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PubMed1992

Are pretrial commitments for forensic evaluation used to control nuisance behavior?

The shift to dangerousness-oriented civil commitment criteria has led to speculation that mentally ill persons who do not meet those criteria are being hospitalized under criminal commitment statutes. Using data on patients' psychiatric symptoms at admission to a state hospital in Massachusetts, the authors retrospectively assessed whether patients charged with minor criminal offenses who were committed for evaluation of competence to stand trial would have met civil commitment criteria. The data suggest that most mentally ill patients who were criminally committed could have been civilly committed. However, a relatively greater proportion of persons with substance abuse, mental retardation, or other conditions who did not meet civil commitment criteria for mental illness were committed for pretrial evaluation.

Adult↗
PubMed2000

Antipsychotic medication for challenging behaviour in people with learning disability.

BACKGROUND: The term 'challenging behaviour', in the absence of psychiatric disorder, encompasses a wide range of behaviours that may be harmful to people or property, may be difficult to manage and may limit access to community facilities. Antipsychotic medications have been used to modify such behaviours in people with learning disability, but there is little evidence to suggest that the benefits outweigh the risks. OBJECTIVES: To determine the effectiveness of antipsychotic medication for people with learning disability and challenging behaviour. SEARCH STRATEGY: Biological abstracts, the Cochrane Library, the Cochrane Schizophrenia Group's Register, EMBASE, MEDLINE, PsycLIT were searched. Further references were sought from published trials and pharmaceutical companies. Trials were reliably identified and data extracted. SELECTION CRITERIA: All randomised controlled trials of antipsychotic medication versus placebo. DATA COLLECTION AND ANALYSIS: Reviewers independently evaluated and analysed data on an intention to treat basis. Data were evaluated at 4 and 8 weeks as longer follow-up data were not available. Reviewers assumed that those subjects lost to follow-up had a bad outcome. MAIN RESULTS: Only three randomised controlled trials could be included in the analyses. These provided no evidence of whether antipsychotic medication helps or harms adults with learning disability and challenging behaviour. REVIEWER'S CONCLUSIONS: There is limited data on this important issue and more research is urgently needed.

Adult↗
PubMed2004

Antipsychotic medication for challenging behaviour in people with learning disability.

BACKGROUND: The term 'challenging behaviour', in the absence of psychiatric disorder, encompasses a wide range of behaviours that may be harmful to people or property, may be difficult to manage and may limit access to community facilities. Antipsychotic medications have been used to modify such behaviours in people with learning disability, but there is little evidence to suggest that the benefits outweigh the risks. OBJECTIVES: To determine the effectiveness of antipsychotic medication for people with learning disability and challenging behaviour without additional mental illness. SEARCH STRATEGY: Biological Abstracts, the Cochrane Library, EMBASE, MEDLINE, PsycINFO and BIOSIS were searched. Further references were sought from published trials and pharmaceutical companies. Trials were reliably identified and data extracted. SELECTION CRITERIA: All randomised controlled trials of antipsychotic medication versus placebo. DATA COLLECTION AND ANALYSIS: Reviewers independently evaluated and analysed data on an intention to treat basis. Data were evaluated at 4, 8 and 12 weeks as longer follow-up data were not available. Reviewers assumed that those subjects lost to follow-up had a bad outcome. MAIN RESULTS: Only nine randomised controlled trials could be included in the analyses. These provided no evidence of whether antipsychotic medication helps or harms adults with learning disability and challenging behaviour. REVIEWERS' CONCLUSIONS: There are limited data on this important issue and more research is urgently needed.

Adult↗
PubMed1980

Aggression against cats, dogs and people.

In order to investigate the nature of animal cruelty in childhood two groups of male psychiatric patients were compared: an Animal Cruelty Group and an Assaultive Group. Most in both groups showed other signs of aggression dyscontrol in childhood. Most in both groups were subjected to parental brutality. Emotional or physical unavailability of a father figure may be a common etiologic factor in childhood cruelty to animals. This may compare with the absence of a father figure noted by several investigators in boys who set fires.

Adolescent↗
PubMed1990

Lithium in drinking water and the incidences of crimes, suicides, and arrests related to drug addictions.

Using data for 27 Texas counties from 1978-1987, it is shown that the incidence rates of suicide, homicide, and rape are significantly higher in counties whose drinking water supplies contain little or no lithium than in counties with water lithium levels ranging from 70-170 micrograms/L; the differences remain statistically significant (p less than 0.01) after corrections for population density. The corresponding associations with the incidence rates of robbery, burglary, and theft were statistically significant with p less than 0.05. These results suggest that lithium has moderating effects on suicidal and violent criminal behavior at levels that may be encountered in municipal water supplies. Comparisons of drinking water lithium levels, in the respective Texas counties, with the incidences of arrests for possession of opium, cocaine, and their derivatives (morphine, heroin, and codeine) from 1981-1986 also produced statistically significant inverse associations, whereas no significant or consistent associations were observed with the reported arrest rates for possession of marijuana, driving under the influence of alcohol, and drunkenness. These results suggest that lithium at low dosage levels has a generally beneficial effect on human behavior, which may be associated with the functions of lithium as a nutritionally-essential trace element. Subject to confirmation by controlled experiments with high-risk populations, increasing the human lithium intakes by supplementation, or the lithiation of drinking water is suggested as a possible means of crime, suicide, and drug-dependency reduction at the individual and community level.

Behavior↗
PubMed1983

Suppressing aggressive-destructive behavior by delayed overcorrection.

Delayed overcorrection reduced the aggressive-destructive behavior of a developmentally delayed adolescent when it was added to previously ineffective procedures of differential reinforcement (tokens and token-removal) of other behavior. The delayed contingency was necessary because target behaviors occurred exclusively in the absence of the only family member who could overpower the subject. A multiple baseline design across two levels of problem-behavior severity indicated that delayed overcorrection effectively suppressed the aggressive-destructive episodes. The results support the notion that delayed contingencies can effectively suppress target behaviors.

Adolescent↗
PubMed1992

A content analysis of written behavior management programs.

A method is described for assessing the elements of individual behavior management programs. The content analysis, consisting of 24 items covering the general categories of behavior specification, objectives, program procedures, data collection, and quality assurance, was applied to 141 written behavior programs of two large institutions from different regions of the United States. These data can be utilized readily to establish a data base for program evaluation at both the individual and institutional levels. In addition, to provide a measure of validity, the items included in the content analysis were rated by experts in the treatment of severe behavior disorders. General strengths and weaknesses of the programs, and of the content analysis itself, are discussed in light of their implications for program implementation and evaluation.

Behavior Therapy↗
PubMed1996

Concurrent risk factors for adolescent violence.

PURPOSE: To examine the risk and protective factors for different types of violent behavior in a sample of high school age adolescents drawn from the general population, illuminate the multiple and cumulative nature of the different risk factors, and characterize gender differences in explanatory variables that foster involvement in violent activities. METHODS: Using data from a 6-year longitudinal self-report survey of over 4,500 high school seniors and high school dropouts from California and Oregon, we developed weighted estimates of the proportions of youth exhibiting different risk factors who are also involved in violent activities. We use risk scales to show the cumulative effects of multiple factors within substantive domains, and logistic regression techniques to pinpoint the effects of each risk factor relative to others included in the models. RESULTS: Major risk factors for violence include gender and deviant behaviors, such as using and selling drugs, committing nonviolent felonies, and engaging in other forms of nonviolent delinquency. Low academic orientation, lack of parental affection and support, and perceptions of parents' substance use also show strong links with violent behavior. As the number of risk factors increases, so does the likelihood of engaging in violent behavior. Boys and girls show somewhat different paths to violence, with girls being comparatively more susceptible to the effects of family problems or disruption and impaired relationships with parents. For boys, engaging in other deviant behaviors provides the most information about their propensity to commit violent acts. Weak bonds with school and family also have an impact on serious violence for boys. CONCLUSIONS: Risk factors from multiple domains--demographic, environmental, and behavioral--contribute to involvement in various types of violent behavior. The strong links between violence, drug use, and delinquency argue for prevention/intervention programs that take into account the clustering of these behaviors, while the contribution of weak familial and school bonds point to the need for efforts to strengthen these institutions. Research is needed to identify effective ways of achieving these ends.

Adolescent↗
PubMed1997

A peer approach to high risk youth.

Denver's Gang Rescue and Support Project (GRASP) is a peer run intervention for youth involved in gangs and those feeling pressure to affiliate with them. GRASP utilizes small group meetings and mentoring to encourage young people to pursue positive life-style changes.

Adolescent↗
PubMed1999

Low literacy and violence among adolescents in a summer sports program.

PURPOSE: To investigate the relationship between inadequate literacy and violent behavior among adolescents. METHODS: This descriptive study involved a convenience sample of 386 adolescents who participated in a summer track and field and literacy program serving youths in low-income neighborhoods in Shreveport, Louisiana, during 1994-1996. Self-reported violence was measured using the Youth Risk Behavior Survey (YRBS) and reading grade levels were measured by the Slosson Oral Reading Test-Revised (SORT-R). RESULTS: Youths ranged in age from 11 to 18 years; 66% were male, and 86% were African-American. Forty-three percent of adolescents tested had below-grade reading levels (> or = 2 grades). Participants with below-grade reading skills had higher rates of self-reported violent behaviors compared with those reading at grade level. When gender, race, and age were controlled for, adolescents reading below grade level were significantly more likely to report carrying weapons [odds ratio (OR) = 1.9; 95% confidence interval (CI) 1.1-3.5], carrying guns (OR = 2.6; CI 1.1- 6.2), to have been in a physical fight at school (OR = 1.7; CI 1.1-2.6), and to have been in a physical fight resulting in injuries requiring treatment (OR = 3.1; CI 1.6-6.1). In addition, youths reading below grade level were significantly more likely to be threatened at school with a weapon (OR = 2.1; CI 1.2-3.7) and to report missing days of school in the previous 30 days because they felt unsafe at school (OR = 2.3; CI 1.3-4.3). In characterizing the violence related behaviors, we found that low reading-level adolescents were more likely to be both aggressor/perpetrator and victim (44% vs. 32%; p = .02) and less likely to be only a victim (6% vs. 12%; p = .04) compared to adolescents with grade-appropriate reading skills. CONCLUSIONS: Below-grade-level reading was significantly related to violence behaviors among adolescents who volunteered for a summer track and field program. Longitudinal studies are needed to further investigate the relationship of below-grade-level reading and aggressive/perpetrator and victim behaviors.

Adolescent↗
PubMed2002

A review of the assessment and treatment of anger and aggression in offenders with intellectual disability.

Rates of aggression amongst people with intellectual disability (ID) have been found to be high in studies conducted on several continents across a number of service settings. Aggression is the primary reason for people with ID to be admitted or re-admitted to institutional settings, and it is also the main reason for individuals in this client group to be prescribed behaviour-control drugs. Anger is a significant activator of aggression, but little is known about the emotional aspects of the lives of people with ID. There are many reasons for this, but a lack of reliable and validated assessment measures is chief among them. The present review found that very little work has been conducted to date concerning the development of robust tools for assessing anger and aggression in this population. A narrative review of interventions for reducing aggression and anger in people with ID showed that there is virtually no evidence to support the use of psychotropic medications. Research has shown that behavioural interventions can be effective; however, they are intrusive and have not been tested in naturalistic settings with higher-functioning clients and low-frequency aggression. More recently, cognitive-behavioural interventions have shown promise, but the mechanisms for effective change have yet to be delineated. Priority research questions relating to assessment, treatment and therapeutic skills in working with anger and aggression problems are offered by the present review.

Aggression↗
PubMed2006

Unprofessional or problematic behaviour of medical students outside the learning environment.

This paper focuses on the question what to do with unprofessional or problematic behaviour of medical students outside the learning environment. Examples are given to raise awareness of the problem and initiate possible solutions. It is advised that medical schools keep an open eye for problematic behaviour outside the learning environment, also because documented unprofessional behaviour during medical training is a predictor of professional misconduct as a physician. Part of this paper was presented by the author as 'Professionalism: between wearing blinkers and big brother' at the AMEE conference, Edinburgh, UK, September 2004.

Behavior↗
PubMed1992

Bayer revisited.

Bayer accuses me of wrongly claiming that he holds a negative thesis about the role that the liberal emphasis on privacy rights has had on AIDS public health policy. In his reply to my review essay, he denies holding such a thesis and, moreover, makes the stronger claim that his position is sympathetic to liberalism, or at least to some versions of it. Although I appreciate Bayer's efforts to clarify his views about liberalism and a "culture of restraint and responsibility", it is clear to me that our differences are related not to a misunderstanding on my part, but to a fundamental disagreement concerning what liberalism as a political philosophy is, and what public policy implications it entails in the case of AIDS....

Acquired Immunodeficiency Syndrome↗
PubMed1988

Parent-child correspondence in identification of firesetting among child psychiatric patients.

This study examined parent-child correspondence in assessing characteristics and correlates of the child's firesetting. Two-hundred and ninety-seven families (164 outpatients and 133 inpatients) were independently interviewed using questions modified from the Schedule for Affective Disorders and Schizophrenia for School-age Children. Parent-child correspondence for the presence or absence of individual behaviors and firesetting correlates was generally moderate-to-high for both samples, with outpatient families showing higher parent-child agreement in classifying the child's firesetting status. Few differences in correspondence due to child age or sex were found. The results are discussed in terms of the clinical assessment of firesetting and other antisocial behaviors and the role of child reports in case identification.

Adult↗