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Biomedical subjects

S K Hoge

Publications and source records attributed to S K Hoge.

At least 37 records · Page 2Linked to original sources
PubMed1995

Long-term, assenting psychiatric patients: decisional capacity and the quality of care.

The objectives of this study were (1) to investigate whether the relationship between functional decisional capacity and the resulting quality of treatment posited by the informed consent theory is found in clinical practice; and (2) to describe the range of decisional impairments found in long-term psychiatric inpatients who comply with prescribed treatment. Eighty-eight long-term, compliant, psychiatric inpatients, in two public hospitals, who were prescribed antipsychotic medications were assessed. Following a formal assessment of decisional capacity, subjects were categorized according to level of impairment, using a hierarchical scheme. All subjects were evaluated for the presence of abnormal involuntary movements. The appropriateness of treatment with antipsychotic medications was determined using accepted clinical guidelines. Patients with more serious impairments of decisional capacity were more likely to receive inappropriate treatment with antipsychotic medication; and serious impairments of decisional capacity were common. The study lends empirical support to one of the bases of the doctrine of informed consent: the notion that capable patient involvement in decisionmaking plays an important role in checking the judgments of treating physicians. Remedial measures are needed to protect long-term psychiatric inpatients with impaired decisional capacity from receiving inappropriate treatment.

Decision Making↗
PubMed1994

Head injury in partner-abusive men.

Research into etiology of marital aggression has focused primarily on psychosocial, political, and cultural factors, to the exclusion of physiological influences. Fifty-three partner abusive men, 45 maritally satisfied, and 32 maritally discordant, nonviolent men were evaluated for past history of head injury, by a physician who was not informed of group membership and aggression history. Logistic regressions confirmed that head injury was a significant predictor of being a battered. The implications of these findings for both marital aggression and post-head injury rehabilitation are discussed.

Adult↗
PubMed1994

Head-injured males: a population at risk for relationship aggression?

Several recent studies suggest that head injury may be a potentially useful factor in explaining some types of aggressive behavior. In our research, we have been able to demonstrate an association between head injury and marital aggression using a sample of male batterers and appropriate comparison groups. Anecdotal and empirical literature also supports the hypothesis that aggression, relationship problems, and negative changes in personality and behavior are common sequelae to a head injury. This article explores the hypothesis that flows intuitively from the above, namely, that head-injured males are at increased risk for physical aggression in their intimate relationships. Empirical data are presented identifying several risk factors for relationship aggression and marital discord that may be sequelae of a significant head injury. Nevertheless, head-injured men were not found to be more physically aggressive with their female partners. The implications of these results are discussed.

Adult↗
PubMed1994

The patient self-determination act and psychiatric care.

The Patient Self-Determination Act (PSDA) has been in effect since December 1, 1991. The primary purpose of the PSDA is to promote patient awareness of advance directives. Many psychiatrists are unaware of the PSDA and its requirements or believe that the PSDA does not apply to psychiatric facilities and patients. In this article the requirements of the PSDA are reviewed. Potential applications of advance directives in psychiatric care are discussed and problem areas are identified. It is suggested that psychiatrists take an active role in the implementation of the PSDA.

Advance Directives↗
PubMed1994

On being 'too crazy' to sign into a mental hospital: the issue of consent to psychiatric hospitalization.

This article examines the notion of informed consent to psychiatric hospitalization. While dicta in a recent U.S. Supreme Court decision, Zinermon v. Burch, has stimulated considerable interest in applying informed consent to psychiatric hospitalization decisions, there are no extant cases that define the contours of the doctrine in the hospitalization context. The potential scope of disclosure and the level of decision-making capacity sufficient for valid consent are examined. A model of consent to admission recommended by the American Psychiatric Association Task Force on Consent to Voluntary Hospitalization is critiqued.

Commitment of Persons with Psychiatric Disorders↗
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↗
PubMed1990

A prospective, multicenter study of patients' refusal of antipsychotic medication.

Refusal of treatment with antipsychotic medication was studied prospectively in a sample of 1434 psychiatric patients admitted to four acute inpatient units in state-operated mental health facilities in Massachusetts during a 6-month period. Compared with a control group of patients who accepted prescribed antipsychotic treatment, the 103 patients who refused were older, of a higher social class, and less likely to have been prescribed antiparkinsonian medications. On admission, prior to refusal of medication, patients who refused were found to have significantly higher Brief Psychiatric Rating Scale scores than compliant patients and more negative attitudes regarding their hospitalization and past, present, and future treatment. Treatment refusal had negative effects on the hospital milieu and on the patient; refusers were more likely to require seclusion or restraint and had longer hospitalizations than treatment acceptors. Most refusal episodes ended with voluntary acceptance of treatment. In 23% of cases medications were discontinued. Only 18% of the sample reached formal, judicial review, and in every case that did, involuntary treatment was ordered. The policy implications of these findings are discussed.

Adult↗
PubMed1989

An empirical comparison of the stone and dangerousness criteria for civil commitment.

Massachusetts civil commitment criteria were compared in an emergency setting with a set of criteria developed by Dr. Alan Stone. Contrary to expectations, the Stone criteria proved to be more restrictive in a sample of 503 patients. Few patients would be newly committable under the Stone criteria; of the 35 patients committable under the Stone standard, 32 also met the current Massachusetts criteria for commitment. The clinical and policy implications of the adoption of the Stone criteria are discussed.

Adult↗
PubMed1989

Head injury and marital aggression.

Of 31 consecutive male patients referred for evaluation of marital violence, 19 (61.3%) had histories of severe head injury. Although the relationship between child abuse and head injury did not reach an acceptable level of significance, it did indicate a trend toward a positive relationship. Alcohol abuse, reported by 48.4% of the sample, was significantly associated with head injury. Confirmation of biological etiologies in marital aggression would have implications for prevention and treatment.

Adolescent↗
PubMed1988

Limitations on psychiatrists' discretionary civil commitment authority by the Stone and dangerousness criteria.

The dangerousness-oriented commitment criteria of Massachusetts were compared with the paternalistic Stone model of commitment in an emergency setting. In a sample of 1062 patients, the Stone criteria were more restrictive than the dangerousness-oriented criteria; 91 patients were committable by the Stone model compared with 218 under the present statute. A second comparison of only those patients who refused treatment yielded similar findings--52 patients were committable according to the Stone criteria compared with 80 under the Massachusetts statute. The greater restrictiveness of the Stone criteria in each comparison was in large part the result of the requirement that the treatment decisions of the patient be incompetent; in the broader sample, the criterion of major patient distress had a comparable impact. A comparison of patients committable under both standards with those patients currently committable who would be excluded under the Stone standard revealed significant differences. The dually committable patients were more likely to be psychotic, to meet statutory criteria for grave disability, and to be diagnosed as manic. The implications of the findings are discussed.

Adult↗
PubMed1987

The prosecution of psychiatric patients for assaults on staff: a preliminary empirical study.

A survey of five public hospitals yielded nine cases in which staff pressed charges against patients who assaulted them. Examining the effects of prosecution on the patients, the legal system, and the staff, the authors found that two patients benefited, three showed little or no change, and four were lost to follow-up. The legal system was responsive to the request to prosecute, although sometimes reluctantly, in six cases, but uncooperative in the rest. In five of the cases, staff were satisfied with the outcome of the legal intervention, even though it benefited only two of those patients. Among the authors' recommendations for dealing with assaults are to use appropriate clinical measures first, address any systems problems that an assault suggests, and, because prosecution may alienate patients from the treatment system, obtain consultation from a psychiatrist outside the patient's care system before proceeding.

Adult↗