Innovations In Clinical Neuroscience

SEP-OCT 2014

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

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and II errors) are compounded by flawed navigation instructions; mismatches in category titles, definitions, and probes; and wording that is susceptible to multiple interpretations. Further, the Columbia–Suicide Severity Rating Scale in its current form does not map to the 2012 Food and Drug Administration's draft classification algorithm for suicidal ideation and behavior. Conclusion: The evidence suggests that the Columbia–Suicide Severity Rating Scale is conceptually and psychometrically flawed and does not map to the Food and Drug Administration's new standards. A new gold standard for assessment of suicidality may be warranted. Are Suicide Terrorists Suicidal? A Critical Assessment of the Evidence .....................................................81 ABSTRACT: Objective: Most of the research on suicide terrorism is conducted in the political science and international relations fields. The prevailing wisdom within this literature is that suicide terrorists are not suicidal. But how good is the evidence for this assumption? Knowing whether suicide terrorists are suicidal has implications for prevention, rehabilitation, and the "softer" side of counterterrorism designed to win minds and hearts. In addition it may deepen our understanding of suicide itself. Design: This article uses a review of existing literature to examine the arguments and evidence for and against the possibility that suicide terrorists could be suicidal in the context of a broad range of explanations for suicide terrorism. Results: Much of the evidence against the possibility that suicide terrorists are suicidal is based on anecdote or faulty assumptions about suicide. Relatively few formal systematic studies of suicidality in suicide terrorists have been conducted. Nonetheless, there is emerging evidence that suicidality may play a role in a significant number of cases. Conclusion: The field needs a more multidimensional approach, more systematic data at the individual level, and greater international cross-disciplinary collaboration. Would-be suicide terrorists (intercepted and arrested on their way to an attack) should be routinely interviewed using standard internationally accepted psychiatric diagnostic interviews as well as suicidality and homicidality rating scales. Psychological autopsies should also be routinely conducted worldwide. Since no one research site can collect all of the information that is needed, the creation of an internationally shared database that focuses on suicide terrorists rather than simply incidents is encouraged. REPORTS Status Update on the Sheehan-Suicidality Tracking Scale (S-STS) 2014 ..................93 ABSTRACT: There is a need for a choice of scales to evaluate the full range of suicidal phenomena. Such scales must be capable of use as both safety and efficacy outcome measures in research and in clinical settings. Central to the success in finding and developing effective anti-suicidal medications is having a sensitive suicidality scale that can detect an efficacy signal in conventional sample sizes used in clinical trials. The Sheehan- Suicidality Tracking Scale was developed for these purposes. This article provides a 2014 status update on the scale's progress, its use, and its properties. The authors review why and how the scale was developed; the scale structure, versions, and properties; the trials in which it was used; the time frames accommodated; its validation and reliability studies; its utility in screening and assessment; its utility in assessing treatment-emergent suicidal adverse events; its use as an efficacy outcome measure; its availability in self-rated and clinician-rated forms; the availability and linguistic validation of pediatric versions; linguistic validation in other languages; how it compares with global ratings of suicidality; and its possible utility and applications. Linguistic Validation of the Pediatric Versions of the Sheehan Suicidality Tracking Scale (S-STS)..........................141 ABSTRACT: Objective: The United States Food and Drug Administration meta-analysis of registration trials of antidepressants found that emergent suicidality under the age of 25 years increases with decreasing age. This led to boxed warnings for antidepressants and the recommendation for careful assessment and monitoring of suicidality in children and adolescents. To address this need, we describe the development of a pediatric suicidality assessment and tracking scale and a novel, empirically based approach to its age-appropriate linguistic validation. Method: Starting with the adult version of the Sheehan-Suicidality Tracking Scale, we collaborated with reading specialists who use the sight word lists of Dolch and Fry and the grade level vocabulary lists of Beck, Farr, and Strickland to adapt the adult version to each age group. Results: Our approach resulted in the development and documentation of a process for linguistically validating three age-appropriate pediatric versions of the Sheehan-Suicidality Tracking Scale from the adult version of the scale: one for 6- to 8-year-olds, a second for 9- to 12-year-olds, and a third for 13- to 17-year-olds. Conclusion: Further reliability and cognitive debriefing studies are needed in diverse demographic, ethnic, and cultural groups to make the pediatric versions of the Sheehan- Suicidality Tracking Scale more reliable, more generalizable, and more useful. CASE STUDIES The Complexity of Assessing Overall Severity of Suicidality: A Case Study.........................................................164 ABSTRACT: Objectives: This paper investigates the relationship between total scale scores and some other measures used to assess global severity of suicidality in order to determine if "global assessment" can be accomplished with one metric or if is it necessary to judge severity of suicidality in a multidimensional fashion. Methods: For over a year, one subject with daily suicidality self-rated a global severity of suicidality score, the time spent in suicidality over 31,183 events of suicidality, the Sheehan- Suicidality Tracking Scale, Hopelessness Spectrum measure, and the Suicide Plan Tracking Scale. Results: Relying on only one or two metrics to assess global severity of suicidality appears to have significant limitations. As with all single case reports, the findings may not be generalizable to other cases of suicidality. Conclusion: At the middle to high end of the suicidality spectrum, it is necessary to rely on multiple metrics, not just a global severity of suicidality rating, to properly assess the overall severity of suicidality. A N N O T A T E D T A B L E O F C O N T E N T S 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 ] 8

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