Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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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 ] 192 with their clinician), confidence that the data are accurate and will not change over time is desired in order for clinicians to effectively treat their p atients. As with most scales, the reported scores progressively decrease with the passage of time when patients reflect back on the same timeframe. 1 Some patients have reported to the authors of this article that they had, at times, been less than truthful with their clinicians (sometimes on purpose and other times because their perspective of symptoms had changed). A few reported being dishonest even with themselves. To explore this phenomenon further, we designed this case study to document to what extent, if any, a subject's reporting of suicidality may vary depending upon who will view the data, the subject's relationship to the reviewer of the data, and whether the reporting varies if several days have passed between the timeframe in question and the time of data collection. METHODS A 29-year-old female subject, who was diagnosed with Asperger syndrome and had chronic suicidality, collected data for 24 timeframes over three months. The data included the 11/11/11 versions of the Sheehan- Suicidality Tracking Scale (S-STS), the Suicidality Modifiers (SM) scale (used in University of Alabama at Birmingham S-STS validation study), and the Alphs Dichotomous Impulsivity and Hopelessness Two Questions (IH Questions) (used in the University of Alabama at Birmingham InterSePT Scale for Suicidal Thinking- Plus [ISST-Plus] validation study). 2–4 Data were collected using the computerized versions of all three scales. 5 In addition, the subject documented any other notes she thought relevant to her scoring choices. The S-STS is an 11-question scale about suicidal phenomena and has one question about non-suicidal self-injury. The SM has five questions on each of two topics: impulsivity and hopelessness. Each of these two scales (S-STS and SM) uses a 0 to 4 (5-point Likert) scoring system with the following descriptive anchors: 0=not at all, 1=a little, 2=moderately, 3=very, 4=extremely. The two IH Questions h ave seven descriptive anchors each that were converted into 1 to 7 numeric values: For the question on usual caution/impulsivity, 1=extremely cautious, 2=very cautious, 3=moderately cautious, 4=in the middle, 5=moderately impulsive, 6=very impulsive, and 7=extremely impulsive; and for the question on usual hopefulness/hopelessness, 1=extremely hopeful, 2=very hopeful, 3=moderately hopeful, 4=in the middle, 5=moderately hopeless, 6=very hopeless, and 7=extremely hopeless. During data collection, the subject was under the care of both a therapist and a psychiatrist. The subject completed the computerized versions of each of the three scales three different times for each timeframe. The first dataset was for the subject alone and was not to be shared (self-version [immediate]). The second dataset, completed just after the first, was for her therapist (self- version [for therapist]). The third dataset was for the subject, but was completed 1 to 5 days following the first. This is referred to as self-version (days later). The subject answered the scales for these three data collection points for each of the 24 timeframes (timeframes varied between 3 to 5 days throughout the study [mean of 3.96 days]). The results of the reliability study data of these three scales is being prepared in another report. The three different versions (self- version [immediate], self-version [for therapist], and self-version [days later]) of each of the three scales were compared for each of the same timeframes to determine what deviations occurred in the question answers and notes. RESULTS Comparison of self-version (immediate) to self-version (for therapist). For the purpose of this comparison, the self-version (immediate) is used as the standard against which the self-version (for therapist) was judged. On the S-STS, there were six interviews on which the subject failed to report to her therapist a ny preparatory behaviors at all. Some of these timeframes contained as many as three preparatory behaviors. There were deviations in the counts of both passive and active suicidal ideation. The deviation was as high as 150 and 230 events, respectively, during one timeframe. Deviations occurred in the severity and type of suicidal planning during in as many as 20 of the 24 timeframes. On the SM, the hopelessness questions deviated in 22 of the 24 timeframes. There were 17 aggregate point deviations in the seriousness of the loss of desire to resist impulsivity across all timeframes. The IH Questions only deviated on the level of usual hopefulness/ hopelessness question, which occurred in seven timeframes. Overall, there was deviation on 41 percent of all scale questions across all timeframes (302 out of a total of 744 questions). The deviation in the note topics was minimal compared to the individual scale questions. However, the subject did not report some of the note topics to the therapist that related to the severity of her symptoms, to details about planning an attempt (including possible dates), and notes that directly related to the therapist that were noted in the self-version (immediate). These deviations occurred in five, 10, and three timeframes, respectively. Comparison of self-version (immediate) to self-version (days later) .For the purpose of this comparison, the self-version (immediate) is used as the standard against which the self-version (days later) was judged. On the S-STS, there were deviations in the counts of active suicidal ideation (320 events across all 24 timeframes). The mean deviation, when there was deviation on this question, was higher here (107 events) than it was comparing the self-version (immediate) to the self-version (for therapist) (89 events). When deviations occurred, almost all

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