Faculty Bibliography

Suicide risk assessment is a subjective process and remains a clinical challenge in psychiatry. We aimed to examine physicians' characteristics that influence management of acutely suicidal patients. In a cross-sectional design, we performed an anonymous internet survey of psychiatry residents and attendings from four academic centers. Gender, years of experience, practice setting, prior patient suicide, and personal exposure to suicide were characterized. Participants were presented with three clinical vignettes and asked to rate suicide risk and clinical disposition. The relationship between responses to the vignettes and physician characteristics were examined with generalized linear models. Fifty-four residents and 49 attendings completed the survey. Four (7%) residents and 24 (49%) attendings had patients die by suicide, whereas 32 (59%) and 36 (74%), respectively, knew somebody outside their practice who died by suicide. Among residents, lower rating of acute suicide risk was associated with prior exposure to non-patient suicide. Less hospitalization chosen by attendings was associated with greater perceived difficulty of suicide risk assessment. In the combined resident and attending sample, less proneness to hospitalize was associated with number of previous patients die by suicide and with outpatient practice. Our results suggest that previous exposure to suicide is associated with more risk-averse management.

Over 22 million US residents are limited English proficient. Hospitals often call upon untrained persons to interpret. There is a dearth of information on errors in medical interpreting and their impact upon cancer education. We conducted an experimental study of standardized medical interpreting training on interpreting errors in the cancer encounter, by comparing trained and untrained interpreters, using identical content. Nine interpreted cancer encounters with identical scripts were recorded and transcribed. Using an 'Error Analysis Tool,' a bilingual linguist and two bilingual medical providers scored the transcripts for interpreting errors made, including their potential clinical severity. Trained interpreters were 70% less likely to have clinical errors than untrained ones. The likelihood of medical error increased with the length of the concept and decreased with the precision of vocabulary. It is important to train medical interpreters and to ensure their availability in cancer education encounters to minimize the risk for errors

Increasing evidence suggests that smooth pursuit eye movement (SPEM) dysfunction may serve as an endophenotype or genetic marker of schizophrenia. The authors tested SPEM and visual fixation (VF) in 31 patients with schizophrenia, 33 of their first-degree relatives, and 24 patients with major depressive disorder. A high rate of abnormal VF was found in schizophrenic patients and their first-degree relatives, but not in affective disorder patients with or without psychotic features. Rate of VF abnormality distinguished schizophrenic patients from acutely depressed mood disorder patients; SPEM did not. VF and SPEM performance correlated only moderately, suggesting that the pathophysiologies of these two eye movement abnormalities may be partially independent. Implications for identifying a schizophrenia endophenotype are discussed

Odor discrimination deficits were found in 80% of 20 schizophrenia patients and in none of the 20 age- and sex-matched comparison subjects. Olfactory discrimination was reliably measured in the patients. Twelve patients in this study also had smooth pursuit eye movement (SPEM) qualitatively recorded. The olfactory discrimination scores were highly correlated to SPEM but not to other clinical measures. This correlation suggests a shared neurobiology, possibly involving working memory