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At least 343 records · Page 19Linked to original sources
PubMed1991

HIV-infected psychiatric patients: beyond confidentiality.

The AIDS epidemic calls for an ethical analysis of conflicting obligations surrounding HIV-infected psychiatric patients and confidentiality, as well as issues that go beyond confidentiality. Although laws pertaining to HIV infection have been enacted in a number of states, these statutes leave much discretion to health professionals. The ethical principle known as "the harm principle" can permit disclosure of confidential information and detention or isolation of psychiatric patients who pose a threat of infecting other patients. From an ethical point of view, however, the circumstances under which traditional protections may be weakened or abandoned remain limited.

AIDS Serodiagnosis↗
PubMed2004

Neuropsychiatric syndromes in adults with intellectual disability: issues in assessment and treatment.

The purpose of this article is to present a survey of important neuropsychiatric issues and recent findings regarding the evaluation and treatment of neuropsychiatric symptoms and syndromes in patients with intellectual disability (ID). The cause of ID, environmental or genetic, can be determined in few patients. Etiology is idiopathic in most patients. ID and psychiatric illness are not mutually exclusive; individuals with ID have increased rates of psychiatric illness. Although recognition of significant axis I psychopathology is important, not all challenging behaviors in persons with ID will have a clear axis I diagnosis. Psychologic, behavioral, and environmental treatments are appropriate measures, but pharmacotherapy often is needed. Our experience has shown us that the more severe, disruptive, and dangerous the behavior, the stronger the indication for empirical drug treatment trials. Community-based models of support with neuropsychiatric intervention can be a potent therapeutic combination in the management of challenging behaviors in individuals with ID.

Adult↗
PubMed1993

Urgent paralysis and intubation of trauma patients: is it safe?

Physicians, fearful of an increase in the incidence of intubation mishaps (IMs) and pulmonary complications (PUCs), have been reluctant to use paralysis and intubation (PI) outside the OR. This study examines the correlations between PI, IM, and PUC. Since 1987, we have used PI when complex injury or combative behavior warranted. From January through December 1989, 851 patients meeting major trauma triage guidelines were evaluated. The medical records of 231 patients (27%) who underwent PI within 8 hours of admission were reviewed; 27 patients were eliminated because of incomplete records. The indications for PI were emergency surgery (131), airway control (30), combativeness (24), and hyperventilation (19). The location was the OR (121), ED (82), other (1). Presence or absence of IM was documented in 198 of 204 charts: Twenty-four IMs (12%) occurred--14 multiple attempts, seven aspirations, three esophageal intubations. Frequency of IM was not statistically related to PI location (Fisher's exact test), AIS, or ISS. In 194 of 204 patients who survived at least 24 hours, there were 15 PUCs (8%): eight pneumonia, five persistent infiltrates, two severe atelectases. No deaths were related to IM or PUC. There was no statistical relationship between IM and PUC (Fisher's exact test). However, patients with PUCs had a significantly higher AIS-chest score (2.9 +/- 1.7 vs. 0.9 +/- 1.5) (p < 0.0005, Student's t test) and ISS (27.3 +/- 9.6 vs. 14.5 +/- 10.8) (p < 0.0005, Student's t test). In our hands, PI is associated with low morbidity, no mortality, and can be safely used to facilitate injury management or to control combative behavior.

Dangerous Behavior↗
PubMed2005

The empirical limits of forensic mental health assessment.

This article introduces a special issue of Law and Human Behavior, including five articles describing the limits of forensic mental health assessments of (a) risk of violence in female adolescents, (b) sexually violent predators, (c) dangerousness in capital murder cases, (d) child sexual abuse, and (e) PTSD litigants. Knowing the limits of forensic mental health assessment methods is essential in order to recognize their strengths, increase the credibility of forensic mental health assessment, and drive research that will enhance the value of assessments for the courts.

Adolescent↗
PubMed1995

Factors influencing disposition decisions for patients seen in a psychiatric emergency service.

OBJECTIVE: The study examined factors influencing clinicians' decisions about disposition of patients seen in a psychiatric emergency service. METHODS: A stratified random unduplicated retrospective sample of 378 patient records was drawn from the records of 1,823 patients who visited the emergency service of an acute care psychiatric hospital in Israel during a seven-month period. Patients were selected from each of the following dispositions: not admitted (N = 96), discharged after brief observation in the emergency service (N = 90), admitted to a open unit (N = 104), and admitted to a locked unit (N = 88). Data on demographic and clinical characteristics of patients and on some clinician and system variables were analyzed using univariate statistical techniques and stepwise logistic regression. RESULTS: Patients were more likely to be admitted if they were judged by clinicians to be suicidal, had more than three previous hospitalizations, were psychotic, had suicidal behavior as the presenting complaint, and were brought to the hospital involuntarily. Variables favoring assignment to a locked unit were age between 20 and 30, dangerousness to self or others, male gender, and a low Global Assessment of Functioning score. CONCLUSIONS: Patients' level of psychopathology and dangerousness were the primary factors influencing clinicians' decisions about disposition of patients from the emergency service.

Adult↗
PubMed1979

"Folk" criteria for the diagnosis of mental illness in rural Laos: on being insane in sane places.

"Folk" criteria for identifying the mentally ill, as distinguished from folk theories about the causes of mental illness, have been comparatively neglected in cultural psychiatry. The authors describe the criteria by which villagers in Laos labeled 35 subjects as baa (insane). Unprovoked assaultive or destructive behavior, social isolation, self-endangerment due to neglect of personal needs, nonviolent but socially disruptive or inappropriate behavior, and inability to do productive work were found to be important folk criteria. The authors emphasize that folk criteria for mental illness are determined primarily by the persistence of socially dysfunctional behavior rather than by disturbances in thought and affect.

Adult↗
PubMedDate not supplied

Behavioral management strategies for young pediatric dental patients with disabilities.

Disruptive behaviors, particularly from those lacking in cooperative ability, often are prompted by the need to protest an unpleasant situation and the impulse to protect oneself from perceived danger. Such behaviors, depending on the patient's age and cognitive ability, should be seen as an attempt of the child to cope with a frightening situation. The inherent challenge for both clinician and parent is to avoid unpleasant and unproductive confrontations from the outset, and to create an environment to facilitate the child's ability to accept care, protect the child's self-esteem, foster a positive outlook toward care, and enhance the work quality of dental personnel. In order to use safely any of the modalities for sedation considered [table: see text] in this paper, it is imperative that the clinician receive adequate clinical instruction before private clinical use is attempted.

Age Factors↗
PubMed1995

Managing behavior of precooperative children.

Disruptive behaviors, particularly from those lacking in cooperative ability, often are prompted by the need to protest an unpleasant situation and the impulse to protect oneself from perceived danger. Such behaviors, depending on the patient's age and cognitive ability, should be seen as an attempt of the child to cope with a frightening situation. The inherent challenge for both clinician and parent is to avoid unpleasant and unproductive confrontations from the outset and to create an environment to facilitate the child's ability to ultimately accept care, protect the child's self-esteem, foster a positive attitude toward care, and enhance the work quality and efficiency of the dental personnel. Use of behavioral management strategies that permit accomplishing these objectives have been described. The reader is encouraged to pursue further knowledge and expertise to make best use of nonaversive strategies for management of the precooperative child.

Anesthesia, Dental↗