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Biomedical subjects

J Monahan

Publications and source records attributed to J Monahan.

At least 55 records · Page 3Linked to original sources
PubMed1996

Mentally ill and non-mentally ill defendants' abilities to understand information relevant to adjudication: a preliminary study.

The legal construct of competence to stand trial, or "adjudicative competence," is based on the premise that some mentally disordered defendants have impaired abilities when compared with most defendants and that adjudication should be barred if these competence-related abilities are significantly impaired. Where the line is drawn between sufficient and insufficient abilities has important consequences: as a result of being adjudicated incompetent, defendants may be detained and treated involuntarily and their trials will be delayed. However, no studies have systematically compared the capacities of relevant groups of defendants. In this study, 84 criminal defendants--42 of whom were hospitalized as incompetent and 42 of whom were regarded as unquestionably competent--were administered three instruments measuring capacity to understand legally relevant information. Incompetent defendants performed more poorly on all measures of understanding. Twenty-eight incompetent defendants were administered the measures a second time, after restoration to competence. Restored defendants improved their performance on all measures of understanding and their performance was similar to that of normal, competent defendants.

Adolescent↗
PubMed1995

Perceived coercion in mental hospital admission. Pressures and process.

BACKGROUND: Patients' perceptions of coercion in admission may affect their attitude toward subsequent treatment, including their inclination to adhere to treatment plans. This study looks at the determinants of patients' perceptions of coercion. METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania community hospital were interviewed within 48 hours of admission about their experience of coming to the hospital. All subjects were 17 years or older. Diagnoses were diverse, and 42% were involuntarily committed. The interview gathered an open-ended description of the admission experience followed by a structured interview that included several measures. RESULTS: Perceptions of being respectfully included in a fair decision-making process ("procedural justice") and legal status were most closely associated with perceived coercion, and a significant relationship was found with perceived negative pressures, ie, force and threats. However, only procedural justice was related to the perception of coercion at both sites and with both voluntary and involuntary patients. CONCLUSIONS: Patients' feelings of being coerced concerning admission appears to be closely related to their sense of procedural justice. It may be that clinicians can minimize the experience of coercion even among those legally committed by attending more closely to procedural justice issues.

Adult↗
PubMed1993

Patient, family, and staff perceptions of coercion in mental hospital admission: an exploratory study.

Little is known about the coercive pressures brought to bear on psychiatric patients in the hospitalization process. Significant methodological hurdles stand in the way of this research. Most notably, reliable and valid methods of ascertaining and quantifying perceptions of coercion have not been developed. This report summarizes the findings of an exploratory study designed to gather data needed to refine the conceptualization and measurement of coercion. Multiple perspectives on admission incidents for forty-three patients (26% of whom were involuntarily hospitalized) were obtained. Patients were administered research interviews and completed a self-administered inventory shortly after the admission decision. The admitting clinician and a family member involved in the admission were administered parallel interviews. In addition, focus groups comprised of outpatients, former patients, family members, and clinical staff were conducted to uncover the terminology and description of coercion commonly used. The implications of these preliminary quantitative and qualitative findings for future research are discussed.

Adult↗
PubMed1993

Inclusion, motivation, and good faith: the morality of coercion in mental hospital admission.

We administered a semi-structured interview to 157 patients shortly after their admission to a psychiatric hospital. In the first, and open-ended, part of the interview, patients were asked to talk about what had been going on in their lives that led to their coming into the hospital. Then, in a more structured format, they were asked more specific details about who was involved, the patients' relationships with those involved, whether any attempts were made to influence the patient to come into the hospital, and whether such attempts were perceived as fair by the patient. This article presents a qualitative review of the transcripts of a subset of these interviews. It attends specifically to patients' perceptions of the morality of attempts by others--primarily family members, friends and mental health professionals--to influence them to be admitted to the hospital, and of the morality of the process by which these influence attempts resulted in admission.

Coercion↗
PubMed1993

Two scales for measuring patients' perceptions for coercion during mental hospital admission.

Legal and extra-legal coercion are pervasive in mental hospital admission and there are sharp disputes about its appropriate role. This article presents two scales for measuring psychiatric patients' perceptions of coercion during hospital admission and reports data on these scales' internal consistency. We measure patients' perceptions of coercion by asking questions, in either an interview or questionnaire format, about their experience of lack of control, choice, influence, and freedom in hospital admission. Patients' responses to questions about their perceptions of coercion were highly internally consistent. The internal consistency of the scale was robust with respect to variation in site, instrument format, patient population, and interview procedure. Correspondence analysis was used to construct two numerical scales of perceived coercion.

Adolescent↗
PubMed1993

Ethical and legal duties in conducting research on violence: lessons from the MacArthur Risk Assessment Study.

This article addresses the ethical and legal duties that must be confronted in any study of the risk of interpersonal violence in the community. Ongoing research--the MacArthur Risk Assessment Study--on the markers of violence among released mental patients is taken as illustrative. Methods by which the researchers are discharging their legal and ethical duties are described and justified. Strategies center around the duty to protect research subjects from their own violence, and the duties to protect research staff and third parties from subjects' violence. By airing these rarely discussed issues, the authors hope to initiate a professional dialogue on crucial ethical and legal aspects of the research process.

Adolescent↗
PubMed1992

Concordance between habitual sleep times and laboratory recording schedules.

The validity of laboratory-based studies of sleep depends, in part, upon good concordance between habitual sleep schedule and laboratory recording schedule. Without good concordance, error variance due to the circadian misplacement of sleep and to different amounts of time in bed is probable. In an assessment of scheduling concordance in 1,762 research patient nights over two time intervals, we observed good concordance (< 30-minute discrepancy) in 71.2-77.3% of bedtimes and waketimes, discrepancy (difference of > or = 30 minutes) in 14.9-24.2% of bedtimes and waketimes, and missing data in 4.6-7.5% of times. Waketime differences were consistently in the direction of earlier laboratory than habitual waketimes, whereas differences in bedtime were about equally divided between earlier and later (laboratory vs. habitual). Subjects with schedule discordance averaged 19.5 minutes less time in bed during laboratory sessions as compared with their habitual sleep schedule, whereas subjects with schedule concordance averaged only 3.6 minutes less (p < 0.001). Our experience suggests that it may be more difficult to achieve higher rates of concordance among young adult and middle-aged subjects than among elders and that patient requests related to external constraints on scheduling were a frequent reason for discrepancy. We strongly recommend a policy of routinely including data on laboratory versus habitual sleep times in peer-reviewed publications.

Adult↗
PubMed1992

"A terror to their neighbors": beliefs about mental disorder and violence in historical and cultural perspective.

This tribute to the enduring legacy of Bernard Diamond explores public perceptions of a link between mental disorder and violent behavior. Research on contemporary American beliefs is summarized and compared both to historical accounts of public perceptions in Western cultures and to anthropological investigations of public perceptions in non-Western cultures. The conclusion of these reviews is that the belief that mental disorder bears some moderate association with violent behavior is both historically invariant and culturally universal.

Cross-Cultural Comparison↗
PubMed1989

Dangerousness and commitment of the mentally disordered in the United States.

This article describes recent developments in mental health laws in the United States, especially as they relate to uses of the concept of "dangerousness" in the civil and criminal commitment of the mentally ill. In addition to providing a brief overview of the U.S. legal system and noting the importance of the Rule of Law, we review the historical development and current status of the relevant laws, provide some basic epidemiological statistics, and refer to some of the considerable body of extant empirical research in the field.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Detection of human leukocyte interferon-alpha A and -alpha 2 genes in genomic DNAs by the use of deoxyoctadecyloligonucleotide probes.

Two deoxyoctadecyloligonucleotides complementary to the sequence spanning a single base substitution between human leukocyte interferon (HuIFN) alpha A and alpha 2 genes were efficiently used as probes to distinguish between HuIFN-alpha A and -alpha 2 genes. At 37 degrees C or 42 degrees C under aqueous conditions (0.9 M NaCl), hybridization between both probes and the alpha A and alpha 2 genes without any mismatch was strong, whereas the hybridization with one base mismatch (alpha A probe-alpha 2 gene and alpha 2 probe-alpha A gene) was very weak or negligible. Because the single base substitution of G in the alpha 2 gene for A in the alpha A gene provides an extra HinfI site in the alpha 2 gene at the center of the sequence hybridizing to the alpha 2 probe, digestion with HinfI restriction endonuclease caused complete loss of the hybridization between the alpha 2 probe and the alpha 2 gene. PvuII digestion provides 298-bp fragments hybridizing to the probes only from the alpha A and alpha 2 genes among the known HuIFN-alpha genes. Thus, with the use of these oligonucleotide probes in combination with PvuII and PvuII-HinfI restriction endonuclease digestion, the existence of the sequences corresponding to both IFN-alpha A and IFN-alpha 2 genes in human genomic DNAs was demonstrated. The results also surprisingly indicate that these genes, formerly considered alleles because of their essential identity (1 base pair difference in the coding sequence), are not likely to be alleles, but represent closely related distinct genes.

DNA Restriction Enzymes↗
PubMed1984

The prediction of violent behavior: toward a second generation of theory and policy.

The "first generation" of research studies on the prediction of violent behavior found such prediction to be highly inaccurate. Many social policy changes were implemented or recommended on the basis of that research. More recently, a second generation of research and theory on violence prediction has begun to develop that emphasizes the limitations of the existing body of research, points to possible improvements in predictive technology, and evaluates public policies involving violence prediction only in the context of the feasible alternatives to those policies.

Commitment of Persons with Psychiatric Disorders↗