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Biomedical subjects

F Cournos

Publications and source records attributed to F Cournos.

50 records · Page 3Linked to original sources
PubMed1990

Medication and psychotherapy in the treatment of chronic schizophrenia.

Current theory in the treatment of schizophrenia emphasizes medication and expresses considerable doubt about the value of psychotherapy. Yet the data that lead to this conclusion have been gathered in studies of carefully selected groups of cooperative patients who consent to treatment and participate well in scientific studies. In public psychiatry, where many patients are uncooperative and even coerced into treatment, we have found that attention to the patient's individual psychology is essential to success. We examine the role of the psychiatrist who provides psychotherapy and medication in the context of a comprehensive program for patients with chronic schizophrenia.

Adult↗
PubMed1989

Rivers in practice: clinicians' assessments of patients' decision-making capacity.

Since the Rivers v. Katz decision in 1986, clinicians in New York State have been required to assess patient decision-making capacity before judicial review of petitions to administer involuntary medication. The authors examined 42 capacity assessments made by psychiatrists at a large state hospital in New York City. Although the capacity assessments were often incomplete and rarely addressed the treatment decision, most clinicians judged patients as lacking capacity to make treatment decisions. The findings suggest that psychiatrists may view capacity assessments as irrelevant because of the manifestly grave nature of patients' illnesses or may not differentiate the capacity assessment from the mental status examination. The capacity assessment may nonetheless be a useful tool because it encourages clinicians to discuss the proposed treatment with patients and to present information more effectively in court.

Adult↗
PubMed1989

The management of HIV infection in state psychiatric hospitals.

Patients with AIDS and related illnesses are entering state mental hospitals in increasing numbers. State hospitals in New York City generally did not plan for patients infected with human immunodeficiency virus (HIV) until the first patient appeared; however, over the past five years, approaches to managing these patients have evolved in the areas of admission policies, in-hospital care, and discharge planning. Strengthening infection control procedures through the adoption of universal precautions was the most straightforward aspect of in-hospital care. Testing for HIV and confidentiality of the test results proved most controversial. Clinical leaders urged that testing be done only with pre- and posttest counseling and only if the patient has symptoms of HIV infection, has requested the test, or has exposed others to infection. The authors describe these and other policies addressing medical care, restraint and seclusion, sexual behavior, and education and training.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Clinical presentations of AIDS and HIV infection in state psychiatric facilities.

The epidemiologic, neuropsychiatric, and medical data on AIDS and HIV infection that are relevant to state psychiatric facilities are reviewed. The epidemiologic data suggest that a larger than expected number of AIDS patients may be seen in these facilities. Patients who are severely disturbed and psychotic may present to state hospitals with HIV encephalopathy. In patients who are chronically and severely ill, physical symptoms, including oral and cutaneous conditions, the HIV wasting syndrome, and lymphadenopathy, may provide early clues to HIV infection. The early neuropsychiatric and medical findings in HIV infection are discussed, and a clinical case is presented.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Involuntary medication and the case of Joyce Brown.

In October 1987, Joyce Brown became the first homeless person removed from New York City's streets and hospitalized under a city initiative that authorized evaluation of "gravely disabled" homeless persons for admission to inpatient psychiatric treatment. Miss Brown's highly publicized and ultimately successful court battle to prevent a course of forced medication is described. Her refusal of medication was upheld based on her capacity to understand the proposed treatment and to express a partially rational opinion about it. The author, who served as independent psychiatric consultant to the court on the decision about Miss Brown's involuntary medication, uses the case to illustrate some of the problems of involuntary psychiatric intervention, including the commitment of competent patients and the lack of a coherent approach to persistent treatment refusal.

Adult↗
PubMed1988

A comparison of clinical and judicial procedures for reviewing requests for involuntary medication in New York.

The Rivers v. Katz decision substituted judicial review for administrative review of requests for involuntary medication of patients in New York State mental hospitals. This change, prompted by concern for the rights of involuntarily committed patients, did not delay or diminish the use of involuntary medication in a large state hospital. Advantages of judicial review include a better understanding by clinicians of the legal basis for involuntary medication and greater patient participation in the review procedure. Disadvantages include lack of an independent clinical review and increased costs.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

The impact of environmental factors on outcome in residential programs.

Although community residential placements are among the leading areas of program expansion for the chronic mentally ill, they have been designed without scientifically validated models. The author reviews the literature on the impact of residential environment on the course of serious mental illness. In most studies, environmental variables were better predictors of outcome than were patient variables. This overall finding suggests the value of further research on environment and the importance of applying the results to program development.

Chronic Disease↗
PubMed1987

Hospitalization outcome studies. Implications for the treatment of the very ill patient.

There are two basic findings from the hospitalization outcome literature: Active treatment is more effective than custodial care, and length-of-stay has little influence on later outcome. We have no current models that help us conceptualize the optimal hospital treatment for patients who are refractory, noncompliant, or without social supports. This article reviews the most important hospitalization outcome studies and emphasizes the need for further research in this area.

Borderline Personality Disorder↗
PubMedDate not supplied

Orders not to resuscitate and the psychiatric hospital.

In 1983, the President's Commission for the Study of Ethical Problems in Medicine recommended that all health care institutions be required to develop appropriate policies and procedures for withholding life-sustaining treatment from terminally ill patients. While such policies have been extensively debated, there has been little discussion of the problem in the psychiatric literature. Yet state mental hospitals handle many terminally ill patients, often without having clarified their medical responsibilities. This article focuses on Do Not Resuscitate (DNR) policies in psychiatric settings. It offers illustrative case examples and reviews the important principles and legal decisions that pertain to DNR policies. In hospitals that have no clearly defined medical standards, patients often receive inferior care. The need to develop DNR policies presents an opportunity to discover more thoughtful approaches to medical care in psychiatric hospitals.

Aged↗