repeated questions were abuse-related. The majority (65%) of the repeated questions were directive, but 33% of the repeated questions contained implicit assumptions. Implicit assumption questions were more likely to be abuse-related. Interviewers repeated questions when the child failed to answer due to playing (31%), for no apparent reason (26%) or for clarification purposes (29%). Children most commonly responded to repeat questions by providing new information (64%), not responding at all (19%) or repeating information (12%). We recommend that interviewers avoid the use of suggestive and repeated questions that contain implicit assumptions in relation to assessment of suspected child abuse.

Defensive practice in mental health.

AIM: This study aimed to assess the extent of defensive clinical practice by psychiatrists and psychiatric nurses in a New Zealand Mental Health Service. METHOD: An anonymous questionnaire survey, addressing perceptions of a variety of defensive practices, was sent to all psychiatrists and psychiatric nurses working in acute clinical settings in the publically funded mental health service in Dunedin, New Zealand. RESULTS: Defensive practice is perceived as widespread in psychiatric settings. In particular, practices such as questioning patients about their safety, admissions to hospital, and delayed discharge from hospital were often perceived as occurring for defensive purposes. Psychiatric nurses were more likely than psychiatrists to perceive such practices as defensive. CONCLUSION: Defensive practice is common in mental health. This is despite New Zealand's no-fault compensation scheme, and so presumably results from concerns other than the risk of financial liability. There may be particular pressures in mental health to practice defensively.

Affective disorders in the first-degree relatives of bipolar probands: results from the South Island Bipolar Study.

The current study was performed to document observed rates of affective disorders in the first degree relatives of probands with bipolar I or II disorder; to determine whether bipolar II probands have an excess of bipolar II relatives; and to determine whether bipolar probands with a history of one or more suicide attempts have more relatives who have also made suicide attempts. Bipolar probands with positive family histories of affective disorder were recruited from a variety of sources for a study on the molecular genetics of bipolar disorder. Probands and relatives were interviewed with the Diagnostic Interview for Genetic Studies (DIGS) and blood was obtained for DNA extraction and genetic analyses. Among 423 first-degree adult relatives of 153 bipolar probands, 7% (29) had bipolar I disorder, 7% had bipolar II disorder, and 7% had bipolar not otherwise specified (NOS) disorder, making 21% of relatives with any bipolar disorder. A further 42% of relatives had a depressive disorder and only 38% had no affective disorder. A suicide attempt by a proband was not associated with any increase in suicide attempts by relatives. We conclude that while unipolar depressive disorders are the most common affective disorders in the first-degree relatives of bipolar probands, extension of the bipolar phenotype to include bipolar spectrum disorders results in 21% of relatives having any bipolar disorder.