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Biomedical subjects

A R Felthous

Publications and source records attributed to A R Felthous.

At least 19 recordsLinked to original sources
PubMed1996

Medically serious suicide attempts in a jail with a suicide-prevention program.

A suicide prevention program was implemented at the Galveston County Jail in 1986, reducing the number of suicides to only one from that time until the present. In the ten years prior to the implementation of the program, there had been seven suicides. Nevertheless, there have been a number of cases of medically serious suicide attempts that have occurred since implementation of the program. Thirteen cases of suicide attempts severe enough to warrant transfer to an emergency room for medical attention were identified through jail incident reports as occurring between 1989, when improvements were made in record-keeping at the jail, and July of 1994, when this study was initiated. Hospital records, jail medical records, jail administrative records and, in some cases, competency evaluations were obtained for each case. The cases were examined regarding demographic data, psychiatric history, circumstances surrounding the act, and results of psychiatric evaluation performed after the act. The findings were then compared to studies of suicides and near-suicides in the literature. Examination of these cases has provided information that should render the suicide prevention program even more effective as well as provide useful information to other jails interested in implementing or improving a suicide-prevention program.

Adolescent↗
PubMed1995

Combined homicide-suicides: a review.

Although the rate of combined homicide-suicides is low compared with that for suicide alone or homicide, homicide-suicides generate much public concern. In some cases, the homicide-suicide involves annihilation of an entire family or multiple non-family members. A difficult phenomenon to study--in part because the perpetrator is dead--it is, nonetheless, crucial to attempt to advance our understanding of this tragic phenomenon from a psychiatric view. This literature review then addresses demographic variables; proposes two classifications, one based on psychopathology, the other on the relationship between offender and victim; and suggests a three dimensional analytical approach to understanding homicide-suicide: 1) psychopathology and ego deficits of the perpetrator, 2) cumulative and precipitating stressors, and 3) motivation and vector of destructive urges against self and the other victim(s). Finally, some implications for mental health clinicians and forensic experts are offered. In attempting to understand acts of homicide-suicide, inquiry into the following dimensions should be useful: Ego Weakness. What type of mental disorder(s), psychopathology, or personality traits may have contributed to the homicidal-suicidal behavior? Stressors. What type of acute and chronic stressors did the individual experience leading up to this act? Vectors. Whom did the individual select to kill and why? Were some victims more clearly primary and others secondary or incidental?

Adult↗
PubMed1994

Preventing jailhouse suicides.

Psychiatric consultants to city and county jails are confronted with the challenge of preventing jailhouse suicides, a problem of national scope. Suicide prevention programs in jails must emphasize screening and identification, psychological support, observation, disarmament, clarity and consistency, and diagnosis, treatment, and/or hospitalization. Exactly how these principles are formulated and implemented will depend on the unique circumstances of each jail. Finally information is presented as evidence that a program that embodies these principles can effectively reduce the number of suicides in a jail where the average daily census has increased from fewer than 400 to greater than 900 in the past six years.

Facility Design and Construction↗
PubMed1994

The incompetent defendant: support systems help avoid future legal problems.

Reducing crime and improving efficiency of our criminal justice system should be facilitated by identifying how to treat and manage mental health patients who are prone to committing criminal acts more effectively. A total of 142 competency evaluations were reviewed from cases evaluated by the Galveston County Forensic Psychiatrist from 1984 to 1990. Examination of data from these defendants allowed us to address the psychiatric needs of these defendants in terms of contact with the mental health system, particularly those who had more than one criminal justice system contact. The latter defendants lacked social support systems and consistent mental health system follow-up to provide stabilization of their condition. It was felt that this was a factor in their more frequent contact with the criminal justice system.

Adolescent↗
PubMed1993

Substance abuse and the duty to protect.

The Tarasoff case provided some legal guidance for handling the situation where a patient threatens deliberate violence against an identifiable individual. But what about the situation where a patient's substance abuse impairs safe driving of a large commercial vehicle such as an airplane, clearly endangering a class of individuals (passengers)? Some legal restrictions on confidentiality, if followed literally, would not even permit the therapist to take preventive measures advocated by the Tarasoff court when deliberate violence is threatened, let alone more specific measures to prevent a tragic accident with loss of many lives. Review of literature on the relationship between alcohol and operator safety leads to the conclusion that therapists must have some latitude in which to exercise judgment free of professional liability. The dilemma posed by contrasting duties to maintain confidentiality and to make preventive disclosures is too rigid to govern all situations, especially a worsening risk of substance-induced accidents by drivers of public carriers.

Accidents, Aviation↗
PubMed1991

The diagnosis of intermittent explosive disorder in violent men.

In a study of violent men, 443 symptomatic adult male volunteers were evaluated for presence of intermittent explosive disorder (IED). Investigators first established presence of severe and frequent violent outbursts not readily explainable by another disorder. Seventy-nine violent men were so selected. Of these, 26 had excessive impulsivity, an exclusionary criterion for IED. Twenty-one were excluded because of other, exclusionary mental disorders. Violent behavior of five subjects was deemed proportionate to the provocation. Insufficient data were obtained for an accurate diagnoses of IED in 12 subjects. Fifteen subjects satisfied all criteria for IED, i.e., 18.9 percent of sufficiently violent men without other major psychopathology or 1.49 percent of all 443 men who complained of violence. Epidemiologic and validity aspects of IED are discussed.

Adult↗
PubMed1989

Blood platelet uptake of serotonin in episodic aggression.

Blood platelet uptake of 3H-serotonin (5HT uptake), a potential marker of serotonergic function, was determined in male outpatients with episodic aggression (n = 15) and in age- and sex-matched nonaggressive controls (n = 15). Correlations with rating scales of "impulsivity" (Barratt Impulsivity Scale, 10th revision) and "anger" (Spielberger Anger Expression Scale) were performed. Mean 5HT uptake was 18% lower in patients with episodic aggression. A significant negative correlation between % difference in platelet 5HT uptake and impulsivity score was observed, but the correlation between 5HT uptake and anger was not significant. These results support the hypothesis of disturbed serotonergic function in aggression and suggest that the primary relationship is in the "control" of aggression. The blood platelet may be useful in identifying impulsive subtypes.

Adolescent↗
PubMed1989

Teaching forensic psychiatry to medical students.

Are separate courses on forensic psychiatry available for medical students? During the 1985 to 1986 academic year, the authors surveyed all U.S. medical schools to identify courses on forensic/legal psychiatry. A minority of schools included separate courses or practicums on forensic psychiatry or mental health law. In a follow-up telephone survey, instructors of each of these courses were interviewed. Information was obtained on format of course, duration, discipline of instructor or instructors, topics covered, reading materials, institutional settings, and the number of students who took the course. The results are discussed and compared with earlier surveys.

Curriculum↗
PubMed1987

Childhood cruelty to animals and later aggression against people: a review.

The existing literature on the relationship between childhood cruelty to animals and later violence against people appears to be inconsistent. The authors review the controlled studies that did not support this relationship and those that did and identify several methodological factors that may have contributed to the contradictory findings. Studies using direct interviews to examine subjects with multiple acts of violence point to an association between a pattern of childhood animal cruelty and later serious, recurrent aggression against people. Identification of such a relationship could improve understanding of impulsive violence and facilitate early intervention and prevention.

Adult↗
PubMed1987

Liability of treaters for injuries to others: erosion of three immunities.

For years treaters of mental patients who harmed other persons were largely protected by three doctrines: the common law rule of nonresponsibility, sovereign immunity, and the "honest error" rule. The present paper examines the erosion of these immunities that has occurred over the last 30 years. As the strength and breadth of these protections have lessened, claims of negligence have expanded. Failure to properly diagnose includes failure to foresee violent acts. Failure to properly treat includes failure to restrain a violent patient. The recently asserted failure to protect others is not necessarily based on failure to diagnose or to treat, or, for that matter, on medical malpractice law.

Confidentiality↗
PubMed1987

Health law and mental health law courses in US medical schools.

Results of a recent survey of all 127 medical schools in the United States indicate that about two fifths of medical schools offer a separate course that focuses on topics in medicine and law and a number of medical schools integrate health law topics into other courses. Presumably reflecting concern over temporary medical malpractice litigation, most health law courses include informed consent, medical malpractice, privileged/confidential information, and patients' rights. In contrast, schools that offer a course on psychiatry and law are clearly in a minority. It is elective at all but two of the 13 schools with such a course. Although the hours allotted and the format of these courses vary greatly, courses typically cover most of the topics listed on the questionnaire. Most of the courses are led or co-led by a member of the American Academy of Psychiatry and the Law. Information from two additional surveys suggests two related factors that may influence a medical school to present a separate course on health law. Medical licensing boards were surveyed to determine which states require physicians to be examined on health law. In two states that require physicians to pass a separate medical jurisprudence examination for licensure, all four-year medical schools offer a course on health law for medical students. Medical malpractice companies providing coverage in all 50 states and the District of Columbia were surveyed to determine which states have the highest claim rates. The claim rate per 1,000 physicians insured per year was significantly greater in states with health law courses than was the rate in states without such courses.

Curriculum↗
PubMed1986

Violence against animals and people: is aggression against living creatures generalized?

An association between childhood cruelty to animals and dangerous aggression against people at a later age could have important implications regarding early detection and treatment, preventive psychiatry, and a social ethic that encourages positive attitudes toward living creatures in general. Research reports in the literature are inconsistent and inconclusive regarding a possible relationship between animal cruelty and aggression against people. Although a single act is not predictive of another act, a pattern of substantial animal abuse may conceivably be associated with a pattern of recurrent violence directed against people. In the present study, extensive interview schedules were administered to aggressive criminals, nonaggressive criminals, and noncriminals. The nature of abuse was described for each subject who gave a history of substantial abuse. A clear relationship was found between early substantial abuse and recurrent violence against people. Possible explanations for conflicting results in the literature are discussed.

Aggression↗
PubMed1986

Schizotypal personality disorder and the insanity defense.

What constitutes a "mental disorder" for purposes of the insanity defense? Does mental disorder denote any diagnosable condition listed in the third edition of the Diagnostic and Statistical Manual of Mental Disorders? Is a mental disorder a disturbance wherein the functional criteria of the appropriate insanity law appear to be met? Or does insanity law define mental disorder apart from functional criteria of insanity? The answer to the last question is that some insanity laws attempt to define or qualify mental disorder, but many do not. Unclarities in the law leave room for unnecessary disagreements between expert witnesses even before the functional criteria for insanity are to be addressed. The potential for confusion is compounded when the defendant's disturbance is ambiguous, amphibious, or both. Schizotypal personality disorder is offered as an example of such a disturbance, and inferences are discussed.

Expert Testimony↗
PubMed1984

Preventing assaults on a psychiatric inpatient ward.

Although appropriate evaluation, management, and treatment of violence-prone patients will tend to reduce the incidence of aggressive acts on a psychiatric ward, such measures are not enough to prevent eruptions of violence. The author discusses several specific preventive steps that staff of psychiatric units can take to reduce the likelihood that assaults will occur: forming and maintaining a social norm against violence, recognizing and managing countertransferential reactions among both staff and patients, ensuring responsible involvement by psychiatrists during violent incidents, thoroughly assessing a patient's potential for assault, and paying prompt attention to the significance of an assault for the involved patient, other patients, and staff.

Aggression↗