Physical and psychological responses to suicide in the family.

Used the psychological autopsy method to examine the effects of suicide on surviving family members. Structured interviews with 39 families consecutively selected from coroner's records focused on the immediate impact of death; current understanding; and social, vocational, physical, and psychological effects 7 mo after the death. Results suggest that physical and emotional reactions among individual survivors were severe and enduring, whereas family relationships were frequently strengthened. Suggestions are made for responding therapeutically to the needs of survivors. (16 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Issues in the psychological autopsy of a controversial public figure.

Psychological autopsy is an investigative technique employed by social scientists to help determine mode of death in equivocal cases. Data derived from interviews with survivors and inspection of public records are employed to arrive at conclusions about the death motivation of the deceased person just prior to his demise. In applying this technique to the study of the death of a famous person—a returned POW who spent 5 yrs in a North Vietnamese prison camp—problems emerged that uniquely illustrate its strengths and weaknesses. The results of the psychological autopsy seem to have influenced US government policy about returned POWs. (4 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping with client death: Using a case study to discuss the effects of accidental, undetermined, and suicidal deaths on therapists.

Over one-quarter of psychologists and psychiatrists will lose a client to suicide, and the impact of suicide on therapists is profound. Therapists report both personal (e.g., emotional) and professional (e.g., fears of litigation, doubts about competency) reactions to client suicide, and these reactions are thought to be pronounced for therapists-in-training. However, little is known about the effect of nonsuicidal client deaths on therapists, especially how the experience of a client suicide might compare with other forms of unanticipated client death, such as accidental injuries (e.g., car accidents) or deaths of undetermined intent. The current article reviews family members' bereavement responses based on differential death classification, as well as therapist reactions to suicidal deaths. A case study of undetermined death will be described in light of the extant literature on therapists' coping responses to suicide, including reflections on emotional and professional implications to a nonsuicidal death. A recent social psychological model of adaptation to emotional experiences (Wilson & Gilbert, 2008) will be used as a theoretical framework to discuss how death by suicide may be construed in comparison to undifferentiated and/or accidental deaths, with a focus on informing sorely needed future research in this area. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

The psychological autopsy: a useful tool for determining proximate causation in suicide cases

This overview article examines the applications of the psychological autopsy method in determining proximate causation in suicide cases. The article reviews the history of the psychological autopsy and describes its procedure and how it has proved helpful in explicating proximate causation. The five standards currently used by the courts to determine proximate causation in suicide cases are described, as are a variety of applications of the psychological autopsy method, including its application to workers' compensation cases, product liability cases, and medical malpractice cases. In particular, issues of prediction and protection are addressed. Finally, there is a discussion of an application of the psychological autopsy to criminal cases. The article concludes with a discussion of the issues raised in the use of the psychological autopsy during expert testimony and the considerations that should be addressed by an expert witness contemplating the use of the psychological autopsy method.     

Analysis of physician attitudes concerning requests for autopsy

To quantify the role of failure to request consent as a determinant of the autopsy rate, questionnaires asking whether an autopsy had been requested and the reasons for that decision were distributed to primary physicians after each death in a consecutive series of 75 patient deaths. Autopsies were requested in only 56% of cases. Common reasons to request an autopsy included unanswered medical questions (37%), medical education (22%), research protocol participation (16%), or routine policy (14%). When autopsies were not requested, the most common reason was the belief that there were no outstanding medical questions (64%). Follow-up interviews with 14 oncologists and hematologists revealed that 8 generally request autopsies (usually to contribute to medical education or to discover unexpected findings) and 6 generally do not (usually because no unexpected findings are anticipated). Attempts to increase the current low autopsy rate should address the question of when and why physicians are willing to request this procedure.     

Deaths at an emergency hospital. Circumstances around the cases as described by physicians and relatives

Cases of death occurring at University Hospital (Akademiska sjukhuset), Uppsala, during a four-month period were studied by means of interviews (n = 258) with the attending physicians and questionnaires answered by relatives (191) of the deceased. In half the cases death was unexpected and the preceding treatment period short. In most cases the family was present at the time of death, one of several signs that family participation has increased. The question of autopsy was raised in 70 per cent of cases, autopsy being performed in 53 per cent. Great importance was attached to relatives' attitudes toward autopsy, which were negative in only about one case in four. Shortcomings remain in the information provided to families, although there was improvement in this respect as compared with findings in earlier studies.     

Challenging the stultifying bonds of tradition: Some philosophical, conceptual, and methodological issues in applying the scientist-practitioner model.

Discusses the quality of school psychology education and training in light of a continuing bifurcation of the science–practice relationship in both education and training and professional practice. The mutuality of science and practice is emphasized, and the problems of better linkage between psychological science and professional practice are discussed. The current status of the scientist–practitioner model is discussed, and arguments for the need to move beyond textbook accounts of the scientific process are presented. The war of words taking place regarding the nature of psychological science is examined, and an answer to the question of what is meant by the integration of science and practice is provided. Considerations are included of suppositions, including that fruitful interaction of science and practice often is an opportunistic process and that there is nothing so theoretical as good practice. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The necessary role of the autopsy in cardiovascular epidemiology

The autopsy rate in the United States today is remarkably low, with proportionally fewer autopsies for natural causes of death. Consequently, most cardiovascular epidemiology studies do not use autopsy data and rely on death certificates, medical records, questionnaires, and family interviews as sources of mortality information. These practices introduce a high degree of variability and uncertainty regarding cause of death. This review illustrates the necessity for increased use of autopsies in cardiovascular epidemiology by critically evaluating other measures of cardiovascular disease (CVD) incidence. We evaluated the literature regarding CVD as cause of death and conducted discussions with cardiologists, pathologists, and epidemiologists. No attempt was made for meta-analysis. This review shows the limited reliability of death certificates, medical records, and interviews as sources of mortality statistics. In addition, the autopsy's role in clearly indicating the presence of CVD is illustrated. The autopsy used in conjunction with medical records is the only reliable means for establishing cause of death from CVD. There is an urgent need to reassess the current dependence of statistical mortality data on death certificates and other inadequate sources of CVD incidence. Death certificates, in general, are inadequately monitored for quality control and appropriate administrative oversight. With an increase in the number of hospitals performing no autopsies to investigate cause of death, a uniform national autopsy database is needed.     

Photoperiodic modulation of monoamines and amino-acids involved in the control of prolactin and LH secretion in the ewe: evidence for a regulation of tyrosine hydroxylase activity

The aim of this study was to analyse medico-legal autopsy rates among Norwegian citizens who died in the two northernmost counties of Norway during the 20-year period 1973-1992. Medico-legal autopsy rate was defined as the number of medico-legal autopsies divided by the total number of deaths. The rates were calculated according to year of death, manner of death, sex, age, police district and county. The material included 1539 medico-legal autopsies. In the total 20-year period 37.9% (n = 1113) of the violent deaths and 1.2% (n = 426) of the natural deaths were subjected to medico-legal autopsy. The annual rates increased gradually up to 1987. In the last 5-year period 51.7% of the violent deaths and 2.1% of the natural deaths were subjected to medico-legal autopsy. Among violent deaths in this period the medico-legal autopsy rates were: suicides 65.7%, motor vehicle traffic accidents 58.3%, falls 8.6%, and other violent deaths 77.1%. Females dying after a fall and due to natural causes were significantly less frequently than males subjected to medico-legal autopsy. These two categories of death also revealed a significant decrease in autopsy rate with increasing age (age group 0-29, 30-59 and > or = 60 years) in each 5-year period. In cases of violent death the medico-legal autopsy rate according to police district varied from 24.1% to 88.9% in the last 5-year period. In conclusion, medico-legal autopsy rates depended on manner of death, sex, age and police district, besides changes in legislation.     

Importance of the autopsy rate. A comparison between clinical assessment and findings at autopsies during the periods: 1 July 1908--30 June 1981 and 1 July 1990--30 June 1991

On the 1.7.1990 a new law was introduced in Denmark whereby specific consent had to be obtained from the deceased's relatives before autopsy could be performed. Autopsy records from two periods before and after this date, namely from 1.7.1980 to 1.7.1981 and from 1.7.1990 to 30.6.1991, are examined here with respect to autopsy rate and agreement/disagreement between clinical assessment as to cause of death and findings on autopsy. With an autopsy rate of 82.7% before and 10.3% after the new law we found that there was significantly more disagreement between the clinical assessment and the autopsy findings in the 1990/1991 period, presumably because of a selection bias towards difficult cases. The autopsy material from 1990/1991 could only be used for statistics in a limited fashion. A very low autopsy rate of about 10% implies that 25-30% of all death certificates from hospitals must be assumed to be incorrect as concerning serious diseases. The study shows that there is a considerable need for the performance of autopsies for the sake of medical statistics.     

Psychological effects on surviving family members of seeing the deceased person after forensic autopsy.

In medicolegal autopsy, it is essential to consider the emotions experienced by relatives of the deceased person. This study examined the psychological effects on surviving family members of seeing the deceased person’s body after forensic autopsy. Participants (n = 359) were surveyed by means of a questionnaire designed to measure posttraumatic symptoms; 62 participants had been involved in traumatic events related to the bereavement (trauma-involved group), and 297 participants had not (no-involvement group). Statistical analyses using structural equation modeling (SEM) showed that the model implying a significant difference between these groups was better fitted, than that implying no difference. The trauma-involved group showed a higher score for posttraumatic symptoms than the no-involvement group (Ms = .32 and .00, respectively). However, there was a negative correlation in the trauma-involved group between seeing the deceased person after forensic autopsy and posttraumatic symptoms (r = ?.43), but there was no correlation (r = ?.01) in the no-involvement group. Furthermore, factor structure for posttraumatic symptoms in bereaved people showed that treatment focused on avoidance behavior would be most effective Japan. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological kinship: Implications for the helping professions.

Describes kinship as the primary organizing principle in human relations. The notion of psychological kinship is introduced to account for those instances where persons treat certain genetically unrelated significant others as if they were family. As in other human relations, psychological kinship is assumed to play an important moderating role in client–therapist and helpee–helper relations in the helping professions. Various implications of psychological kinship for professional helping, "low" and "high" kinship approaches, and characteristics of the "kinship therapist" are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychological factors in diabetes and its treatment.

Reviews the psychological factors of diabetes with respect to etiology, psychological impact and adjustment to the disease, family dynamics, and psychological programs to aid diabetes management. Stress appears to influence metabolism both directly and indirectly. Little evidence exists for a consistent pattern of traits that typifies diabetes or poor management of the disease. Several studies have shown diverse psychological problems related to diabetes, especially in the area of social problems and peer relationships among juveniles. A variety of psychological interventions may be helpful in the care of diabetes; however, none of these are conclusively useful. Research should clarify the role of stress and stress management and focus on psychological factors related to metabolic control. Treatment research needs careful specification of interventions and measurement of both behavioral and metabolic outcomes so that connections among them may be assessed. (97 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The short tandem repeat loci hTPO, THO1 and FGA

PURPOSE: The purpose of this study was to describe perceptions of quality of life (QOL) of Hispanic patients with cancer pain. DESCRIPTION OF STUDY: This qualitative pilot study is guided by the conceptual framework of pain and QOL. From interviews with 17 Hispanic patients with cancer pain, data on perceptions of QOL were analyzed and are reported here. RESULTS: The study demonstrated the influence of culture on perceptions of QOL and the impact of pain on QOL. Several themes were identified for each domain of QOL, including physical, psychological, social, and spiritual well-being. The role of the family and faith in God were important components of QOL for all patients. CLINICAL IMPLICATIONS: It is important for clinicians to devote greater attention to cultural assessment and to include cultural beliefs in cancer care to improve QOL for Hispanic patients. The role of the family and religious beliefs should be included in the planning and evaluation of each patient's care.     

Constructivist family therapy with the elderly.

Presents an approach for family therapy with elderly persons based on G. A. Kelly's (1955) personal construct theory. This approach provides a constructivist model of psychological functioning in families with elderly members. The model focuses on the events construed by the family, the content of family constructs, the focus of family construing, and outcomes of family construing for elderly family members. A case example of therapy with the family of a 75-yr-old man who presented with depression following the death of his wife is presented. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Real-time X-ray diffraction study at different scan rates of phase transitions for dipalmitoylphosphatidylcholine in KSCN

A questionnaire survey was carried out to examine the attitudes and practices of Australian and New Zealand intensivists with regard to brain death and organ donation. A return rate of 82.5% was achieved. Fifty-eight per cent had written evidence of their own wishes to donate organs and 94% would agree to donation from a dependent. At least one intensivist is involved in certifying brain death on 95% of occasions. Intensivists are involved in the request for organ donation over 90% of the time although one-third do not believe that it is their role to request organ donation. Although two-thirds believe that the family should always be approached for organ donation, another 52 out of 254 indicated that it was their (the intensivist's) role to decide if families should be asked for organ donation. Possible reasons for not requesting are language or other communication problems, perceptions of cultural differences and degrees of family distress. Twenty per cent of respondents do not provide haemodynamic support before brain death confirmation. Australian and New Zealand intensivists overwhelmingly support the concept of brain death, current methods of confirmation of brain death, organ donation and transplantation. Possible reasons behind loss of potential donors include decisions not to resuscitate both before and after brain death is confirmed. Perceptions of family grief and cultural differences clearly inhibit requests for organ donation. A very few units have an effective policy on approaching families about organ donation. Intensivists have almost exclusive control over requests for organ donation and thus bear a full professional responsibility for this element of hospital practice.     

The psychosocial aspects of female patients with genital cancer

Revealing a diagnosis as cancer, usually generates various emotional and psychosocial response in the patients: anxiety, negation of reality, passivity and generalized state of shock and anguish; long term projects and personal responsibilities are annihilated, the image of death grows enormously. Genital cancer women patients also exhibits sexual problems which can seriously complicate the psychic representation of disease and impair family life. Our study comprised 20 women patients who were hospitalized, with genital cancer diagnosis (ovarian cancer, neoplasms of the cervix and of the endometrium); by anamnesis and further discussions we tried to establish the main elements which generated different psychologic reactions. The perception of the reality of the diagnosis was proved to depend on age, personality type, doctor-patient and family-patient relationship. Each stage of disease and each treatment applied generates individual psychologic reaction which can be alleviated by communication between doctor and patients, by a patient adapted language. Complexity of psychological and sometimes psychic reactions of such patients requires that a psycho-oncologist be included in the complex oncologic treatment team; deeper knowledge of the problems and employment of individual or group therapy (the patient's family included) may lead to better psychic response to the malady.     

The metamorphosis of clinical psychology: Toward a new charter as human services psychology.

Contends that the traditional conceptions of clinical psychology (CP) as centering around the treatment of individuals suffering from mental health problems are no longer adequate. The concept of human services psychology, defined as a sector of professional psychology concerned with the promotion of human well-being through the acquisition and application of psychological knowledge about the treatment and prevention of psychological and physical disorders is proposed as an alternative capable of representing both training and practice in contemporary CP and related professional specialities. A biopsychosocial model of human behavior would be the basis for a generic professional program that would be functionally rather than categorically based at the doctoral level. Such a program, based on a systems orientation, has been established at the author's university. It is suggested that human services psychology graduates will be able to confront racism, sexism, delinquency, the effects of poverty, and other social ills in an effective and cost-efficient way. (41 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)