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J D Bloom

Publications and source records attributed to J D Bloom.

At least 37 records · Page 2Linked to original sources
PubMed1994

Beta-3 adrenoceptor selectivity of the dioxolane dicarboxylate phenethanolamines.

The beta-1, beta-2 and beta-3 adrenergic properties of several benzodioxole-containing phenethanolamines were determined in vitro in both functional and binding assays. In addition, two of the compounds were evaluated for their effects on radioligand binding and cyclic AMP (cAMP) production in stably transfected Chinese Hamster Ovary (CHO) cells expressing the cloned rat or human beta-3 adrenoceptor or the human beta-2 or beta-1 adrenoceptor. The (+/-)-R*,R*-racemate, CL 314,514, and the pure (-)-R,R enantiomer, CL 316,243, stimulated rat adipocyte lipolysis (beta-3 effect) with EC50 values in the low nanomolar range, while having no effect on the rate of contraction of guinea pig atria (beta-1 effect) and little or no ability to prevent the insulin-stimulated incorporation of [14C]glucose into rat soleus muscle glycogen (beta-2 effect) with concentrations as great as 100 microM. The lack of beta-1 and beta-2 adrenergic activity was confirmed by the low affinity of the compounds for beta-1 or beta-2 adrenoceptors in plasma membranes from rat heart or rat soleus muscle, respectively. In CHO cells expressing each human beta adrenoceptor subtype, CL 314,514 bound to beta-3-CHO cells with a Ki of 2 microM and stimulated cAMP production with an activation constant (Kact) of 1 microM, whereas it did not bind to either beta-1- or beta-2-CHO cells at 100 microM. CL 316,243 bound to membranes from rat beta-3-CHO cells with a Ki of 1 microM and stimulated cAMP production in beta-3-CHO cells with a Kact of 0.7 nM.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Agonists↗
PubMed1994

The No Harm Contract in the emergency assessment of suicidal risk.

BACKGROUND: The No Harm Contract has been widely accepted in clinical practice, yet there is no broad consensus as to its value. This paper examines the contract and offers recommendations for its use as well as cautions about its misuse. METHOD: After a literature review, the No Harm Contract is examined from diagnostic, therapeutic, and medicolegal perspectives. RESULTS: Diagnostically, the No Harm Contract can be used to assess the nature and severity of a patient's suicidality, uncover specific troubling issues precipitating suicidal thoughts, and evaluate the patient's competency to contract. Therapeutically, the contract affords an opportunity to initiate a therapeutic alliance, establish the limits of the psychotherapeutic framework, and reduce both patient and clinician anxiety. Medicolegally, the contract is not legally binding and grants no suicide malpractice suit protection. CONCLUSION: Although the No Harm Contract is a frequently used clinical tool that can provide diagnostic information and therapeutic advantage, it can also short-circuit comprehensive suicidal assessment and disposition decisions.

Adult↗
PubMed1993

Long-term follow-up of rural involuntary clients.

A cohort of 72 persons who had entered a rural Oregon county's involuntary treatment system in 1979 through 1982 was followed for six years. While schizophrenia was the most frequent diagnosis, several other conditions were represented including adjustment disorders, organic mental disorders, and substance abuse. The majority (55%) of persons with organic mental disorders died as did 12% of the individuals with schizophrenia. The overall mortality rate was three times the expected figure (p = .002). During the follow-up period, only 39% of the initial cohort received treatment from a community mental health program whereas 28% were newly admitted (involuntarily) to a state mental hospital. Hospital recividism was most likely among individuals who had had prior involuntary treatment. At least in rural areas, the civil commitment system seems to serve both "infrequent" and "persistent" users. Infrequent users mainly have diagnoses of adjustment disorders and/or substance abuse. Persistent users chiefly have diagnoses of organic mental disorders, mood disorders, or schizophrenia. Modifying the involuntary treatment system to take account of this heterogeneous population's diverse needs is discussed.

Adult↗
PubMed1993

Effects of publicity on a forensic hospital.

Oregon's forensic psychiatry hospital experienced a convulsing chain of events that began with the escape of an insanity acquittee who had been hospitalized following two murders. Although the patient was arrested without reoffending, there were major repercussions in the hospital. This event and related state hospital topics became the subject of intense publicity in the local newspaper. Articles ran almost daily for over a month, the majority of which were on page one. We give here an account of the episode and examine the meaning of the media coverage in the light of administration of public mental health systems, particularly where forensic psychiatry is involved.

Adult↗
PubMed1993

Excluding personality disorders from the insanity defense--a follow-up study.

Examining the effects of Oregon's statutory reform excluding personality disordered individuals from the insanity defense, we previously identified a study sample of insanity acquittees, each of whom was given a primary diagnosis of a personality disorder during subsequent evaluation at the state hospital. In the present study we explore the relationship between that diagnosis and the pretrial psychiatric diagnosis presented to the trial court. By reading the forensic mental health evaluations used at trial we found that 50 percent of our study sample of 34 personality disordered patients were diagnosed with psychotic disorders, affective disorders, retardation, and organic brain disorders. In addition to investigating the diagnosis offered as evidence at trial, we performed assessments of 38 mental health reports using published standards for forensic evaluation reports. We found compliance rates in the various categories ranged from 8 to 84 percent with a mean of 45 percent. We question the value of the mental health input to these trials, and believe that the data tend to validate past aspersions of forensic practice.

Adolescent↗
PubMed1992

Chronic mental illness and perinatal outcome.

A retrospective review of pregnant women admitted to a state psychiatric facility and to an acute university psychiatric unit compares various characteristics of the two populations. No major significant differences were noted in demographic, psychiatric, or obstetric characteristics. It was hypothesized that the patients from the state facility would have a better perinatal outcome secondary to an opportunity for closer prenatal follow-up. No differences were noted in perinatal outcomes between the two facilities. Significantly poorer perinatal outcomes were noted in the combined group of psychiatric patients when compared were noted in the combined group of psychiatric patients when compared with the state of Oregon's birth-outcome statistics. The importance of prenatal care in this high-risk population is discussed, and specific recommendations are offered.

Adult↗
PubMed1992

Improving quality assurance through psychiatric mortality and morbidity conferences in a university hospital.

To make quality assurance more outcome oriented, the department of psychiatry in a university hospital developed a program of psychiatric mortality and morbidity conferences for reviewing cases with undesirable outcomes. The conference combines aspects of a traditional medical mortality and morbidity conference with features of utilization review and risk management. Case review is focused on mortality, morbidity, or specific indicators developed by the departmental services involved and on a determination of whether an adverse outcome was avoidable, possibly avoidable, or unavoidable. The authors summarize the 100 cases reviewed in the first seven months. They believe the focus on outcome gives the method a useful role in quality assurance; advantages include its recognizable contributions to continuing education and training.

Aged↗
PubMed1992

Do-not-resuscitate orders for depressed psychiatric inpatients.

Many patients, especially those who are elderly and who have chronic medical illnesses, choose to forgo cardiopulmonary resuscitation (CPR) in case of cardiac arrest. The right of mentally competent patients to refuse CPR is supported by ethicists, the courts, and medical associations. Psychiatrists are increasingly presented with dilemmas about resuscitation preferences of elderly psychiatric inpatients whose decision-making capacity may be impaired because of mental illness such as depression. The authors discuss justifications for patients' refusing resuscitation, the role of advance directives in communicating patients' preferences, and the use of do-not-resuscitate orders for depressed psychiatric inpatients. Survival rates after CPR among elderly patients with chronic medical illnesses are low. Patients and their families need accurate information about the risks and benefits of CPR and about the consequences of refusing the procedure.

Aged↗
PubMed1992

The involvement of schizophrenic insanity acquittees in the mental health and criminal justice systems.

This article described the mental health and criminal justice involvement of a large group of schizophrenic insanity acquittees and the program designed to manage and treat these individuals. Most insanity acquittees in our system are chronically mentally ill individuals who fit well into the psychosocial rehabilitation models that have developed over the past 15 years. In addition, the use of conditional release and monitored care in the community appears to be the most realistic approach to this group of individuals who show a high degree of involvement with the mental health and criminal justice service systems. This research has continued implications for the development of outpatient civil commitment and for the attempt to give people as much liberty as they are capable of handling while being realistic about their capacities to survive in the community.

Adolescent↗
PubMed1991

Weapons possession by patients in a university emergency department.

STUDY OBJECTIVE: Violence in the emergency department, a not uncommon but complex phenomenon, may become more serious when patients possess weapons. Searches are used frequently to reduce this danger, though guidelines for searches are not well delineated. We examined our practices in order to formalize our guidelines. DESIGN: Retrospective chart review of patients found to be carrying weapons. SETTING: General, university-based emergency department in the Northwest. PARTICIPANTS: Of 39,000 patients seen during the 20-month study period, 500 (1.3%) were searched. MEASURES AND MAIN RESULTS: Of all patients seen in the ED, 92% were medical patients (153, 0.4% of whom were searched) and 8% were psychiatric patients (347, 11.1% of whom were searched). Weapons were found on 89 patients (0.2% of all ED patients and 17.8% of all patients searched). Review showed that 24 (15.7%) medical and 60 (17.3%) psychiatric patients carried weapons. CONCLUSION: Although various factors contributed to a clear bias toward searching psychiatric patients, we believe that the rate of weapons possession did not support this bias.

Adult↗
PubMed1991

Psychiatric consultation to a state board of medical examiners.

This article describes the evolution of psychiatric consultation to the Oregon Board of Medical Examiners. The board is charged with the licensing and regulation of physicians in the state of Oregon in order to protect the public and uphold the standards of the medical profession. Psychiatric consultation has focused on the board's investigations of physicians with mental illness and/or substance abuse and physicians who inappropriately prescribe psychoactive drugs or sexually abuse patients. Each of these physician groups is described, and remedial programs for each group are discussed. The authors conclude that psychiatric consultation to medical boards is a feasible and productive activity that can make a positive contribution to the lives of a large number of physicians and patients.

Drug Prescriptions↗
PubMed1991

Monitored conditional release of persons found not guilty by reason of insanity.

This article reviews the recent literature documenting changes that have taken place in the management and treatment of insanity defense acquittees with the development of conditional release and monitored community treatment. The review demonstrates that conditional release is particularly important as a means of balancing the protection of society with the treatment of insanity defense acquittees in the least restrictive environment. The review also highlights the development of community programs based on treatment models for the chronically mentally ill. In addition, monitored community treatment programs appear cost-effective when compared with hospital-based programs. These factors point to the development in the 1990s of program standards for the release of insanity defense acquittees.

Civil Rights↗