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Biomedical subjects

J L Geller

Publications and source records attributed to J L Geller.

At least 19 recordsLinked to original sources
PubMed1992

Clinical encounters with outpatient coercion at the CMHC: questions of implementation and efficacy.

Clinical encounters with three outpatients at a CMHC who were managed with alternating periods of voluntary or uncoerced and involuntary or coerced treatment are presented. The two periods of coerced community treatment--of eight months and then two to four years duration--produced positive results quite distinct from the periods of uncoerced community treatment. In discussing the implementation and efficacy of coerced outpatient treatment at the CMHC, the author addresses legal, clinical, and resource issues which form the basis for seven arguments often heard as to why staffs at CMHCs hesitate to employ involuntary or coercive interventions.

Adult↗
PubMed1992

Adult lifetime prevalence of firesetting behaviors in a state hospital population.

Hospital records of all patients under age 65 years old on the census of Worcester State Hospital (WSH) on October 25, 1988 (n = 279) were reviewed for indications of firesetting behaviors during the individuals' adult lifetime. The prevalence of firesetting behaviors was found to be 27.2%. The prevalence of firesetting episodes, a subset of firesetting behaviors, was found to be 17.6%. A stepwise discriminant function analysis was used to determine whether any factors significantly differentiated the members of the firesetting behavior group from the remainder of the population. This analysis revealed that the number of WSH admissions, the number of admissions to other inpatient facilities, and a history of injurious behavior to self are significant positive predictors of membership in the firesetting behaviors group. The results of the WSH analysis are very similar to those found at Northampton State Hospital in 1983. These high prevalence rates have implication for treatment, education, record keeping, and liability.

Adult↗
PubMed1992

Who repeats? A follow-up study of state hospital patients' firesetting behavior.

The authors report on a population of psychiatric patients who were studied over a 6.75 year period to determine the occurrences of firesetting behavior noted in their psychiatric inpatient records. Two groups of 50 patients each were drawn from an earlier study and were matched by sex, age, and diagnoses. One group of patients had prior firesetting behavior; the other did not. Firesetting behavior was found not only in patients originally identified as having previously engaged in this behavior, but also in those with no documented history of this act prior to the period of the study. Patients having firesetting behavior in their past psychiatric record set more actual fires. Total number of episodes of firesetting behavior, however, was not significantly different between the two groups. Results are discussed in terms of the communicative function of firesetting and the dilemma of clinical prediction.

Female↗
PubMed1992

A historical perspective on the role of state hospitals viewed from the era of the "revolving door".

OBJECTIVE: By focusing on the functioning of a state hospital throughout its existence, the author provides a historical perspective on the nature and causes of "revolving door" admissions. METHOD: Northampton State Hospital was chosen as a prototype, and data on characteristics of patients and patterns of hospital utilization were analyzed from three 10-year periods: 1880-1889, 1930-1939, and 1980-1989. The data for the first two time periods came from the hospital's admission and discharge logbooks and its annual reports; the material for the most recent decade was obtained from unpublished yearly reports generated by the hospital's medical records department. RESULTS: The hospital operated very differently in each of the decades analyzed, but only in the 1980s was recidivism a major finding. This was not, as has often been thought, due to problems or populations unique to the state hospital in the 1980s nor to the fact that in earlier eras the state hospital rarely discharged patients. The once-large asylum has been replaced by a facility rapidly admitting and discharging patients, many of whom have accumulated more than 10 lifetime admissions, in a pattern of care not previously noted. CONCLUSIONS: State hospitals have functioned in different yet questionable ways throughout their history. Their current role of providing a revolving-door pattern of care to a considerable population is rooted in a contemporary shift in ideology. This role for state hospitals appears to make no more sense than did their earlier role as neglected and neglectful asylums, and it should be reevaluated.

Adult↗
PubMed1992

The relationship between community resources and state hospital recidivism.

OBJECTIVE: The authors examined the propositions that a revolving state hospital door is an inevitable consequence of deinstitutionalization and that enhancing resources for community-based care can limit this phenomenon. METHOD: They analyzed the recidivism patterns of state hospital patients in a region of Massachusetts where, because of a federal court consent decree, the level of funding for community programs was more than twice as high as it was in other regions in the state and compared the pattern of recidivism in this region with that observed in the other areas of the state. RESULTS: Despite the fact that the average daily state hospital census in the resource-rich region was only half that of the other regions, longitudinal data on hospital use showed that the readmission patterns were similar in all state regions. CONCLUSIONS: The authors suggest that attributes of serious and persistent mental illness may have more effect on hospital readmission patterns than service system variables.

Community Mental Health Services↗
PubMed1992

Hypothalamic lesions and intermittent explosive disorder.

The authors present two cases of patients with craniopharyngiomas who meet the DSM-III-R criteria for intermittent explosive disorder. Episodes of rage developed before and/or after surgery for removal of the craniopharyngioma. Magnetic resonance imaging revealed hypothalamic-hypophyseal involvement. It is suggested that hypothalamic lesions played a major role in the development of aggressive behavior in both cases.

Adult↗
PubMed1992

A report on the "worst" state hospital recidivists in the U.S.

A total of 196 nonspecialty state hospitals in the U.S. each identified one patient--referred to as the hospital's "worst" recidivist--admitted to the hospital in 1987 who had the most lifetime admissions to that hospital. Persons admitted for mental retardation or substance abuse detoxification were excluded. The mean age of the recidivists was 42.2 years; their mean age at first admission was 24.7. The number of admissions per patient ranged from five to 121, with a mean of 31. Compared with the national population of state hospital admissions, significantly larger proportions of recidivists had diagnoses of schizophrenia, bipolar disorder, and personality disorder. More research is needed to determine actual community tenure of patients who receive revolving-door care and whether alternative approaches would be more effective.

Adult↗
PubMed1992

Arson in review. From profit to pathology.

Arson is a crime committed by thousands of people throughout our nation for nearly every reason, justification or excuse known to mankind ... Arson is one of the easiest crimes to commit but the hardest to prevent or prove ... Arson is a crime which involves little skill, as the weapon used is legally carried and too readily available ... Unlike many other covert criminal activities, the impact of increased major arsons has a direct visible effect on the lives of the average citizen. Insurance premiums are raised, property is destroyed, people are killed or maimed, and the quality of life in the area affected by arson is diminished considerably. These statements, taken from US Senate hearings on arson in the late 1970s, are as true and as troubling today as they were over a decade ago. Many who set fires need mental health services of some kind, a fact alluded to even in popular literature. Dick Francis, a well-known author of British mysteries, writes, "There are people in this world who cause trouble because it makes them feel important. They're ineffectual, eh? in their lives. So they burn things ..." But nobody wants these arsonists in their midst. Psychiatric facilities do not want them so they end up in prison: Yet another case has been reported of a mentally disordered person being sent to prison because there is no other institution willing to receive her ... a severely mentally disordered woman aged 22 [was sentenced] to life imprisonment for arson ... in default of other appropriate facilities ... to protect the public. And general hospital emergency rooms cannot find anyplace to send them: "The hardest patients to sell are the repeaters with bad reputations, the firesetters and those who are potentially violent." Any arson episode is an act the magnitude of which the perpetrator cannot predict accurately. Once set, the fire is no longer responsive to the desires or dictates of the firesetter. To address the problem of arson in our times, arson investigators for law enforcement agencies and for insurance companies, fire chiefs, and mental health professionals must develop a joint commitment to public education, cooperative plans for prevention and intervention, and a shared research agenda.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1991

"Anyplace but the state hospital": examining assumptions about the benefits of admission diversion.

One function of contemporary psychiatric emergency services is to divert patient admissions from state hospitals. Underlying this mandate are a series of untested assumptions about the positive effects of admission diversion. The author examines these assumptions using data on inpatient admissions from a crisis intervention service. Although the service was successful in preventing first admissions to the state hospital, the rate of recidivist admissions increased. Inpatient treatment in general or private hospitals did not result in shorter lengths of stay or fewer bed days than state hospital treatment. Because patients could be sent to any of several hospitals, some located far from the catchment area, continuity of care and treatment in the local community were not advanced by diverting admissions from the state hospital.

Community Mental Health Centers↗
PubMed1991

Effect of evaluations of competency to stand trial on the state hospital in an era of increased community services.

The authors studied court-ordered inpatient evaluations of competency to stand trial at two Massachusetts state hospitals for the period from 1972 to 1987, with particular attention to the effects of a 1978 federal court consent decree that created an extensive system of community-based services in the catchment area of one of the hospitals. The authors found that the broad array of community services developed under the consent decree did not reduce commitments to the state hospital for evaluation of competency to stand trial at the same rate as it reduced civil commitments, with the result that the composition of the patient population changed to include a significantly larger proportion of patients referred by the criminal justice system. This proportion was as high as 17.8 percent in 1985. These patients used a disproportionate share of the hospital's resources, staying in the hospital for a median of 28 days, compared with 12 days for all other patients.

Antisocial Personality Disorder↗
PubMed1990

Empirically assessing the impact of mobile crisis capacity on state hospital admissions.

The literature on emergency psychiatric services contains numerous claims to the effect that mobile crisis capacity reduced hospitalization by resolving emergencies in the community. To date these claims have not been substantiated by empirical analysis. This study, using 1986 data from Massachusetts, compares first and total admission rates of catchment areas with mobile capacity to those without such services, controlling for differences in community resources and demand for hospitalization. This analysis showed no effect of mobile capacity on admission rates. These findings are not interpreted as evidence of the ineffectiveness of mobile services, but are seen as indicative of the need for further empirical investigation of these services.

Analysis of Variance↗