Patients' suicides: frequency and impact on psychiatrists.

Results of a national survey of randomly selected psychiatrists revealed that 51% (N = 131) of the 259 respondents had had a patient who committed suicide. This event had an impact on both their personal and their professional lives. Sixty-five psychiatrists reported stress levels in the weeks following the suicide that were comparable to levels reported in studies of people seeking treatment after the death of a parent. Younger, less-experienced clinicians were more affected by a patient's suicide than older clinicians with more experience. Implications of these results for the training and practice of psychiatrists are discussed.

The effect of decreasing delays in appointments on patients' failure to keep appointments.

Patients who fail to keep their appointments for mental-health services are not likely to receive optimal treatment for their disorders and valuable professional time is not used efficiently. One means to decrease failures to keep appointments is to decrease delays in appointments. This study examined the effects of decreasing delays in appointments on appointment keeping for patients who were scheduled for initial intake appointments at a day-treatment center. Decreasing delays in appointments from 5.44 days during baseline to 1.67 days during intervention resulted in a significant decrease in failures to keep appointments from 34 to 13% (P less than 0.05). Reducing delays in appointments, therefore, can be an effective means to reduce failures to keep appointments and increase the likelihood that psychiatric patients who are initially seeking services at mental-health programs will receive prompt attention to their disorders.

Relationship of cynical hostility and PTSD among Vietnam veterans.

The personality construct of cynical hostility, as measured by the Cook-Medley scale (an MMPI subscale), has been implicated as a risk factor for cardiovascular disease. A literature review suggests that Vietnam veterans exhibit many cynical hostility-like characteristics. We examined the association between Cook-Medley scores and PTSD among Vietnam and other-era veterans. Study 1 involved analyses of data from 1293 MMPIs administered at Department of Veterans Affairs in Honolulu between 1986-1991. Cook-Medley scores were highly correlated with MMPI PTSD scores, and Vietnam Era veterans obtained higher scores than veterans from other eras. In Study 2, twenty nine Vietnam veterans with PTSD disability ratings obtained very high Cook-Medley scores which were higher than Vietnam Era veterans without rated PTSD. Findings indicate that the cynical hostility literature has considerable relevance for study of PTSD and suggest that PTSD veterans may have heightened risk for developing cardiovascular disease. Several directions for future research are suggested.