PubMed Health⌕ Search

Biomedical subjects

J M Harkavy-Friedman

Publications and source records attributed to J M Harkavy-Friedman.

8 recordsLinked to original sources
PubMed2001

Delusions and suicidality.

OBJECTIVE: Delusions have been considered a risk factor for suicidal behavior. To determine whether specific delusion types are related to suicidal behaviors, the authors compared the clinical characteristics of patients with mood disorders and schizophrenia who did and did not have a history of suicide attempts. METHOD: After admission for inpatient or outpatient psychiatric treatment, 429 patients (ages 14-72 years; 47.1% male; and 73.0% Caucasian) were assessed with a structured clinical interview that generated axis I and II diagnoses. In addition, their psychiatric symptoms, history of suicide attempts, and overall functioning were rated. RESULTS: Data for three diagnostic subgroups (223 patients with major depression, 150 with schizophrenia, and 56 with bipolar disorder) were analyzed separately. Multivariate analyses did not find evidence of a relationship between delusions and history of suicidal ideation or suicide attempts in any of the diagnostic groups. CONCLUSIONS: This study did not find evidence that the presence of delusions distinguished persons with or without a history of suicide attempt.

Adolescent↗
PubMed2001

Therapist reporting of suspected child abuse and maltreatment: factors associated with outcome.

Several studies have found that making a report of suspected child abuse or maltreatment concerning a client in psychotherapy is more likely to have a positive outcome for the relationship or to effect no change, than to be damaging. The current study examined factors that were associated with outcome. Three variables, all of which concerned the client-therapist relationship, were found to be important for outcome. The quality of the relationship before the report made the greatest contribution to predicting outcome, with stronger alliances associated with positive outcome. Also important is the length of time in treatment, with longer periods of time related to positive outcome. In addition, more effective handling of making the report is related to positive outcome in that it differentiated improved from no-change groups. Lastly, statistical trends were found both for a relationship between therapist comfort in reporting and positive outcome, and for families tending to have more negative outcomes than adults in individual treatment or children. This is the first time that the examination of factors related to outcome was based upon information received from mental health professionals who were confirmed by CPS as reporters of suspected child abuse and maltreatment. Findings from this and related studies should be incorporated into training programs to ease concerns about the effects of reporting on the psychotherapy relationship and to offer guidance about factors that could increase positive outcomes. Such training could provide needed information to practitioners in reporting situations and enable more complete reporting.

Adult↗
PubMed1999

Suicidal behavior in schizophrenia: characteristics of individuals who had and had not attempted suicide.

OBJECTIVE: This study compares demographic and clinical characteristics of 52 individuals with schizophrenia or schizoaffective disorder who had attempted suicide with those of 104 individuals with schizophrenia or schizoaffective disorder who had not made a suicide attempt. METHOD: Participants were interviewed with the Diagnostic Interview for Genetic Studies. RESULTS: Most suicide attempts were of moderate to severe lethality, required medical attention, and involved significant suicidal intent. Individuals who had and had not attempted suicide did not differ with respect to demographic variables, duration of illness, rate of depression, or substance abuse. The two groups are affected differentially when depressed. CONCLUSIONS: Biopsychosocial assessments and interventions are essential for reducing the risk for suicidal behavior in individuals with schizophrenia.

Adult↗
PubMed1997

Management of the suicidal patient with schizophrenia..

No matter what the course of treatment determined to be most appropriate, suicidal behavior must be considered thoroughly, and it must be conveyed to the patient that the clinician can assist him or her through this period of increased distress. Hopelessness must be viewed as a symptom with the assumption that a more meaningful sense of purpose will emerge despite the chronic and potentially limiting nature of schizophrenia. Most people with schizophrenia are not suicidal, and most who are suicidal can be offered interventions that will reduce their symptomatology and thereby dissipate their suicidal behavior.

Combined Modality Therapy↗
PubMed1997

Assessment and intervention for the suicidal patient with schizophrenia.

The risk for suicidal behavior in schizophrenia is high with 10-15% committing suicide and 20-40% making suicide attempts. Due to the chronicity and complexity of schizophrenia and the multi-determined nature of suicidal behavior, the clinician must utilize a biopsychosocial approach to assessment and intervention. Clinical factors such as psychosis, depression and substance abuse increase the risk for suicidal behavior in schizophrenia. Social factors such as social adjustment and social supports also play a critical role. Ongoing assessment and intervention of suicidal behavior, clinical symptomatology, social environment and treatment issues are essential. Prediction and prevention of suicidal behavior are not always possible however. Treatment focused on the reduction of symptomatology and maintenance of an effective social environment may attenuate the risk for suicidal behavior in schizophrenia.

Chronic Disease↗
PubMed1997

Change in the therapist: the role of patient-induced inspiration.

Clinicians experience positive changes in emotion, cognition, and behavior that they attribute to their work with particular patients. This process of change is termed inspiration. The goals of this study are: (1) to demonstrate that clinicians report being inspired by certain patients; (2) to compare inspiring and noninspiring patients regarding the strength of the therapeutic alliance; (3) to explore how the therapist changes as a result of working with the inspiring patient, and (4) to investigate what patient factors are inspiring. Of 300 randomly selected NASW members in the New York metropolitan area working in mental health settings, 84 completed a survey about inspiring and noninspiring patients that included the Working Alliance Inventory. Of these participants, 59 provided narrative responses about ways in which they have changed as a result of their work with inspiring patients. Inspiring patient factors were described by 37. The therapeutic alliance with the inspiring patient was found to be stronger than that with the noninspiring patient. Clinicians described various changes in personal and professional realms. In addition, specific patient factors such as perseverance and the ability to overcome serious obstacles were described as inspiring. The process of inspiration and implication of the findings in this study are discussed.

Adult↗
PubMed1993

Suicidal behaviors in adult psychiatric outpatients, I: Description and prevalence.

OBJECTIVE: Because the findings of previous studies of suicidal behaviors in psychiatric outpatients may not necessarily generalize to outpatients with a wide spectrum of psychiatric diagnoses, the authors evaluated the prevalence of suicidal behaviors in a large general psychiatric outpatient clinic whose patients represented a full spectrum of psychiatric illness. METHOD: A total of 651 patients participated in the study between 1987 and 1989. These patients had sought treatment at the outpatient psychiatry department of a private nonprofit hospital. Before being interviewed for treatment, all patients were given a comprehensive self-rating survey packet that included the Harkavy Asnis Suicide Survey and the Hopkins Symptom Checklist-90. The Harkavy Asnis Suicide Survey is a self-report questionnaire that assesses demographic variables, current and past history of suicidal behaviors of the patient as well as family members and peers, and a detailed description of each previous attempt. RESULTS: Fifty-five percent of the patients had a history of suicidal ideation, and 25% reported at least one previous suicide attempt. Approximately half of the suicide attempters reported multiple attempts. The predominant methods of attempt were overdose (53%), jumping (17%), and wrist cutting (17%). Suicidal behavior was prevalent in most diagnostic groups. The rates of suicidal ideation among patients with mood disorders (major depression, dysthymia, and bipolar disorder), adjustment disorders, and alcohol/substance abuse were significantly greater than that of the patients with generalized anxiety disorder. CONCLUSIONS: The authors conclude that suicidal behavior is prevalent among patients who seek treatment in a general outpatient department.

Adjustment Disorders↗