Biomedical subjects

M H Rajab

Publications and source records attributed to M H Rajab.

14 recordsLinked to original sources

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

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

Three years of experience with prospective randomized effectiveness studies.

We developed methodology for prospective randomized effectiveness studies using a demonstration project at a multispecialty practice, health maintenance organization, and hospital in academic medical center. An operational unit called the effectiveness registry was developed to design and support comparisons of potential practice improvements with standard care. The studies differ from observational effectiveness studies in that they provide long-term follow-up of randomized comparison groups. Physician involvement in data collection is limited. No tests or observations are made other than those required for clinical care. Follow-up and data collection are modeled after tumor registry procedures. Patients who refuse randomization enter the study in whichever treatment arm they choose. The protocol for each study is approved by the institutional review board (IRB) before recruitment begins, and all patients, randomized and nonrandomized, sign an informed consent document. Between its beginning on October 7, 1993 and April 7, 1997, the IRB approved 14 trials. Four were terminated after entering at most a few patients. Recruitment is complete in four trials and continues in six. Randomization was accepted by 74% (596/804) of the patients. Over 800 patients in 10 studies are being followed at least annually. Major peer-reviewed journals have accepted reports of initial findings for two studies. Prospective randomized effectiveness studies are feasible in the multipractice setting and have potential to provide useful and reliable assessment of treatment outcomes. Collaborative arrangements between several institutions are needed to provide larger sample sizes.

Academic Medical Centers↗

PubMed1997

Forced-air warming is no more effective than conventional methods for raising postoperative core temperature after cardiac surgery.

OBJECTIVE: To determine whether postoperative forced-air warming of cardiac bypass patients in the intensive care unit (ICU) results in faster rate of warming and improved outcomes compared with more conventional ICU warming methods. DESIGN: Prospective randomized effectiveness study. SETTING: Three hundred fifty-bed university-affiliated hospital. PARTICIPANTS: Sixty consenting randomized patients from a consecutive series of 84 patients undergoing routine adult cardiac surgery. INTERVENTIONS: One group of patients received usual patient care, which includes warm blankets and overhead heat lamps. Patients in the other group were placed under forced-air warming devices on arrival in the ICU. Sixty consenting patients (30 in each group) were randomly assigned to one or the other method of warming. The remaining 24 patients refused randomization and self-selected a treatment group. MEASUREMENTS AND MAIN RESULTS: Results are presented for the randomized groups. Core temperature, measured by pulmonary artery catheter thermistor, increased in both groups at the rate of 0.25 degree C per hour. No statistically or clinically significant differences were found between the group for whom the warming device was used and the standard care group in the incidence of postoperative cardiac arrhythmia, duration of time in the ICU, or any other clinical variable. CONCLUSIONS: There is no evidence from this study to warrant use of forced-air warming devices for the care of postoperative cardiac surgical patients in the ICU.

Aged↗

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

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↗

PubMed1995

Use of the modified scale for suicidal ideation with suicide ideators and attempters.

The Modified Scale for Suicidal Ideation was administered to, and subsequently cross-validated on, a large sample of suicide ideators and attempters. Results confirmed previous reliability estimates and provided convincing evidence of the scale's concurrent, construct, discriminate, and predictive validity. The utility of the scale in screening with high-risk populations and other areas of critical need it addresses are discussed.

Adolescent↗

PubMed1995

Help negation after acute suicidal crisis.

This study represents one of the first efforts to empirically differentiate between suicidal patients who complete treatment and those who voluntarily withdraw after resolution of the immediate crisis and, accordingly, before formally beginning treatment or within the first 2 days. Participants were contrasted across a range of variables, including suicide ideation, depression, hopelessness, problem solving, life stress, diagnoses in accordance with the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987), and characterological features. Results indicate the high-risk nature of those withdrawing prematurely from treatment and suggest that this behavior potentially represents another manifestation of overall maladaptive coping, consistent with prominent avoidant, negativistic, and passive-aggressive personality traits.

Adolescent↗

PubMed1994

Problem-solving appraisal in suicide ideators and attempters.

The present study expands on previous research proposing a diathesis-stress-hopelessness model of suicidal behavior. The role of problem-solving appraisal within such a conceptual framework and the generalizability of the model across both suicide ideators and attempters are explored. Results support the critical role played by problem-solving appraisal in predicting both hopelessness and suicide ideation.

Adolescent↗

PubMed1993

Diagnostic comorbidity in persons with suicidal ideation and behavior.

OBJECTIVE: An initial finding of heightened risk of suicidal ideation or behavior among individuals in a random community sample who met diagnostic criteria for panic disorder or panic attacks was not replicated in later studies of both general and specific groups of psychiatric outpatients. The present study represented another effort to validate the finding. METHOD: The participants included 209 outpatients who had attempted suicide or were at high risk for continued suicidal behavior or eventual suicide. All subjects were evaluated with a structured clinical interview for assigning DSM-III-R diagnoses, the Modified Scale for Suicidal Ideation, the suicidal ideation subscale of the Suicide Probability Scale, and the Beck Hopelessness Scale. RESULTS: The findings indicated the relative complexity and importance of diagnostic comorbidity among these suicidal subjects. Mood disorders were the most frequent primary diagnoses, followed by phobias, posttraumatic stress disorder (PTSD), generalized anxiety disorder, and panic disorder. Panic disorder was not present as an isolated, independent diagnosis; on the contrary, all of the patients with panic disorder also received at least one additional comorbid diagnosis. Mean scores for suicidal ideation and hopelessness were greatest for patients with current comorbid primary mood disorder and panic disorder. However, a critical and equally important role was played by comorbid PTSD, generalized anxiety disorder, and phobias. CONCLUSIONS: The findings represent another failure to validate, with a specific clinical group, panic disorder as an independent risk factor for suicidal ideation or behavior. However, they highlight the possibility that panic disorder and other anxiety disorders are risk factors when they co-occur with a primary mood disorder.

Adolescent↗

PubMed1992

Performance of three tropical hair sheep breeds.

The performance of three hair sheep breeds (Brazilian Somali, Morada Nova, and Santa Ines) was evaluated in the production environment of northeastern Brazil. Data from a total of 524 lambs sired by 21 rams and out of 190 ewes were analyzed. These data were collected from 1980 to 1983 at Sobral, Brazil from an experiment designed to compare performance of the three breeds. The traits included weights of lambs at birth, weaning, 8 mo, 10 mo, and yearling ages and ewe characters of weight at lambing (EWT), total lamb weight born (LWB), total lamb weight weaned (LWW), and prolificacy rate (PR). Differences (P < .01) among breeds were found for all characters. The Brazilian Somali, the smallest and slowest-gaining breed, was less sensitive to yearly variation than were the other breeds. The Santa Ines, the largest and fastest-gaining breed, was superior in LWB and LWW per ewe lambing. Averaged over the 4-yr period, the Morada Nova had the highest PR (1.82), and the Brazilian Somali and Santa Ines had similar PR (1.39 and 1.31, respectively). Environmental effects on PR due to yearly rainfall quantity and distribution pattern influenced lamb growth up to weaning and ewe reproduction performance. Breed x year (P < .05) interaction effects on PR were largely attributable to the Somali breed's exhibiting higher PR than the Santa Ines and Morada Nova breeds during the relatively wet years of 1981 and 1982.

Age Factors↗

PubMed1991

Simulation of genetic and environmental interaction of three tropical hair sheep breeds.

The Texas A&M Sheep Simulation Model was used to examine genetic-environmental interactions (GEI) among Brazilian Somali, Morada Nova, and Santa Ines breeds and type and level of feed supplement in northeast Brazil. Two sets of simulations were conducted to examine effects of different supplement quality (napier grass vs cunha legume) and quantity (napier grass only). The analyses indicated the benefits from supplementing lambs at weaning during the dry season and from supplementing lactating ewes at the beginning of lambing season when forage is scarce. The cunha legume was an effective supplement, but choosing between cunha legume and napier grass is an economic consideration. Increasing the amount of napier grass supplement per ewe from 200 g/d to 400 g/d resulted in a significant GEI (i.e., different levels of response such as lamb mortality rate, lamb weaning weight, and lambing rate for different breeds). The Brazilian Somali was the least responsive, whereas the Santa Ines was the most responsive to supplementation. It was concluded that the level of supplement should be higher for the Santa Ines and Morada Nova than for the Somali. The amount of supplement should be regulated so that it neither substitutes for nor lowers the utilization of the native caatinga forage. None of the breeds was simulated to be superior in all environments. Thus, considering the wide range of resources of individual farmers, any one of these breeds may be the preferred choice, depending on the individual set of production resources.

Animal Feed↗