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PubMedDate not supplied

Adult failure to thrive in the older rehabilitation patient.

Increasing numbers of older adults require rehabilitation therapy upon discharge from a hospital. This pilot study tested a tool developed to assess failure to thrive syndrome (FTT) in patients admitted to a long-term rehabilitation unit (N = 34), examined the association among commonly recognized FTT factors (persistent, unexpected impairment in physical function, cognitive impairment, and poor nutrition and mood state), and investigated relationships between FTT factors and discharge disposition. Patients with a high level of physical function differed from those with a low level of function in terms of age, mood state, and discharge disposition. Patients discharged home differed from patients who were unable to return home in mood state, physical function score, and admission serum albumin. Suggestions for practice and further research are offered.

Activities of Daily Living↗
PubMed1996

Insanity and filicide: women who murder their children.

A mother who murders her child challenges the empathic skills of evaluating clinicians. In this chapter, original research, supplemented by detailed case histories, compares women adjudicated criminally responsible for the murders of their children with those adjudicated not guilty by reason of insanity.

Adult↗
PubMed1993

Do psychiatric patients need greater protection than medical patients when they consent to treatment?

It is commonly assumed that psychiatric patients require greater protection than medical patients when they make health care decisions. A review of the literature reveals that there is meager evidence for this belief and that both groups have significant capacity problems. Many factors other than psychiatric illness have been shown to impede understanding of informed consent information in health care settings. These include powerful emotional states, lack of a high school education, the presence of a severe medical illness, and increasing age. Clinicians can help patients become more adequate decision makers by taking such steps as providing adequate disclosure and inquiring about patient understanding. Even then, setting a realistically lenient standard of capacity seems the most practical approach. If screening for capacity is important for a specific health care decision, all vulnerable groups should be targeted.

Attitude to Health↗
PubMed1995

The hidden effects of Montana's "abolition" of the insanity defense.

Montana abolished the affirmative insanity defense in 1979. In this article we examine the effect of this change by focusing on all defendants who raised mental health in his/her defense from 1976 to 1985. We found that while post-reform insanity acquittals did dramatically decline, there was a corresponding rise in findings of incompetent to stand trial with charges dismissed, perhaps negating the desired impact. We also compared the defendants and the legal process, finding no significant differences pre to post reform.

Adult↗
PubMed1995

Physical control of patients on an inpatient setting: forensic vs. civil populations.

The current study examines the use of physical control (seclusion and restraint) in a sample of patients hospitalized in a public mental hospital during 1989. A total of 243 patient records involving physical control were examined; of these, 124 had been civilly committed and the remaining 119 were forensic (Incompetent to Stand Trial or Not Guilty by Reason of Insanity). Some 870 physical control events occurred in the sample, a rate that is intermediate when compared with other facilities described in the literature. Seclusion was employed most often (46% of events), with the combination of seclusion and restraint used in 32% of events and the remaining 22% of physical control events being restraint. Seclusion tended to be used more often with civilly committed patients, with restraint more frequently employed with forensic patients. Forensic patients differed from civil subjects in their greater frequency of threats, agitation, and verbal hostility. However, civil patients were more frequently aggressive toward others and destructive of property. These findings are discussed in the context of previous evidence also describing forensic patients as being perceived as more dangerous, but behaving in a fashion no more physically aggressive than civil patients.

Adult↗
PubMed1995

Lost in the shuffle: the influence of patient classification scheme on views about the relationship between refusal of medication and involvement in important hospital-based outcomes.

The approach used to classify patients into "refuser" subgroups can influence conclusions about the relationship between refusal of antipsychotic medication and involvement in important hospital-based outcomes such as the need for seclusion and restraint. Use of a cross-sectional taxonomy led to conclusions which were somewhat negatively biased against "refusers." In contrast, use of a longitudinal taxonomy which reflects changes in formal informed consent behavior over time, suggests that it is not refusal, per se, but changes in informed consent status that appear to be associated with problematic behavior. In fact, "consistent-refusers" tended to be the least troublesome of the three informed consent status groups studied. Researchers are encouraged to use patient classification schemes which consider patterns of formal informed consent behavior over time when examining the relationship between refusal and involvement in important outcomes.

Adult↗