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Biomedical subjects

J D Bloom

Publications and source records attributed to J D Bloom.

At least 73 records · Page 4Linked to original sources
PubMed1988

The duty to protect others from your patients--Tarasoff spreads to the Northwest.

The California Supreme Court's Tarasoff decision was the seminal case in the area of the duty to protect third parties from the potential of violence from patients. Tarasoff-related issues have now spread to many jurisdictions in the country. This article will pay particular attention to the cases influencing law in Washington and Oregon and will review the clinical duty to protect others from your patients that existed before Tarasoff, as physicians were taught to work between privilege and civil commitment statutes. The California law designed to limit Tarasoff liability and the reasons why legislators should be willing to support such legislation are discussed.

Confidentiality↗
PubMed1988

The influence of the right to refuse treatment on precommitment patients.

The unplanned extension of the right to refuse treatment to the precommitment period is described in this paper. This extension of the right to refuse treatment has important public policy implications for the civil commitment process. These implications, as well as the pros and cons of the extension of the right to refuse treatment, are discussed.

Adult↗
PubMed1987

The prevalence and significance of medical illness among chronically mentally ill outpatients.

The prevalence and significance of medical illnesses were examined in a sample of chronically mentally ill patients from an urban community mental health program. Eighty-eight percent had at least one significant medical illness, 51% had at least one previously undiagnosed illness and 53% were judged to be in need of some form of medical attention. The bulk of these illnesses were typical of primary care problems. In terms of causal significance, nearly as many medical illnesses appeared to be the result of the psychiatric disorder (18%) as vice versa (22%). Community mental health programs should make provisions for the medical needs of patients in comprehensive management programs.

Adult↗
PubMed1987

Academic, community and state mental health program collaboration: the Oregon experience.

The authors review the relationship that has evolved over the years between the Department of Psychiatry at Oregon Health Sciences University and Oregon's community and state mental health programs. They describe the compatibility that exists between the basic requirements of academic psychiatry departments and public mental health programs and demonstrate how these organizations have been able to fulfill one another's needs in Oregon. Specific examples of successful collaborations in the areas of education, administration, research, and service are presented to illustrate how relationships that have been designed to meet specific requirements of one organization can fulfill many requirements of both. Suggestions are provided for those organizations contemplating similar collaborative endeavors.

Community Mental Health Centers↗
PubMed1987

The use of DSM-III axis III in recording physical illness in psychiatric patients.

The randomly selected charts of 50 discharged psychiatric inpatients were reviewed for documentation of medical illness and DSM-III axis III diagnoses. Twenty-eight percent of the patients had had medical symptoms, 56% had had medical findings, 36% had had laboratory findings, and 60% had been given axis III diagnoses. In at least seven cases, the medical findings were poorly reflected in the final axis III diagnosis. In no case did the record indicate that medical factors were viewed as the cause of a patient's immediate psychiatric syndrome.

Adult↗
PubMed1987

Competency determinations in civil commitment.

The authors present a brief overview of competency determinations in criminal justice and civil commitment proceedings and review the American Psychiatric Association's Model Commitment Statute, which gives competency a central role. They present an alternative proposal that involves determining a person's competency to undergo civil commitment before a formal commitment hearing and delineates the responsibilities of legal and medical decision makers in the commitment process.

Commitment of Persons with Psychiatric Disorders↗
PubMed1987

The legal basis of forensic psychiatry: statutorily mandated psychiatric diagnoses.

Using the Oregon statutory scheme as an example, the authors review certain areas of the law where psychiatric expertise is mandated by statute. This review points out the diversity of determinations where forensic psychiatric expertise is required by law. The authors' thesis is that forensic psychiatry draws its vitality from the law. Legal requirements, however, should not dictate psychiatric response, which should be guided by psychiatric knowledge and ethical concerns.

Capital Punishment↗
PubMed1987

Psychiatric manpower and services in a community mental health system.

Executive directors of Oregon's 36 community mental health programs were surveyed in the fall of 1983 to determine the nature of psychiatric services offered and the roles played by psychiatrists. The study showed that a total of 18.2 full-time-equivalent psychiatrists were working in the community system, a mean of .5 per program, considerably below the national average. None of the responding directors were psychiatrists, and only six employed psychiatrists as medical directors. The directors valued psychiatrists most highly for their skills in educating, supervising, and consulting with staff; for their unique clinical skills; and for medication management. They considered the biggest disadvantage of employing psychiatrists to be the expense. The authors discuss factors that contribute to psychiatrists' satisfaction with work in community mental health programs and strategies for recruiting and retaining psychiatrists in the programs.

Community Mental Health Services↗
PubMed1987

Treatment refusal among forensic inpatients.

Although the United States Supreme Court has not offered a definite opinion, some states have established the qualified right of involuntarily committed patients to refuse treatment. Controversy continues between psychiatry and law over what procedural protections should be provided to patients when therapists seek to override nonemergency refusal of treatment. The authors review Oregon's administrative approach and its application to the treatment refusal of 33 state hospital forensic patients. Patient characteristics, refusal patterns, and implications of treatment refusal are also described.

Adult↗
PubMed1987

Methodology for the analysis of civil commitment detention times and costs.

The authors expand their methodology for quantifying and comparing civil commitment processes by developing new formulas for the determination of the average commitment detention time and cost. They also examine the effects of specific changes in commitment procedures on the average detention time and cost. Using data from Oregon's civil commitment process, the authors present several examples of the practical application of their methodology and conclude with a discussion of its major administrative and research implications.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

A method for quantifying and comparing civil commitment processes.

The authors present a three-step civil commitment model and formulas for calculating 1) the probability of release from the commitment process and 2) the relative importance of the three steps in determining outcome. Using data from Oregon's civil commitment process, they present five examples that demonstrate how their method might be used to study and monitor civil commitment processes within and between jurisdictions. The major public policy and research implications are discussed.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Oregon's Psychiatric Security Review Board: a comprehension system for managing insanity acquittees.

The insanity defense is a particularly controversial aspect of the interaction between law and mental health. During the past decade, many states have revised or abolished their insanity defenses. Oregon, however, chose in 1974 to retain its existing defense and create a new, unique system for the post-adjudication management of insanity acquitees. Oregon's legislature established the Psychiatric Security Review Board (PSRB), which is composed of five part-time members drawn from different disciplines, to conduct periodic hearings to determine the placement and supervision of defendants who successfully raise the insanity defense and remain mentally ill and dangerous. The PSRB has received national attention as a promising approach to managing mentally ill offenders. The authors first describe the structure and operation of the Oregon system. Then they summarize the empirical studies they have conducted of the PSRB in action.

Forensic Psychiatry↗