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Biomedical subjects

L H Roth

Publications and source records attributed to L H Roth.

At least 37 records · Page 2Linked to original sources
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↗
PubMed1989

Statutory approaches to limiting psychiatrists' liability for their patients' violent acts.

A consensus has developed among mental health professionals that the legal duty to protect potential victims of their patients' violent acts, as fashioned by the courts, requires modification. To date, 12 states have responded with legislation designed to clarify and limit clinicians' responsibilities. In addition, APA has distributed a model statute as a resource document to aid those psychiatrists interested in stimulating legislative action. This paper examines existing statutes and the APA resource document, considers the variety of ways in which the goals of reform can be achieved, and recommends approaches that balance desires for public safety with the legitimate needs and concerns of the mental health professions.

Forensic Psychiatry↗
PubMed1988

The psychiatrist as legal guardian.

Most discussions about legal guardianship pertain to special populations, such as the mentally retarded or demented. Except for the case of refusal of antipsychotic medication, little has been written about using guardianship to authorize nonemergency treatment for a person who is mentally ill and treatable. The authors present several cases in which a consulting or administrative psychiatrist served as a temporary guardian for a hospitalized patient's personal affairs. The psychiatrist-guardian authorized diagnostic procedures or ECT for the temporarily incompetent patient and was then discharged as guardian. The authors discuss the problems and limitations of such a role for the psychiatrist.

Aged↗
PubMed1988

Assessing the NCSC guidelines for involuntary civil commitment from the clinician's point of view.

Two clinicians who helped develop the National Center for State Courts' 50 guidelines for involuntary civil commitment assess how well the guidelines address some of the common problems clinicians face during the commitment process. The guidelines with potential to help clinicians call for the establishment of screening agencies to reduce unnecessary commitments; encourage the development of models for outpatient commitment; attempt to ensure that information gathered during the evaluation process reaches clinicians; suggest how clinicians can more validly predict whether a patient is dangerous; and advocate more research and evaluation of civil commitment processes. The guidelines that would hamper good clinical care advocate using lawyers as brokers of services and requiring the courts to approve treatment plans. Clinicians are urged to become familiar with the guidelines.

Advisory Committees↗
PubMed1985

Informing patients about tardive dyskinesia.

The effects of a formal (written) approach v an informal (oral) approach to obtaining informed consent for neuroleptic treatment were compared in 25 schizophrenic outpatients with tardive dyskinesia. Both groups had significant increases in knowledge, but only the informal/oral presentation group retained significant new knowledge at two-month follow-up. Overall, patients did not learn the information deemed most relevant for rational decision making about neuroleptic treatment. Younger patients started out with more knowledge and retained significant new knowledge at follow-up. All study patients remained in treatment and all but one remained on neuroleptic regimens. There was no increase in relapse or treatment noncompliance in the study population compared with a comparison group. While information about tardive dyskinesia can be safely disclosed to schizophrenic outpatients, such disclosure is evidently most meaningful when repeated informally in the context of a therapeutic relationship.

Adult↗
PubMed1985

Informed consent in psychiatric research: preliminary findings from an ongoing investigation.

Preliminary findings from an investigation of informed consent processes in four psychiatric research projects (two being carried out at a university medical center and two at a public psychiatric hospital) are reported. Study methods include the systematic observation of investigator/subject information disclosure sessions using audio and videotape, as well as the use of standardized interaction rating forms and subject understanding interviews. In an attempt to determine if subjects' understanding of research can be improved through increased subject education, several modes of information disclosure are compared. Partial results from the public psychiatric hospital portion of the investigation suggest low subject understanding in many areas with subjects often demonstrating difficulty differentiating between treatment and biomedical research. Subjects' problematic understanding of research purposes and methodology was compounded by investigator disclosures which often emphasized the therapeutic, personalistic and nonresearch-oriented aspects of the project. Nevertheless, even when information disclosures were significantly improved, subject understanding in many cases continued to be low--suggesting that additional factors aside from the quality of investigator disclosure are involved in psychiatric subjects' comprehension and understanding of research. The implication of these findings for informed consent, regulation of biomedical research and the protection of human subjects are discussed.

Antidepressive Agents↗
PubMed1984

Involuntary treatment in medicine and psychiatry.

It is often asserted in the debate on the right to refuse treatment that psychiatrists are the only physicians who treat patients against their will. During 11 weeks on two wards in a general medical hospital, the authors observed 18 episodes of involuntary treatment and restraint (1.17 episodes per 100 patient-days). Involuntary treatment was usually employed when the refusals of patients judged incompetent interfered with needed treatment. Restraints and psychoactive medications were the most common interventions. These data suggest that involuntary psychiatric treatment is mirrored in general medicine and has its roots in medical paternalism, rather than in the function of social control.

Aged↗
PubMed1984

Children's understanding of psychiatric hospitalization.

The authors summarize the results of what they believe to be the first systematic study of children's concepts of their own psychiatric hospitalization. They found that children 6-12 years old are able to gain progressive insight into their problems and the roles that therapeutic staff (doctors and nurses) play in treatment. These findings provide new information about the child's point of view and cognitive understanding of psychiatric hospitalization, illness, and treatment. The findings suggest that preadmission legal hearings addressing the child's understanding of the nature of psychiatric hospitalization would not be meaningful.

Age Factors↗
PubMed1983

Patients who refuse treatment in medical hospitals.

Treatment refusal in medical hospitals, despite the interest it has aroused among lawyers and ethicists, has been largely ignored by the medical profession. This study of the phenomenon in a number of medical and surgical settings has disclosed that refusal is a common occurrence. In this study, refusals were often precipitated by problems within the physician-patient relationship, although several interactive factors were usually involved. Physicians' responses to refusal tended to be undifferentiated with regard to the precipitants, depending more heavily on the medical urgency of the situation. Costs of refusal were measurable in terms of delay and increased expense when treatment was ultimately accepted and, less commonly, in terms of physical harm to the patient. These findings illustrate important strains in the modern physician-patient relationship and suggest that closer attention to factors underlying refusal may increase the rate of successful resolution.

Adult↗