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PubMed2005

Relationships between patient, family, and significant other disposition preferences in psychiatric emergency services and the clinical symptom ratings and disposition decisions of psychiatrists.

A previous paper examined the relationship between 10 clinical ratings made by psychiatrists and 465 psychiatric emergency service (PES) dispositions. A logistic regression model explained 52% of the variance in the psychiatrist's decisions to admit to inpatient services or release. The 5 clinical ratings in the model, rated on 8-point scales, were severity of danger to self, psychosis, inability to care for self, impulse control, and depression. The current paper examines the relationships between patient and family/significant other dispositional preferences expressed in the PES, and the psychiatrist's disposition decision and the 10 clinical ratings. It found that the dispositional preferences of the patient, family, and other individuals (community clinician, police, or ambulance driver) were very consistent with the actual decision made by the PES psychiatrist. Further, it found that these preferences explained an additional 35% of the variability in the psychiatrist's decision to admit or release. Finally, the ten clinical ratings made by the PES psychiatrist explained only a small amount of the variance in the dispositional preferences, and some of the significant coefficients were in the opposite direction expected. Patient, family and other significant individuals' expressed preferences and expectations in the PES are important and should be routinely recorded in the charts. The small relationships between clinical ratings and preferences suggests that the reasons the family/significant other and the patient seeks hospital admission or release may differ with psychiatrists' reasons for disposition.

Choice Behavior↗
PubMed2002

The voice of detainees in a high security setting on services for people with personality disorder.

BACKGROUND: British government Home and Health Departments have been consulting widely about service development for people with ' dangerous severe personality disorder' (DSPD). There has, however, been no consultation with service users, nor is there any user view literature in this area. METHODS: All people detained in one high security hospital under the legal classification of psychopathic disorder were eligible but those on the admission or intensive care wards were not approached. Views of service were elicited using a purpose designed semi-structured interview. The principal researcher was independent of all clinical teams. Confidentiality about patients' views was assured. AIMS: To establish views on services from one subgroup of people nominated by the government department as having 'DSPD'. RESULTS: Sixty-one of 89 agreed to interview. With security a given, about half expressed a preference for a high security hospital setting, 20% prison and 25% elsewhere, generally medium secure hospitals. Participants most valued caring, understanding and 'experience' among staff. An ideal service was considered to be one within small, domestic living units, providing group and individual therapies. Some found living with people with mental illness difficult, but some specified not wanting segregated units. Views were affected by gender and comorbidity. CONCLUSIONS: As the sample were all in hospital, the emphasis on treatment may reflect a placement bias. All but five participants, however, had had experience of both health and criminal justice services, so were well placed to talk with authority about preferences.

Antisocial Personality Disorder↗
PubMed2006

Short term involuntary psychiatric examination of children in Florida.

This study describes the use of emergency mental health services by children over a 4-year period. Analysis of a statewide database revealed 51,861 or 15% of all involuntary examinations were conducted on children. These youth were on average a little over 14 years of age and law enforcement officials initiated the majority of examinations. The majority of examinations were initiated due to the children demonstrating harmful behaviors to themselves or others. One-fifth of the children (21%) experienced more than one examination over the 4-year period. Areas of future research on this topic are discussed. The implications of the nature of examinations and patterns of repeated examinations are discussed.

Adolescent↗
PubMedDate not supplied

Empirically derived consequences: a data-based method for prescribing treatments for destructive behavior.

Behavioral treatments are often prescribed on the basis of a functional assessment. However, in a significant number of cases, functional assessment results are equivocal or suggest that internal stimuli are maintaining the behavior. In this investigation, we evaluated an alternative data-based assessment that may be useful in such cases. This assessment was used to identify reinforcers and punishers based on the reinforcement assessment procedure described by Pace, Ivancic, Edwards, Iwata, and Page (1985). We then assessed whether empirically derived reinforcers and punishers could be combined to treat the destructive behaviors of two clients. For both clients, the rates of destructive behavior decreased markedly. The results suggest that empirically derived consequences may be useful in decreasing destructive behavior when a functional assessment is inconclusive or is consistent with the hypothesis that the behavior is stereo-typic and maintained by internal stimuli.

Aggression↗
PubMed1998

A cross-cultural study of family and peer correlates of adolescent misconduct.

Participants were 4 groups of early adolescents from middle-class backgrounds (European and Chinese Americans in southern California and Chinese in Taipei, Taiwan, and Beijing, China). The 591 adolescents (M age = 13.8 years) completed questionnaires about their involvement in misconduct and about family and peer characteristics. Mothers of a subsample of adolescents (n = 405) also completed a questionnaire about their relationships with their adolescents. The 4 groups of adolescents reported significantly different mean levels of family and peer correlates but showed strikingly similar levels and patterns of self-reported misconduct. Structural equation models revealed that 2 latent variables (family relationships and peer sanctions) accounted for more variance in misconduct among European and Chinese American adolescents (51%-62%) than among the 2 Chinese groups (15%-24%), mainly because of a greater contribution of peer factors in the former groups.

Adolescent↗
PubMed1994

Modifying quiet room design enhances calming of children and adolescents.

OBJECTIVE: To determine whether altering design of a quiet room (QR) produced more rapid calming of agitated or aggressive hospitalized children. METHOD: One of five similar QRs was modified by painting the white walls tea rose, carpeting the vinyl floor, and painting a picturesque mural on one wall. The effects of these modifications were assessed in 19 patients (mean age = 9.6 years), using a within-subjects, repeated-measures design. Overt Aggression ratings were made at the time of placement, and at 5-minute intervals thereafter, until the child was dismissed. Children were blind to the fact that a study was being conducted; raters and staff were not. RESULTS: Total aggression ratings were 45% lower in the modified QR than in the standard QR (p < .03), and initial aggression scores fell by 50% during 5 minutes of placement in the modified QR, but only after 20 minutes of placement in the standard QR (p < .0001). Motor excitement and verbal aggression were the two component factors most strongly influenced by QR design. CONCLUSION: This preliminary report suggests that it may be possible to modify QRs to facilitate calming of aggressive, agitated children and provides preliminary support for redesign of QRs.

Acting Out↗
PubMed2005

Adolescent attitudes toward serious mental illness.

While there is a growing literature on mental illness stigma and strategies for reducing stigma among adults, less is known about how children and adolescents view persons with mental illness. In this paper, we describe the Attitudes Toward Serious Mental Illness Scale-Adolescent Version (ATSMI-AV) and our initial examinations of its factor structure and variations among subgroups of adolescents. Findings suggest that strategies aimed at reducing stigma in this age group would be wise to specifically target categorical thinking about mental health and mental illness and perceptions of persons with mental illness being violent and out of control.

Adolescent↗
PubMed1997

Geropsychiatric restraint use.

OBJECTIVES: To investigate predictors and reasons for restraint use with geropsychiatric patients. DESIGN: A prospective, correlational study. SETTING: The geriatric unit of an acute-care psychiatric hospital. PARTICIPANTS: Twenty-one staff nurses and 131 patients admitted consecutively over a period of 6 months. MEASUREMENTS: Disruptive behaviors were measured with the Nursing Home Behavior Problem Scale (NHBPS), cognitive function was measured with the Mini-Mental State Examination (MMSE), mobility was measured with a Functional Mobility Screen (FMS), and reasons for restraint use were obtained with a questionnaire completed by nurses. RESULTS: Patients with a diagnosis of dementia, impaired mobility, or behavioral problems were more likely to be restrained. The most frequent reasons given by staff for restraint use were an unsteady gait and a risk of falling. The incidence of restraint use was 27.1%. CONCLUSIONS: The use of restraint with geropsychiatric patients may be more common than previously reported and requires further investigation.

Accidental Falls↗
PubMed1978

[The psychological behavior of patients in danger of infection under conditions of isolation].

36 patients with agranulocytosis among them 29 cancer patients were treated in a Life Island (LI) during totally 990 days and were studied for their psychological reactions. Another group of 9 patients among them 6 leukemia patients were treated in reverse isolation (RI) during 578 days. The psychological reactions of these patients were equally studied and were compared with those of the first group. Main reactions to the isolation in the LI were signs of deprivation, specially movement deprivation, as well as aggressive and regressive behaviour. The patients in RI showed on the other hand sensations of loneliness and boredom. To enter and to leave the LI was more important for the patients than the beginning and the end of RI. The isolation was never terminated for psychological reasons. The following factors are important for coping with the isolation; human bindings to doctors, nurses and relations, activities, music, religion as well as adequate information and an attitude of the patient himself which allows him to support the fact of the illness.

Adult↗
PubMed2003

A guide for managing acute aggressive behavior of youths in residential and inpatient treatment facilities.

This article presents recommendations developed in 2001 by a committee of the Maryland Department of Health and Mental Hygiene that are used for managing acute aggressive behavior of youths in residential and inpatient treatment facilities in Maryland. The recommendations are highly similar to practice parameters published by the American Academy of Child and Adolescent Psychiatry, although they were developed independently. The recommendations are not prescriptive, nor are they based on an algorithm. Rather, they are based on a therapeutic process and designed to acknowledge the importance of professional and patient autonomy. The first step in the therapeutic process is to define the problem by addressing three issues: the target symptoms, the severity of those symptoms, and possible precipitants of the aggressive behavior. The next two steps are to select the goals of the intervention and to choose among three levels of immediate intervention, from least to most restrictive. The recommendations describe specific interventions, including medications that can be used at each level. The authors caution that the recommendations should be used in accordance with current regulations of the Center for Medicaid and Medicare Services and the Joint Commission on Accreditation of Healthcare Organizations.

Adolescent↗
PubMed1992

Family therapy in the treatment of adolescents.

A family with an adolescent must transform itself from a predominantly nurturant unit to one that can tolerate and encourage the adolescent's need to separate. When an adolescent presents with symptoms that disrupt the developmental process, the clinician who is familiar with several models of family therapy is better able to select a therapeutic and cost-effective intervention. For family assessments, the authors recommend a biopsychosocial approach, which has replaced the outdated view that families cause psychiatric problems and which acknowledges the family as a potential source of healing. The authors describe several models of family therapy--Satir's communication model, the structural model of Minuchin, Bowen's cross-generational model, and psycho-education--and examine features of these approaches useful for working with adolescents. Illustrative vignettes and some guiding principles for matching model and problem are offered.

Adolescent↗
PubMed2007

Risk-taking behaviors among Israeli adolescents exposed to recurrent terrorism: provoking danger under continuous threat?

OBJECTIVE: This study aimed to assess 1) the relationship between risk-taking behaviors and exposure to terrorism, 2) the relationship between posttraumatic symptoms and risk-taking behaviors, and 3) gender differences in the type and frequency of risk-taking behaviors and their differential associations with posttraumatic symptoms. METHOD: The participants were 409 Israeli adolescents 15 to 18 years of age. Exposure to terrorism was assessed with a questionnaire developed specifically for the Israeli security situation. Posttraumatic symptoms were measured with the University of California at Los Angeles Reaction Index. Functional impairment was measured with the Diagnostic Interview Schedule for Children. Risk-taking behavior-and the adolescents' perceptions of such behavior-was assessed with a self-report questionnaire. RESULTS: Israeli adolescents exposed to continuous threats of terrorist attacks reported high levels of risk-taking behaviors. The severity of risk-taking was associated with greater terrorism exposure. Adolescents suffering from posttraumatic symptoms reported more risk-taking behaviors than nonsymptomatic adolescents. Although there was no gender difference in the degree of exposure to terrorism, boys reported taking more risks than girls. The association between posttraumatic symptoms and risk-taking behaviors was stronger in boys than girls. Functional impairment, gender, avoidance symptoms, level of exposure, and degree of fear predicted the severity of risk-taking behaviors. CONCLUSIONS: Clinicians and educators should be aware of the strong link between posttraumatic distress and risk-taking behaviors. Risk-taking behaviors may be a manifestation of functional impairment and posttraumatic distress, especially for boys exposed to terrorism.

Adolescent↗