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PubMed2001

Fitness to plead. A prospective study of the inter-relationships between expert opinion, legal criteria and specific symptomatology.

BACKGROUND: Psychiatrists are asked to give opinions as to fitness to plead, a legal concept. There is a dearth of research into fitness to plead in the UK, with no prospective studies and no studies involving the comparison of fit and unfit subjects. In particular, there have been no investigations into the meaning of 'unfit to plead' in terms of psychiatric symptomatology, or as to the relative importance of each legal fitness criterion in psychiatrists' conclusions as to fitness. METHOD: The study comprised a prospective evaluation of 479 consecutive referrals to psychiatrists at court. Individual legal fitness criteria were examined as predictors of unfitness. Associations of unfitness, and of individual legal fitness criteria, were examined with Brief Psychiatric Rating Scale (BPRS) symptom scores. RESULTS: The two most important of the legal criteria in clinical decisions as to unfitness were whether the person could follow the proceedings of the trial or give adequate instructions to their solicitor. The legal criteria concerning trial were more predictive of unfitness than those concerning plea. Unfitness was significantly associated with the presence of positive psychotic symptomatology, in particular conceptual disorganization and delusional thinking, but not with symptoms of anxiety, depression or withdrawal. CONCLUSION: Unfitness is most significantly associated with symptoms affecting comprehension and communication. The fitness criteria could be simplified without loss of power. These results, predominantly concerned with mental illness, may not generalize to the mentally impaired.

Adult↗
PubMed1998

Cultural barriers in oncology: issues in obtaining medical informed consent from Japanese-American elders in Hawaii.

In east-west cultural contexts medical decision-making by elderly Japanese-American oncology patients is made complex by cultural differences from mainstream service providers. Cultural, religious and practical factors thought to contribute to delays in obtaining informed consent for treatment in oncology from mentally competent Japanese-American elders in Hawai'i are identified in this study of health care professionals at Queen's Medical Center in Honolulu (n = 50). Circumstances under which Japanese-American elders sign informed consent documents without understanding them are also examined. Recommendations are offered by the participants and researchers for improvements to the informed consent process. Implications of the findings and recommendations are discussed for Health Care Practice with Japanese-American and other ethnic elderly patients in mainstream health care organizations.

Journal Article↗
PubMed1998

The efficacy of involuntary outpatient treatment in Massachusetts.

One means to address some of the unintended consequences of the shift of treatment for individuals with serious mental illness from hospitals to communities has been involuntary outpatient treatment (IOT). Using Massachusetts data, 19 patients with court orders for IOT were matched to all and to best fits on demographic and clinical variables, and then to individuals with the closest fit on utilization before the IOT date. Outcomes indicated the IOT group had significantly fewer admissions and hospital days after the court order. The full impact of IOT requires more study, particularly directed toward IOT's effects on insight and quality of life.

Adult↗
PubMed2004

Support needed to create psychiatric advance directives.

Psychiatric advance directives (PADs) inform treatment during periods of compromised decision-making. We report consumer desire and need for support to create PADs among 106 adult outpatients with severe and persistent mental illness. PADs were completed using computer software and flexible peer support. All participants were able to complete PADs. However, nearly all participants needed support using the software, or clarification of PAD information. Types of support needed may vary depending on PAD creation methods. While one-third of participants wanted support from case managers to complete PADs, the appropriate level of clinician support is not clear-cut, and should be at consumers' discretion.

Adult↗
PubMed2007

[Developmental aspects in expert testimony for juvenile court].

The history of German legislation resulting in the developmental orientation of juvenile court law (JCL) led to setting the minimum age of criminal responsibility at the age of 14, which places Germany within the average range compared to other EU countries, even though most skills regarding the discernment of right- or wrong-doing are developed in earlier stages of life. The requirement put by section sign 3 JCL that legal discernment be emotionally grounded and the necessity to explore context factors (family or group, specific situation) make psychiatric evaluation of adolescents in court a delicate task. It is indispensable that new findings in neurobiology be considered upon making an assessment of the individual neuro-developmental status. In contrast, an assessment according to section sign 105 JCL considers the overall development irrespective of the crime(s). Developmental issues regarding legal prognosis are discussed for some types of offences (homicide, sexual offences, arson).

Adolescent↗
PubMed1981

Shape, orientation, and apparent rotational motion.

Apparent rotational motion was investigated in polygonal shapes ranging in rotational symmetry from random to self-identical under 180 degrees rotation. Observers adjusted the rate of alternation between two computer-displayed orientations of any given polygon to determine the point of breakdown of perceived rigid rotation between those two orientations. For asymmetric polygons, the minimum stimulus-onset asynchrony yielding apparent rigid rotation increased approximately linearly with orientational disparity, as anticipated on the basis of the extension of Korte's third law to rotational motion by Shepard and Judd. For nearly symmetric polygons, however, the critical time increased markedly as the disparities approached 180 degrees, owing to the availability of a shorter, nonrigid rotation in the opposite direction. The results demonstrate the existence of competing mental tendencies to preserve the rigid structure of an object and to traverse a minimum transformational path.

Discrimination, Psychological↗
PubMed2004

Intelligence: is it the epidemiologists' elusive "fundamental cause" of social class inequalities in health?

Virtually all indicators of physical health and mental competence favor persons of higher socioeconomic status (SES). Conventional theories in the social sciences assume that the material disadvantages of lower SES are primarily responsible for these inequalities, either directly or by inducing psychosocial harm. These theories cannot explain, however, why the relation between SES and health outcomes (knowledge, behavior, morbidity, and mortality) is not only remarkably general across time, place, disease, and kind of health system but also so finely graded up the entire SES continuum. Epidemiologists have therefore posited, but not yet identified, a more general "fundamental cause" of health inequalities. This article concatenates various bodies of evidence to demonstrate that differences in general intelligence (g) may be that fundamental cause.

Age Factors↗
PubMed1999

Attitudes of Oregon psychologists toward physician-assisted suicide and the Oregon Death With Dignity Act.

Since the passage of the Oregon Death With Dignity Act (ODDA), psychologists have been grappling with how to fulfill their legally specified role in the process of physician-assisted suicide. We surveyed Oregon psychologists to elicit their views on assisted suicide and the process of assessing patients who request such assistance. There was a high degree of support for assisted suicide and the ODDA, but also a minority who were highly opposed. Most survey respondents raised ethical or practical concerns with their role as assessors. Many important questions about how evaluations in the complex area should be conducted remain unanswered.

Attitude of Health Personnel↗
PubMed2000

The treatment of adult patients with mental disability. Part 1: Consent and duty.

Over recent years practitioners are increasingly being asked to attend to, or to provide treatment for, adult patients with some degree of mental illness, either in their homes or in the dental surgery. Demographic changes, an ageing population with increasing incidence of dementia, and the philosophy of 'care in the community' for those with long-term mental health problems will ensure that such requests will continue. Such requests present the practitioner with a number of ethical and legal problems. This series of papers looks at the legal issues that arise by reference to case scenarios in this area of 'special needs' dentistry. This first paper deals with the issue of consent, and the legal duty of care that arises on the part of the dentist when attending a patient who is unable to consent to treatment.

Adult↗
PubMed1997

Anthropometric measurements from a cross-sectional survey of community dwelling subjects aged over 90 years of age.

OBJECTIVE: To measure anthropometric variables of weight, height, body mass index (BMI) and triceps skin fold thickness (TSF) and produce local percentiles for > 90 y old subjects. To assess prevalence of conventional measures of under nutrition (BMI at or below 18.5 kg/m2) or over nutrition (BMI values > 30 kg/m2) in this age group. DESIGN: Community cross-sectional study. SETTING: Belfast, Northern Ireland. SUBJECTS: 238 subjects > 90 y of age who were apparently well, mentally competent and recruited from all areas of Belfast. RESULTS: Mean weight was significantly heavier in male 63.9 (s.d. 9.1) kg compared to female subjects 54.4 (s.d. 11.9) kg (P < 0.0001). Men were significantly taller than women with mean height of 162 (s.d. 5.9) cm compared to 150 (s.d. 6.7) cm in women (P < 0.0001). Increasing age was associated with a fall in weight (P = 0.06 female; P = 0.09 male) and in height for women (P = 0.04). Mean BMI was 24.3 (s.d. 3.0) kg/m2 for men and 24.6 (s.d. 5.4) kg/m2 for women with no sex or age differential. 10% of females had values for BMI < 18.5 kg/m2. 11% of female and 2% of male subjects had BMI values > 30 kg/m2. TSF values were 11.7 (s.d. 4.1) mm in male and 12.3 (s.d. 4.5) mm in female subjects with no age or sex-related difference. CONCLUSIONS: Local percentiles for anthropometric variables are presented for subjects > 90 y. Both BMI and TSF show no sex or age-related difference. Ten percent of females have BMI values consistent with either under nutrition or over nutrition.

Aged↗