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Biomedical subjects

M D Rudd

Publications and source records attributed to M D Rudd.

At least 19 recordsLinked to original sources
PubMed2001

The course of post-crisis suicidal symptoms: how and for whom is suicide "cathartic"?

We investigated suicide "catharsis" as evidenced by decreased suicidality following a suicide attempt. Past research has examined this issue with mixed results (Bronisch, 1992; Davis, 1990; van Praag & Plutchik, 1985). In the present study, we examined Modified Scale for Suicide Ideation (MSSI) scores for 198 suicidal men during suicidal crisis, prior to entry into a treatment study, and again at 1-month and 12-month follow-ups. Patients were divided into ideators, single attempters, and multiple attempters. We found evidence for decreased suicidality, but interpreted it as the gradual action of interpersonal support, rather than as emotional catharsis. Also, multiple attempt status affected the long-term course of post-crisis suicidality.

Adult↗
PubMed2000

Parameters of suicidal crises vary as a function of previous suicide attempts in youth inpatients.

OBJECTIVES: Although suicidal crises demand an enormous amount of clinical attention, surprisingly little empirical research has been conducted on the parameters of suicidal crises in general, and in children and adolescents in particular. On the basis of past conceptual work on the unique characteristics of multiple suicide attempters, as well as work on the effect of previous suicidal and depressive experience on later functioning, the authors developed predictions regarding the intensity and duration of suicidal crises in youths presenting to inpatient psychiatry units. Specifically, it was hypothesized that multiple attempt status would relate significantly to intensity of suicidal crises and would relate more strongly to intensity than to duration of crises. METHOD: Data on past suicide history and self-rated symptoms were collected for 50 suicidal patients, all of whom were available at follow-up. RESULTS: Findings conformed to prediction: Multiple attempters experienced more intense but not more long-lasting crises; the relation between multiple attempt status and crisis intensity exceeded that between multiple attempt status and crisis duration. CONCLUSIONS: Previous suicidal experience may alter the parameters of current suicidal crises. Implications of these findings for suicide risk and clinical assessment and management are discussed.

Acute Disease↗
PubMed2000

The suicidal mode: a cognitive-behavioral model of suicidality.

This article discusses the theoretical foundation and potential clinical application of the suicidal mode, a cognitive behavioral theory of suicidality. The model presented represents a specific elaboration of Beck's modal theory of psychopathology. In addition to discussing the fundamental requirements of a theory of suicidality, the theoretical assumptions of the suicidal mode are identified, its component parts defined, its inherent strengths emphasized, and its application in clinical settings detailed. Definition of a modal theory of suicidality represents the growing influence of cognitive-behavioral theory in efforts at psychotherapeutic integration in clinical suicidology.

Cognitive Behavioral Therapy↗
PubMed2000

Personality types and suicidal behavior: an exploratory study.

This study used cluster analysis to explore prominent personality traits among a sample of suicidal psychiatric patients (n = 86), with a goal of identifying distinct clusters based on descriptive personality traits as measured by the Millon Clinical Multiaxial Inventory-II (MCMI-II). Three clusters were identified, accounting for 97% of study participants with available data. Additional analyses were conducted to explore differences and similarities among the three groups. The three clusters were comparable with respect to symptomatology (i.e., depression, anxiety, hopelessness), psychiatric diagnoses, and negative life stress, suggesting that cluster differences were not due to severity of disturbance (i.e., symptom severity) or diagnosis. Although all three clusters evidenced prominent negativistic and avoidant traits and two of the clusters showed prominent borderline traits, each was characterized by a distinct trait with implications for interpersonal functioning. Results are discussed in terms of implications for treatment and future research, particularly the importance of the therapeutic relationship with suicidal patients.

Adult↗
PubMed1999

Physiological hyperarousal: construct validity of a central aspect of the tripartite model of depression and anxiety.

Physiological hyperarousal (PH) is an understudied component of the tripartite model of depression and anxiety. This study contributes to the literature on PH, the tripartite model, and anxiety and its disorders, using data from psychotherapy outpatients (n = 2,448), air force cadets (n = 1,335), and undergraduates (n = 284). Psychometrics and exploratory and confirmatory factor analyses showed that PH is a reliable, cohesive, discriminable, and valid construct. Compared with subjective anxiety, PH was more associated to panic versus mood disordered status, and to panic versus generalized anxiety disordered status. As hypothesized, an aspect of anxiety sensitivity (i.e., fear of body sensations) was particularly related to subjective anxiety in the presence of PH. Results support the PH construct as replicable, valid, and clinically important and support the utility of the tripartite and related models for understanding the relation of depressive and anxious syndromes.

Adolescent↗
PubMed1999

Agreement between self- and clinician-rated suicidal symptoms in a clinical sample of young adults: explaining discrepancies.

This study compared self- versus clinician-rated suicide assessment among participants referred for suicidal ideation or behavior, with emphasis on understanding self- versus clinician-rated discrepancies. A total of 328 participants in a suicide-treatment project completed baseline measures of symptoms and personality (including self-report and clinician-rated indexes of suicidal tendency), and portions of the sample completed follow-up assessments at 6, 12, and 18 months. A high rate of discrepancy between self- and clinician ratings of suicidal tendency was noted: the nature of this discrepancy was such that clinicians were likely to see patients as high in suicidal tendency, whereas patients were less likely to see themselves as such. Data on future symptoms indicated that patients' self-ratings contained considerable predictive value. Variables such as history of previous attempts and histrionic personality style may help explain self-versus clinician-rated discrepancies.

Adult↗
PubMed1998

Overview of special issue on adolescent suicide: risk, assessment, and treatment.

Regarding the pressing international health problem of adolescent suicide, the contributors to this special issue have provided new findings and perspectives around the theme of risk and its assessment. These contributions are summarized, and are viewed as examples of the reciprocal efforts of scientists and clinicians to systematize and deepen knowledge on adolescent suicide, and thus beneficially affect a pernicious health problem.

Adolescent↗
PubMed1998

An integrative conceptual framework for assessing and treating suicidal behavior in adolescents.

Suicidal adolescents represent a uniquely demanding clinical population. Regardless of psychotherapeutic orientation, the existing standards of care demand a relatively broad and integrative approach with multiple and specific treatment targets, as well as ongoing and repeated risk assessment. The current article provides an integrative conceptual framework for these tasks in day to day clinical practice with essentially two goals: (1) to provide a summary of therapeutic and assessment tasks (i.e. the content of therapy and assessment) consistent with existing standards of care and supported by empirical findings, and (2) to emphasize the varied roles, tasks, demands and limitations of psychotherapy with suicidal adolescents.

Adolescent↗
PubMed1998

The role of symptom induction in the treatment of panic and anxiety. Identifiable domains, conditional properties, and treatment targets.

Although the importance of affectively charged material in the treatment of panic and anxiety has been emphasized and implicitly viewed as essential for effective therapeutic change, a general framework for organizing, understanding, implementing, and evaluating symptom induction techniques has yet to be offered. This article offers a framework for organizing symptoms induction techniques, categorizing treatment targets, and, accordingly, assessing therapeutic change in the treatment of panic and anxiety. Symptom induction techniques are examined in three exposure domains: physiological, cognitive, and situational/circumstantial; treatment targets fall into five categories: (a) poor symptom tolerance and resultant hypersensitivity and hypervigilance, (b) avoidance of internal and external triggers, (c) the emergence of specific catastrophic thoughts and related misinterpretations, (d) diminished adaptive coping skills, and (e) a reduction in general self-efficacy. Additionally, a distinction is proposed between conditional and unconditional properties of symptom induction, with an emphasis on the potential deleterious role conditional properties play during the course of treatment.

Adaptation, Psychological↗
PubMed1997

Perfectionism, perceived weight status, and bulimic symptoms: two studies testing a diathesis-stress model.

Among a total of 890 women from 2 separate nonclinical samples (1 collected in 1982 on college undergraduates, n = 435, and 1 collected in 1992 on women who were in college in 1982, n = 455), the authors tested a diathesis-stress model of the interrelations of perfectionism, perceived weight status, and bulimic symptoms. The authors predicted and found that perfectionism served as a risk factor for bulimic symptoms for women who perceived themselves as overweight but did not serve as a risk factor for those who did not perceive themselves as overweight. Perceived weight activated perfectionism as a predictor of bulimic symptoms; actual weight did not serve the same role. These findings are discussed in the context of recent clinical and social psychological theory regarding development of bulimic symptoms.

Adult↗
PubMed1997

The Modified Scale for Suicidal Ideation: factors of suicidality and their relation to clinical and diagnostic variables.

The authors conducted the 1st large-sample factor-analytic study of the Modified Scale for Suicidal Ideation (MSSI; I. W. Miller, W. H. Norman, S. B. Bishop, & M. G. Dow, 1986) on a sample of 330 suicidal young adults. Factor analyses revealed 2 MSSI factors: Suicidal Desire and Ideation (ongoing thoughts or desires about suicide) and Resolved Plans and Preparation (intense thoughts, plans, and courage and capability to commit suicide). The Resolved Plans and Preparation factor was more related to Attempt versus Ideator status than was the Suicidal Desire and Ideation factor. The Suicidal Desire and Ideation factor was more highly related to depressotypic indicators than was the other factor, suggesting that level of depression, although predictive of ideation, may not be as strong a correlate of preparation. Comparison of depression- and anxiety-related diagnostic groups on the MSSI factors revealed little difference, consistent with previous work highlighting the occurrence of suicidality across diagnostic groups. These findings have implications for the structure of suicidality, as well as its clinical assessment.

Adult↗
PubMed1996

Amanitin greatly reduces the rate of transcription by RNA polymerase II ternary complexes but fails to inhibit some transcript cleavage modes.

The toxin alpha-amanitin is frequently employed to completely block RNA synthesis by RNA polymerase II. However, we find that polymerase II ternary transcription complexes stalled by the absence of NTPs resume RNA synthesis when NTPs and amanitin are added. Chain elongation with amanitin can continue for hours at approximately 1% of the normal rate. Amanitin also greatly slows pyrophosphorolysis by elongation-competent complexes. Complexes which are arrested (that is, which have paused in transcription for long periods in the presence of excess NTPs) are essentially incapable of resuming transcription in the presence of alpha-amanitin. Complexes traversing sequences that can provoke arrest are much more likely to stop transcription in the presence of the toxin. The substitution of IMP for GMP at the 3' end of the nascent RNA greatly increases the sensitivity of stalled transcription complexes to amanitin. Neither arrested nor stalled complexes display detectable SII-mediated transcript cleavage following amanitin treatment. However, arrested complexes possess a low level, intrinsic transcript cleavage activity which is completely amanitin-resistant; furthermore, pyrophosphorolytic transcript cleavage in arrested complexes is not affected by amanitin.

Amanitins↗
PubMed1996

Cluster analysis of MCMI scores of suicidal psychiatric patients: four personality profiles.

Millon Clinical Multiaxial Inventory (MCMI) scores from 299 suicidal psychiatric outpatients were cluster analyzed in hopes of identifying clinical subgroups and deriving specific treatment indications. The analysis revealed four personality profiles: Negativistic/Avoidant/Schizoid, Avoidant/Dependent/ Negativistic, Antisocial, and Histrionic/Narcissistic. This grouping was validated by examining demographics, diagnoses, and scores on several psychometric scales. Results showed few differences in demographics, diagnosis, or intelligence, but significant differences in depression severity, hopelessness, anxiety, problem-solving self-appraisal, and alcohol abuse. Implications for tailoring interventions for subtypes of suicidal patients are discussed.

Adolescent↗
PubMed1996

Relationships among suicide ideators, attempters, and multiple attempters in a young-adult sample.

The relationships among suicide ideators, attempters, and multiple attempters were explored in 332 psychiatric patients referred specifically for suicidal ideation or behavior. Previous researchers have subsumed multiple attempters under the general category of attempters. However, comparisons across a range of variables, including Axis I diagnoses from the revised 3rd edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1987) depressive and anxiety symptoms, suicidal ideation, hopelessness, problem solving, and a range of personality features revealed that multiple attempters presented a more severe clinical picture and, accordingly, elevated suicide risk compared with attempters and ideators. Observed differences between groups were maintained when attempters with "questionable intent" (i.e., those making equivocal attempts) were excluded from the analyses.

Adult↗
PubMed1996

Effectiveness of an outpatient intervention targeting suicidal young adults: preliminary results.

This study evaluated the effectiveness of a time-limited, outpatient intervention targeting suicidal young adults. Participants (N = 264) were randomly assigned to either the experimental treatment or the control condition (i.e., treatment as usual). In addition to intake assessments, participants completed follow-ups at 1, 6, 12, 18, and 24 months. Both treatment and control participants evidenced significant improvement across all outcome measures throughout the follow-up period. Reductions were reported in suicidal ideation and behavior, associated symptomatology, and experienced stress, along with marked improvement in self-appraised problem-solving ability. Results also indicated that the experimental treatment was more effective than treatment as usual at retaining the highest risk participants. Available data demonstrate the efficacy of a time-limited, outpatient intervention for suicidal young adults. Implications of current findings for intervention with and treatment of this population are discussed.

Adolescent↗
PubMed1996

Millon Clinical Multiaxial Inventory profiles and maladjustment in the military: preliminary findings.

The Millon Clinical Multiaxial Inventory (MCMI) profiles of 69 active duty male soldiers who presented to an outpatient mental health clinic for a broad range of problems are compared to a local normative sample of 84 males. The clinical and comparison groups differed significantly on all 20 scales. In agreement with previous findings, the mean profile for the clinical group was a 2 (Avoidant)-8 (Passive-Aggressive) codetype, whereas the comparison group showed a 5 (Narcissistic)-6 (Antisocial) codetype. Findings offer specific codetypes that effectively discriminate functional versus dysfunctional individuals in a military setting and provide an empirical foundation on which to base future, and critically important, prospective studies of the predictive validity of the MCMI with military personnel. The potential role of the MCMI as a screening and assessment tool in military settings is discussed.

Adolescent↗