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Biomedical subjects

S Eth

Publications and source records attributed to S Eth.

At least 19 recordsLinked to original sources
PubMed1992

The psychotherapist as witness for the prosecution: the criminalization of Tarasoff.

The "duty to protect" doctrine heralded by the Tarasoff decision seeks to prevent physical harm to third parties by psychiatric patients. Recent court cases have mandated the testimony of a criminal defendant's psychotherapist both about the Tarasoff warning itself and about confidential treatment information that was associated with the warning. One court further ruled that some clinical sessions were not psychotherapy and therefore were not afforded the protection of psychotherapist-patient privilege. The continuing erosion of confidentiality has resulted in psychiatrists and other mental health professionals becoming prosecution witnesses at the criminal trials of their own patients.

California↗
PubMed1991

Mass hysteria among student performers: social relationship as a symptom predictor.

OBJECTIVE: In April 1989 an outbreak of illness suddenly afflicted student performers in Santa Monica, Calif., and an extensive investigation revealed no environmental cause. To clarify the details of the epidemic and determine whether mass hysteria occurred, the authors examined physical, psychological, and social factors that might have contributed to the outbreak. METHOD: Participating middle- and high-school performers were surveyed; 93% (N = 519) responded; cases were defined as students who had one or more symptoms during the outbreak. A stepwise logistic regression analysis was used to determine significant predictors of illness. RESULTS: Characteristic features of mass hysteria were present, including preponderance of illness in girls, symptom transmission by sight or sound, presence of hyperventilation, and evidence of psychological or physical stress. Symptomatic and asymptomatic groups differed in frequency of several physical and psychological variables, but observing a friend become sick was the best predictor of the development of symptoms. CONCLUSIONS: These results confirm earlier research demonstrating multiple psychological and physical factors that contribute to such outbreaks, particularly symptom transmission through social networks. Investigators should explore social transmission as an additional characteristic feature of mass hysteria in order to facilitate early identification of future outbreaks.

Achievement↗
PubMed1991

Legal and ethical issues in electroconvulsive therapy.

The use of electroconvulsive therapy (ECT) today has become mired in legal regulations. Obtaining a valid informed consent prior to administering ECT is the duty of the treating psychiatrist; failure to obtain such consent is the most common area of professional liability. The trend of increased judicial scrutiny of ECT has generated both clinical and ethical dilemmas, especially in the context of the emerging concept of the right to effective treatment.

Electroconvulsive Therapy↗
PubMed1991

The Tarasoff dilemma in criminal court.

The duty to protect, or Tarasoff duty, has been conceptualized as arising solely in the context of a clinical setting. A recent California Supreme Court ruling in People v. Clark adds legal, clinical, and ethical dilemmas to the oftentimes contentious Tarasoff issue. Though the Tarasoff issue is but a minor legal point in Clark, a possible consequence of Clark is that a Tarasoff warning could be deemed nonconfidential and admissible in a criminal trial. Psychotherapists could therefore be testifying in criminal courts as prosecution witnesses. While the possibility of a chilling effect on patients' disclosure of violent ideation in the context of psychotherapy first caused apprehension after the California Supreme Court's 1976 decision in Tarasoff v. Regents of the University of California, this same Court's ruling in People v. Clark some 14 years later may ensure that this fear finally becomes realized.

Adult↗
PubMed1990

Patient psychopathology and expressed emotion in schizophrenia.

The relationship of a full range of psychiatric symptoms to EE was examined in 40 men with BPRS and SANS diagnoses of schizophrenia or schizoaffective disorder. Patients from high-EE families had significantly higher ratings of positive symptoms, anxious depression, and overall psychopathology, but not negative symptoms, than did those from low-EE families. In predicting relapses of schizophrenia, account may need to be taken of an interaction between subtle differences in symptoms and relatives' attitudes.

Adult↗
PubMed1989

Can schizophrenia cause posttraumatic stress disorder?

Theories about schizophrenia have viewed stress and anxiety as both predisposing factors and associated features of the disorder. But these theories ignore a possible fundamental interaction: Terrifying psychotic experiences might act as traumatic events and precipitate a posttraumatic stress syndrome. We present a case of schizophrenia complicated by posttraumatic stress disorder and discuss the implications of this comorbidity for theory, research, and practice.

Adult↗
PubMed1989

Behavioral science and the juvenile death penalty.

Behavioral science data included in an amicus brief has been introduced into a recent Supreme Court decision (Thompson v. Oklahoma) involving the juvenile death penalty. However, a close examination of the data fails to provide support for either the pro- or antijuvenile death penalty position.

Adolescent↗
PubMed1988

The child victim as witness in sexual abuse proceedings.

The psychiatrist working with a child witness in a sexual abuse case is at an intrinsic disadvantage. Most of the activities take place in a legal system where the psychiatrist may feel like a stranger in a strange land. Further, a major area of concern to the courts is cognitive development and memory, which unlike phenomenology, dynamics, and therapeutics, are somewhat remote from the psychiatrist's core expertise. It is not surprising, then, that the stress associated with the role of child advocate or expert witness often produces anxiety for the psychiatrist or may result in a frank avoidance of forensic tasks. This paper is intended to militate against such a reaction by familiarizing the psychiatrist with the salient issues of the sexually abused child as a witness.

Child↗
PubMed1987

Life threat and posttraumatic stress in school-age children.

One hundred fifty-nine children (14.5% of the student body) were sampled after a fatal sniper attack on their elementary school playground. Systematic self-reports of posttraumatic stress disorder (PTSD) symptoms were obtained by use of a child PTSD Reaction Index. Analysis of variance revealed significant differences by exposure but not by sex, ethnicity, or age. Additional analyses were conducted of individual item response, overall severity of PTSD reaction, symptom grouping, and previous life events. The results provide strong evidence that acute PTSD symptoms occur in school-age children with a notable correlation between proximity to the violence and type and number of PTSD symptoms. Sampling at approximately one month after the trauma provided adequate delineation among exposure groups. The symptom profile of highly exposed children lends validity to the diagnosis of acute PTSD in childhood.

Acute Disease↗
PubMed1987

Protecting third parties: a decade after Tarasoff.

The authors discuss current public policy concerning the treatment of potentially violent psychiatric patients and outline some legal and ethical precedents of the current policy. Therapeutic interventions before and after the Tarasoff decision are compared. The authors make specific recommendations for clinicians, who they believe tend to interpret laws too restrictively. They suggest that courts need to rethink current liability standards so that legal decisions can be more clinically informed. Finally, they believe that legislative interventions which specify that warning the potential victim and notifying the police absolve psychotherapists from liability may lead to reflexive rather than reflective management of violent patients.

California↗
PubMed1987

Consent and liability: special problems with anxiolytics.

The use of benzodiazepine anxiolytic therapy has sometimes been associated with certain adverse reactions. The authors discuss the extent to which the clinician is responsible for warning patients that benzodiazepine therapy may result in addiction, withdrawal problems, and/or impaired cognitive and motor skills. The development of new anxiolytics such as buspirone, which seem to exert less effect on cognitive and motor skills and lack addiction potential (and thus withdrawal problems), presents the clinician with a treatment alternative. The authors review two legal cases involving benzodiazepine-induced driving impairment and discuss whether the clinician is obligated to prescribe the agent that generally demonstrates the least interference with such common activities as driving. Primary issues that arise in the discussion of physician responsibility are informed consent (both verbal and written) and the documentation of all treatment decisions. The authors recommend quality care and individualized treatment to avoid liability.

Anti-Anxiety Agents↗
PubMed1987

Legal liability with psychotropic drug use: extrapyramidal syndromes and tardive dyskinesia.

The use of medication has become essential to the practice of modern psychiatry. Despite the enormous benefits associated with the administration of psychotropics, these drugs also carry the risk of significant adverse reactions. The legal implications of side effects of antipsychotic agents are explored. The particular focus is on the potentially serious liability confronting the psychiatrist whose patient develops delayed neuromuscular complications. Whenever neuroleptic medication is used, it is crucial for all psychiatrists to be cognizant of the need to obtain voluntary informed consent in the context of clinically appropriate treatment.

Basal Ganglia Diseases↗
PubMed1987

Death notification.

Death notification--informing the deceased's family of an unexpected death--is a singularly stressful task common to medical personnel, clergy, and police. We surveyed by questionnaire a group of 50 Los Angeles Police Department homicide detectives, 21 of whom were subsequently interviewed by telephone. The detectives stated that their initial apprehension stemmed from feeling unprepared. Identification with victims' families was common and compounded the stress. One prevalent worry concerned the possible reactions of the family upon hearing the news, especially the risk of a violent attack on the police officer. Several coping styles were recognized. Our findings suggest that the repetitive performance of this continuously stressful task may be a prominent and underappreciated contribution to occupational burnout.

Death↗