Innovations In Clinical Neuroscience

SEP-OCT 2014

A peer-reviewed, evidence-based journal for clinicians in the field of neuroscience

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[ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ] Innovations in CLINICAL NEUROSCIENCE 171 ratings than seen in a larger heterogeneous sample and a wider spectrum of score severity than usually found within most single s ubjects. The findings need to be investigated in larger samples with more diversity of comorbid diagnoses and more ethnic and religious diversity. CONCLUSION At the middle to high end of the suicidality spectrum, it may be prudent not to rely on one suicidality variable to gauge the true global severity of suicidality. Using multiple variables and taking the time spent in suicidality into consideration may be a more prudent approach. For example, in spite of the fact that the total scores of the standard version of the S-STS and the SPTS capture a wide spectrum of information about suicidality, neither one of these is sufficient in itself at the upper end of the spectrum to give the clinician a comprehensive picture of a patient's suicidality. When suicidality is very severe, there is a tendency for some patients to minimize the global severity of their suicidality when it is rated on a single dimension. In our case study, when the severity of suicidality reached a midpoint or higher, the hopelessness became an important aggravating factor in further worsening the suicidality. Hopelessness can be the factor that drives the suicidality further out of control. The findings invite debate and discussion on whether the use of m ultidimensional scaling is a more reliable approach in assessing overall severity of suicidality than using a single dimension of global severity. Suicidality may be more complex than other psychiatric disorders in that it may be so laden with stigma, fear, medico-legal implications, concerns about the need for hospitalization, and very dangerous outcomes that these issues may enter into and contaminate clinician and patient ratings of a single dimensional global severity measure. The subject's interpretations of the findings appear to support the presence of such unspoken influences. This may make global assessment of suicidality on a single dimension more complex than in other psychiatric disorders. The assumptions that guide a scientific concept like "global rating of severity" are often buried and not exposed to adequate scrutiny. This case study attempted to uncover and investigate what Agger calls the "blind spots, omissions, tensions and contradictions […and] internal fissures and fault lines" in assessing global severity of suicidality using a single global dimension. 6 REFERENCES 1. Endicott J, Spitzer RL, Fleiss JL et al. The Global Assessment Scale. Arch Gen Psychiatry. 1976;33:766–771. 2. McGlashan T (ed). The Documentation of Clinical Psychotropic Drug Trials. Rockville, MD: National Institute of Health; 1973. 3. Sheehan DV, Giddens JG, Sheehan IS. Status Update on the Sheehan Suicidality Tracking Scale (S-STS) 2014. Innov Clin Neurosci. 2014;11(9–10):93–140. 4. Dolphin Electronic Data Capture (eMINI Professional Version 2.1.1/R131112.1 Database Version 2.26) [Software]. (1994–2012). 5. Alphs L. Two dichotomized spectrum test questions (one assessing a impulsivity—caution dichotomous spectrum—the second using a hopefulness— hopelessness dichotomous spectrum) developed by L Alphs for the study reported in "Comparative Validation of the ISST-Plus, the S-STS and the C- SSRS for assessing suicidal thinking and behavior." Poster presented at the 14th International Congress on Schizophrenia Research (ICOSR), April 21–25, 2013, Orlando, FL, USA. (L Alphs, personal communication). 6. Agger B. Cultural Studies as Critical Theory. London, UK: The Falmer Press; 1982:102. Innovations in CLINICAL NEUROSCIENCE [ V O L U M E 1 1 , N U M B E R 9 – 1 0 , S E P T E M B E R – O C T O B E R 2 0 1 4 ]

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