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PubMed1981

Alternative to the back ward: the quarterway house.

The Quarterway House was founded in December 1978 to deinstitutionalize and provide rehabilitation services to a small group of long-term, seriously ill inpatients of the Massachusetts Mental Health Center. The purposes of the residential program are to provide a less institutional therapeutic environment and to develop a psychosocial treatment program that might enable some patients to move toward more independent settings in the community. In a randomized experimental study, with center inpatients as the control group, the effectiveness of the program was assessed by multiple outcome measures before the program began and at one year. Although neither group moved rapidly to more independent community living, Quarterway House patients showed improvement in general functioning and socialization-survival skills and decreased medication and seclusion. They did not show a decline in psychotic symptoms, obstreperousness, or antisocial behavior. Over-all, the findings suggest the program may prove useful for the long-term rehabilitation of severely ill patients.

Activities of Daily Living↗
PubMed1985

Variation among state hospitals in use of seclusion and restraint.

The author attempted to determine whether hospitals of the same type, with similar admission and discharge policies and operating under identical regulations, had similar patterns of use of seclusion and restraint. Admissions to seven Massachusetts state hospitals over a two-week period were followed until discharge or up to 16 weeks. The hospitals were found to use confinement to widely varying degrees that could not be explained by patient demographic characteristics, legal status, diagnoses, or violence-related behavior preceding hospital admission. The author suggests that factors relating to individual hospital practices and conditions strongly influence the use of confinement. He discusses the implications of this conclusion.

Adult↗
PubMed1999

Interventions for challenging behavior in residential settings.

Predictors of interventions for challenging behavior by residential service providers were examined. Three forms of intervention investigated were (a) Individualized Habilitation Plan (IHP) objectives concerning challenging behavior, (b) one-to-one crisis intervention in the preceding 30 days, and (c) services from behavior management professionals in the preceding 6 months. Findings across these three interventions were largely consistent. Externalized challenging behavior (outwardly directed aggressive or disruptive behavior aimed at other people or objects) was consistently associated with all interventions. The implications of these findings for service providers and service users are discussed.

Adult↗
PubMed1979

Physical restraint and the nonpsychotic patient: clinical and legal perspectives.

Recent legal challenges to the use of therapeutic seclusion in the treatment of the mentally ill have forced psychiatrists to defend this practice in court. The clinical characteristics of 10 nonpsychotic inpatients who required restraint are reviewed. These patients are characterized by intense labile affect, impulsive, manipulative behavior and transient micropsychotic episodes in the context of immature personality patterns suggestive of the borderline syndrome. Restraint was precipitated by transient micropsychotic episodes or impulsive behavior during sustained regression. Physical control in these cases is required to defend the social milieu more often than to prevent injury to self or others. The legal implications of these clinical findings are discussed.

Adult↗
PubMed2006

Evolutionary function of dreams: A test of the threat simulation theory in recurrent dreams.

proposed an intriguing and detailed evolutionary theory of dreams which stipulates that the biological function of dreaming is to simulate threatening events and to rehearse threat avoidance behaviors. The goal of the present study was to test this theory using a sample of 212 recurrent dreams that was scored using a slightly expanded version of the DreamThreat rating scale. Six of the eight hypotheses tested were supported. Among the positive findings, 66% of the recurrent dream reports contained one or more threats, the threats tended to be dangerous and aimed at the dreamer, and when facing a threat, the dreamer tended to take defensive or evasive actions that were possible and reasonable. However, less than 15% of the recurrent dreams depicted realistic and probable situations critical for one's physical survival or reproductive success and the dreamer rarely succeeded in fleeing the threat despite important and appropriate efforts. The findings thus provide mixed support for the threat simulation theory.

Adolescent↗
PubMed1993

Assessment of potential violence in the paranoid worker.

Violence in the workplace is sometimes a manifestation of an untreated psychiatric disorder. Paranoid personality disorder, paranoid schizophrenia, and delusional (paranoid) disorder are three psychiatric syndromes in which paranoid ideation is a prominent feature. While the vast majority of people with these conditions are not violent, paranoid workers can exhibit violent behavior as a reaction to beliefs that co-workers or supervisors are threatening or persecuting them. Three cases are described to illustrate the clinical presentation of these disorders and their management in an occupational setting.

Adult↗
PubMed1981

The risk of assaultive behavior in suicidal patients.

This study assessed the occurrence of assaultive behavior in a group of suicidal patients who were in psychiatric hospitals, many for long periods of time. Of the 94 suicidal patients, 42 (45%) patients physically assaulted other persons at least once in the 3 months preceding the survey. Although many patients manifested active psychotic psychopathology at the time of the survey, there were no significant differences between assaultive and non-assaultive suicidal patients in terms of the presence of psychosis. The sex, race, primary psychiatric diagnosis, and length of stay of patients also were not related to the occurrence of assaultive behavior in suicidal patients. Only youth and the presence of seizure disorders were related to increased risk of assaultive behavior in hospitalized suicidal patients. The author compares the findings of this study to his previous study of concurrent assault and suicide just before or at the time of admission to psychiatric hospitals.

Adolescent↗
PubMed1989

Medication refusal and the rehospitalized mentally ill inmate.

Records of all inmates committed to a state forensic hospital in fiscal year 1982 (N = 472) were studied to examine the inmates' hospital utilization between September 1977 and April 1984 and the reasons for their admissions. Medication refusal, hallucinations and delusions, and threatened or potential violent behavior toward others were the most frequently documented reasons for admission. Medication refusal was associated with a greater number of hospitalizations, shorter hospitalizations, diagnoses of paranoid schizophrenia or schizophreniform disorders, longer prison sentences, and convictions for more serious felonies. Inmates admitted for medication refusal were also likely to be referred concurrently for threatened or potential violent behavior toward others. The study demonstrates the particularly violent nature of a large proportion of the hospitalized mentally ill inmates and the important role of medication refusal in their rehospitalization.

Commitment of Persons with Psychiatric Disorders↗
PubMedDate not supplied

Limiting the psychotherapist-patient privilege: the therapeutic potential.

The author first explores the law of the psychotherapist-patient privilege along with the traditional rationale for the privilege. The results of studies challenging the assumptions upon which the privilege rests are summarized. Finally, the potential therapeutic advantages are explored. The author suggests that the absence of an absolute privilege might in fact prevent harmful behavior. Those patients who communicate to their therapists the desire or intent, for example, to commit a crime, might not act on their urges for fear of disclosure of the communication in a future criminal proceeding.

Confidentiality↗
PubMed2004

Situating unusual child and adolescent sexual behavior in context.

There is a lack of scientific knowledge concerning what constitutes normal versus unusual sexual behaviors among minors. Clinical judgements in these cases often are clouded by unfounded sociocultural assumptions, personal biases, legal issues, and moral considerations. Current diagnostic nomenclature that is used commonly for adult sexual activities is inappropriately applied to minors. Considerations about unusual sexual interests (ie, frequency of sexual behaviors, difficulties controlling sexual expression,consent, nonheterosexual interests, much older or younger partners, atypical sexual stimuli, number of partners, and sexual abuse) are explored to provide perspective for evaluation.

Adolescent↗
PubMed2006

Sexual sadism and sadistic personality disorder in sexual homicide.

Controversies exist about the diagnostic validity of sexual sadism and its relation to sadistic personality disorder in sex offenders. The aim of this study was to investigate which diagnostic, developmental, and criminal characteristics differentiate sexual sadistic from non-sadistic sexual homicide perpetrators. Psychiatric court reports on 166 men who had committed a sexual homicide were evaluated regarding psychiatric, sexual and criminal history. Sixty-one offenders (36.7%) with sexual sadism (SeSd) were compared with 105 (63.3%) offenders without this diagnosis (NSeSd). Besides the sexual sadistic symptoms, there were seven factors that discriminated best between the two groups (sexual masochism, sadistic personality disorder, isolation in childhood, multiple sexual homicide, previous rape, previous tendencies for similar behavior, and long duration of the homicidal act). Sexual sadism is connected with circumscribed other characteristics and has to be considered in risk assessment and treatment of sex offenders.

Antisocial Personality Disorder↗
PubMed1985

The use of restraints on a general psychiatric unit.

A 9-month prospective study of all patients restrained on the acute psychiatric units of two general hospitals and a group of nonrestrained controls revealed significant demographic and diagnostic differences between restrained and nonrestrained patients. Restraint occurred more often in young, unmarried, seriously ill men with a previous history of violent behavior and previous psychiatric treatment. These characteristics were coupled with inadequate neuroleptic treatment and a perception of inadequate power authority (low staffing levels of male orderlies). There was a significantly higher frequency of a history of previous violence in restrained patients compared to nonrestrained patients on the same unit. These data have important clinical and legal implications for persons involved in making predictions of "dangerousness."

Adolescent↗
PubMed2004

Analysis of monoamine oxidase A (MAO-A) promoter polymorphism in male heroin-dependent subjects: behavioural and personality correlates.

The promoter of the monoamine oxidase A (MAO-A) gene was analysed to test whether length variation of the repeat polymorphism contributes to variation in individual vulnerability to aggressive-criminal behaviour, and liability to heroin dependence. The repeat number of the MAO-A polymorphism was assessed in 199 male subjects of Italian descent, a sample comprising 95 healthy subjects and 104 heroin-dependent subjects including 52 addicted individuals with violent behaviour and antisocial personality disorder. The frequency of the low-activity 3-repeat allele was significantly higher in violent offenders among heroin addicts, compared to addicted individuals without antisocial behaviour (34.6 vs. 15.4%; p<0.03) and controls (18.9%; p<0.05). No significant difference was evidenced in the frequencies of the MAO-A alleles between heroin-dependent subjects in general and control subjects. High activity 4-repeat allele frequency was significantly higher in addicted individuals without antisocial behavior compared to antisocial-aggressive heroin-dependent subjects (76.9 vs. 55.8%; p<0.02). Buss Durkee Hostility Inventory (BDHI) mean total scores were significantly higher in heroin addicts than in controls (p<0.001), and in antisocial-violent heroin addicts in comparison with addicted individuals without antisocial behaviour (p<0.005). Among heroin addicts BDHI irritability, suspiciousness and resentment subscales scores were found significantly higher in low activity 3-repeat allele subjects than in high activity alleles subjects (p<0.001; p<0.05; p<0.05, respectively). No association was found between MAO-A polymorphism and suicide history. Our findings suggest that the low-activity 3-repeat allele of the MAO-A promoter polymorphism confers increased susceptibility to antisocial-violent behavior and aggressiveness, rather than drug dependence per se, in heroin-dependent males.

Adult↗
PubMedDate not supplied

Characteristics of freebase cocaine psychosis.

Psychosis was present in 29 percent of cocaine-disordered patients hospitalized in 1985 during an epidemic of freebase cocaine abuse in the Bahamas. Record reviews revealed that a variety of psychotic phenomenologic patterns were present. Prior major mental disorders and increased dosage of cocaine were more common among psychotic than non-psychotic patients. Violent behavior was common among cocaine patients, especially those with psychosis. We conclude that freebase cocaine psychosis is neither rare nor benign.

Adult↗
PubMed1994

Death due to cocaine intoxication initially thought to be a homicide.

We present a case of accidental death due to cocaine ingestion in which the victim's bizarre behavioral manifestations initially led law enforcement officials to consider the death a homicide. By virtue of the medical examiner's thorough investigation, the true accidental nature of the death was brought to light.

Adult↗
PubMed1993

X-linked borderline mental retardation with prominent behavioral disturbance: phenotype, genetic localization, and evidence for disturbed monoamine metabolism.

We have identified a large Dutch kindred with a new form of X-linked nondysmorphic mild mental retardation. All affected males in this family show very characteristic abnormal behavior, in particular aggressive and sometimes violent behavior. Other types of impulsive behavior include arson, attempted rape, and exhibitionism. Attempted suicide has been reported in a single case. The locus for this disorder could be assigned to the Xp11-21 interval between DXS7 and DXS77 by linkage analysis using markers spanning the X chromosome. A maximal multipoint lod score of 3.69 was obtained at the monoamine oxidase type A (MAOA) locus in Xp11.23-11.4. Results of 24-h urine analysis in three affected males indicated a marked disturbance of monoamine metabolism. These data are compatible with a primary defect in the structural gene for MAOA and/or monoamine oxidase type B (MAOB). Normal platelet MAOB activity suggests that the unusual behavior pattern in this family may be caused by isolated MAOA deficiency.

Adult↗
PubMed1992

Language disorders in disruptive behavior disordered homicidal youth.

Eight homicidal youths were assessed for language disorders and psychiatric diagnoses using a battery of standardized language tests and the Diagnostic Interview for Children and Adolescents. Both language disorders and Diagnostic and Statistical Manual III-R psychiatric diagnoses were present in all subjects.

Adolescent↗
PubMed1990

Quality assurance for psychiatric emergencies. An analysis of assessment and feedback methodologies.

Improvement in the quality of evaluation and treatment of behavioral emergencies presenting to hospital emergency rooms requires a multicomponent assessment of resources, clinician performance, and outcome. The authors present a summary of data and conclusions derived from index-based assessment of quality of care in over 2000 psychiatric emergencies. The study revealed that emergency room physicians rendered high-quality medical care, but were deficient in crucial aspects of psychiatric evaluation and treatment including evaluation of dangerousness and substance abuse and provision of appropriate follow-up care. A positive association was observed between quality of care and compliance with referral. Subsequent review with the staff pointed to issues such as staffing, emergency room and community resources, and adequacy of documentation as significant influences on quality of care, as assessed by the chart-audit, index approach. A pilot study demonstrated uniform improvement of quality scores in a small group of physicians receiving written and oral feedback about their performance. The use of focused quality assessment studies that examine both structural and process factors, and their correlation with outcome, is discussed in light of the information obtained from the previously described study. A feedback methodology that emphasizes an interactive process to identify deficiencies in care and to explore their causes and remedies is presented.

Aftercare↗