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At least 451 records · Page 25Linked to original sources
PubMed1990

Clinicians' self-reported reactions to psychiatric emergency patients: effect on treatment decisions.

Masters-level social work clinicians at two urban psychiatric emergency services self-rated their cognitive reactions and conscious feelings toward a total of 783 patients. Negative self-reported affect toward patients was related to their displaying overt psychotic symptoms, having a final diagnosis of substance abuse, being impulsive, unemployed, or having a history of criminal behavior. However, clinicians' reactions did not enter into the model predicting hospitalization, which included opinion of family and friends, degree of psychopathology, suicidal ideation and lack of social supports as the major predictors of whether or not a patient would be hospitalized.

Adult↗
PubMed1985

Correlations of self-directed violence in acute schizophrenics with clinical ratings and personality measures.

Schizophrenic patients admitted to an acute inpatient unit were evaluated with the Comprehensive Psychopathological Rating Scale (CPRS), items reflecting hostility from the same scale, the Eysenck Personality Questionnaire (EPQ), and the Socialization and Self-Control scales of the California Psychological Inventory (CPI). Incidents of violent and nonviolent suicidal behavior and suicidal ideation before admission, and assaultiveness against self subsequent to admission were recorded. It was determined that behavioral ratings of degree of schizophrenic symptoms on the CPRS are more highly likely than ratings of hostility to correlate with self-directed violence before and subsequent to admission. Personality measures that reflect violence toward others (Psychoticism on the EPQ and Socialization on the CPI) also correlate with violence toward self.

Acute Disease↗
PubMed1994

The HIV-positive psychiatric patient and the duty to protect: ethical and legal issues.

UNLABELLED: A small, yet significant, percentage of HIV-positive patients have a concomitant psychiatric or neurological disorder associated with impaired judgment. Clinical problems such as psychoses, certain personality disorders, and dementias are associated with disinhibition of impulses and diminished capacity for self-monitoring. These deficits in reasoning and judgment may prevent the patient from comprehending the significance of their HIV status and the consequences of sexual behavior or needle sharing. There are indications that the Tarasoff duty-to-protect may apply to this situation. METHOD: Available data about the prevalence of HIV risk behavior and HIV infection among psychiatric patients are reviewed. The applicability to these situations is described. RESULTS: When an HIV patient engages in high risk sexual behavior with identifiable partners and refuses to notify them of their HIV status, physicians and mental health professionals may have a legal and ethical duty to warn. CONCLUSION: A decision model for this clinical dilemma is presented. Clinical strategies for these patients may include ongoing supervision and monitoring as well as possible quarantine.

AIDS Dementia Complex↗
PubMed1993

Determinants for hospitalization from an emergency mental health service.

There has been limited systematic study of determinants of acute psychiatric hospitalization of children and adolescents. This study reviewed the records of children and adolescents who received emergency mental health services in one New Jersey county during 6 months of 1990 (N = 226). Using a structured form to abstract data, information was obtained on demographics, precipitating problems, past mental health services, substance use, family problems, and disposition. While suicidal behavior was not a predictor of acute hospitalization, the interaction of assaultive and suicidal behavior was predictive. Other contributory factors identified in the multivariate analysis included: child's substance use, family member's substance use, and initial emergency screening site. Recognition of present utilization patterns will facilitate the development of intensive community-based options for those with acute mental health problems.

Adolescent↗
PubMed2004

"Barebacking": intentional condomless anal sex in HIV-risk contexts. Reasons for and against it.

Intentional condomless anal sex in HIV-risk contexts ("barebacking") has been heatedly debated in gay circles, the gay media, and, to a lesser degree, the mainstream media. Yet it has received little attention in the scientific literature. In order to better understand the reasons behind this behavior, we conducted a content analysis of messages posted on an Internet message board following Gay.com's decision to close a company-sponsored bareback chat room. Individuals posting messages self-identified in their online profiles as being mostly White/ European gay men residing in the US, with an average age of 35 years. Out of 130 messages, 62 (48%) were pro-barebacking, 55 (42%) were against barebacking, and 13 (10%) referred to other topics. The content analysis of the messages showed that both those in favor of and against barebacking felt well-informed about HIV/AIDS and the risks of HIV transmission. Those in favor considered condomless sex more enjoyable than sex with condoms (both in actual experience and in erotic imagery), felt that condomless sex conferred a sense of freedom, minimized the risks involved in barebacking (assuming that practitioners were already HIV infected and that the risk of superinfection was small), and ultimately believed that barebacking was a personal decision and responsibility. Those against barebacking believed the behavior was dangerous, advocated for condom use and personal and social responsibility, and felt barebackers needed to be sensitized to the burdens of HIV disease. Implications of these results are discussed, pointing out the need for further scientific inquiry in this area.

Adult↗
PubMed1992

A psychodynamic approach to the master treatment plan.

Formulating master treatment plans for the hospital treatment of psychiatric patients is especially challenging to psychodynamically oriented clinicians unaccustomed to reducing complex intrapsychic and interpersonal phenomena to specific observable behaviors. In collaboration with a wide cross section of hospital staff members, the authors developed a conceptual framework for treatment plans compatible with psychodynamic thinking. They describe the treatment evaluation research from which the format of the treatment plan evolved, as well as the guide they developed to facilitate its implementation .

Activities of Daily Living↗
PubMed2001

[Schizophrenia and violence. Results of a comprehensive inquiry in an Austrian providence].

The question as to whether schizophrenics have an increased potential for delinquency and violent behavior has given rise to much controversy. During the past few years, a large number of epidemiological studies have demonstrated a moderate but reliable relation between schizophrenic disorders and violence. In the present study, a new approach at investigation was used by evaluating the overall rate of convictions and commitments to psychiatric institutions for general delinquency, violence, and homicide among schizophrenics. The most outstanding results demonstrated that the treatment of schizophrenic offenders was only insufficiently covered by the psychiatric care system, showed the lack of compliance in the study group, and demonstrated the high significance of coexisting acute and chronic alcohol and drug abuse. The risk of delinquency and violent behavior was much higher in schizophrenics than in the general population. It is indicated, however, that mentally ill delinquents are only of minor importance within the overall group of offenders and that better preventive and therapeutic measures present opportunities for prevention.

Adolescent↗
PubMed1987

Common suicidal subtypes and their treatment.

Self-destructive behavior is the final pathway for a variety of underlying problems. Because there is such a wide range of diagnostic possibilities in patients who attempt suicide, more precise diagnosis is essential. The often-asked question "Will the patient attempt suicide again?" is insufficient. Rather, an understanding of why the person is unhappy facilitates identification of the suicidal subtype and the necessary therapeutic interventions.

Adult↗
PubMed2000

[Aggressive behavior of mentally incompetent psychiatrically ill criminals during inpatient treatment].

UNLABELLED: OBJECTIVE, METHODS: To assess the amount of violent behaviour among mentally ill offenders NGRI during forensic long-term inpatient-treatment we retrospectively investigated the official incident-reports concerning verbal and physical aggression and damage to foreign property during an 8-year period in Austria's central high-security institution. RESULTS: 29.2% of our patients exhibited violent behaviour with only 7.8% being responsible for 41.1% of all incidents. Mentally impaired patients were significantly overrepresented in the violent group. Physical violence was reported in 25.8% (= 16.48 assaults/100 patients/year). 68% of the total amount of physical violence was directed against fellow patients. Violent behaviour was less driven by psychotic symptoms but rather by current everyday conflicts and stress situations. CONCLUSIONS: The majority of incidents had only minor consequences. Yet, an inquiry concerning the offenders' intentions and the danger experienced by staff members indicated a reasonable violent potential also in minor assaults which appears to be important with respect to ward climate and distress of staff.

Adult↗
PubMed1999

Behavioral health issue brief: outpatient civil commitment.

Civil commitment is a term associated with involuntary treatment of individuals with mental illness. It can be an inpatient admission for treatment in a hospital or other health facility or it can be outpatient treatment that is court ordered. Either way the treatment is considered to be mandated or involuntary. But if a person, who suffers from mental illness, is not able to make appropriate decisions about his or her care and treatment, who will? How can society be assured that person takes the medication a physician says is needed to treat their illness? Opponents of civil commitment argue that it is a violation of a person's civil rights to order treatment. They fear that relaxing commitment standards may, again, lead to institutionalization of our mentally ill. Proponents contend that by not following recommended treatment plans these people can become a danger to themselves or others. Therefore, someone must take responsibility for them, otherwise they may violate the rights of, or fall victim to, others and are likely become incarcerated within the criminal justice system.

Civil Rights↗
PubMed2000

The substance user at risk of harm to self or others: assessment and treatment issues.

This article is divided into two main sections, one discussing suicide and substance use, and the other describing substance use and various forms of violent behavior toward others, including sexual assault and domestic violence. In each section, issues regarding prevalence of harm to self and others in substance users, clinical assessment and treatment, etiologic factors, definitional problems, and research needs are discussed. Substance use appears to be associated strongly with both violence toward self and violence toward others, but the exact nature of these relationships is somewhat unclear.

Adult↗
PubMed1988

The effects of unstable clients in adolescent treatment: contagion versus continuity.

This study examined the effects of integrating an unstable group of seriously disturbed adolescents into an existing day treatment program. Behavioral data were collected for an established group of subjects who were in treatment one year prior to and one year after the arrival of a new group of severely disturbed adolescents. It was found that the disruptive behavior displayed by the new admission subjects was not imitated by the subjects of the established group. Rather, there was a significant decrease in aggression and in the overall number of psychiatric events for the established group. The treatment milieu was seen to be resistant to the effects of the new admissions largely due to the structured form of treatment.

Adolescent↗
PubMed1985

From conflict to collaboration: psychiatry and the hospital police.

Social control is one of the major tasks of the profession of psychiatry (Astrachan, Levinson, and Adler 1976; Adler, Astrachan, and Levinson 1981). The reduction and control of deviant behavior in the community, in the hospital, and on the psychiatric ward are essential, if underappreciated, responsibilities which psychiatrists must negotiate every day. In large urban general hospitals, an increasingly common site for psychiatric programs, deviant behavior derives both from the psychopathology of the patients and from the intrusion of criminal influences from the community. Many urban hospitals have an institutional police force that, like the psychiatry service, is charged with responsibility for managing deviant behavior, albeit through law enforcement methods rather than clinical ones. In recent years law enforcement officers and psychiatrists have increasingly become involved with each other in areas where their social control responsibilities overlap. This increased involvement has often been accompanied by tension, distrust, and, at times, overt antagonism between the two groups. This paper will describe and analyze fundamental sources of this tension and outline one approach to its reduction.

Dangerous Behavior↗
PubMed1990

The relationship of gender to violent behavior in acutely disturbed psychiatric patients.

On the basis of extensive review of the medical records of 253 patients hospitalized in a locked psychiatric unit, the authors found that before hospitalization, men engaged in significantly more physical attacks and fear-inducing behavior than did women. During short-term psychiatric hospitalization, although men continued to engage in more fear-inducing behavior, women engaged in proportionately more physical attacks. To control for possible confounding variables, the authors repeated the analyses after stratifying by demographic and diagnostic variables that were distributed differently among men and women. The same pattern of relationships between gender and violence was found. The authors give case examples and discuss possible explanations and implications of the findings.

Acute Disease↗
PubMed2004

Suicidality of chronic schizophrenic patients in long-term community care.

In the provision of mental health care for chronic schizophrenic patients, the specific problems and requirements of long-term community care of suicidal behavior is an area of research not yet fully explored. This study focuses on a 4 1/2-year prospective assessment of normative and subjective needs for care related to this specific area for a cohort living in the Dresden region (Germany). One significant result of this study shows the constant high level of needs for care in the area of suicidal behavior imposed on community services by 30-40% of this diagnostic group. Furthermore, the study identified a special high-risk subgroup for suicides as well as specific needs for care. This subgroup is characterized by clinical reasons for the index hospitalization (suicidal risk or attempt) as well as by psychopathological features (suicidal thoughts and higher levels of anxiety/depression) 1 month after release from index hospitalization. Four items of care were rated as potentially effective for addressing suicidality in the community setting: clinical assessment, increased supervision or systematic recording of (suicidal) behavior, medication, and a sheltered environment. Because these care measures are provided, the percentage of unmet normative needs for the area of suicidal behavior was rather low. Due to limitations of the instrument used for assessment of normative needs, the Needs for Care Assessment (NFCAS), the care measures most frequently provided do not define a quality standard of community care for this problem. A subjective needs assessment differing from the normative approach has to be integrated in establishing guidelines for effective community care.

Adult↗
PubMed1981

Delirium tremens and precipitous behavior. An analysis of two cases.

Alcoholism exists in alarming numbers of medical and surgical patients, often adding significant difficulties to their hospital management. Patient experiencing delirium tremens are known to exhibit irrational behavior, such as attempts to escape the hospital by any available means. Two cases of surgical patients at Rochester General Hospital who jumped from windows are discussed. These cases are reviewed closely, revealing deficiencies in history taking, errors in pharmacotherapy, and lapses in nurse-physician communication. The psychiatric consultant is alerted to a potential role in helping his medical and surgical colleagues avert disasters such as those described.

Adult↗
PubMed1990

[Alcohol and criminal behavior].

The topic 'alcohol and crime' has several aspects. This article shows how drug administration is based on a complex network of legal provisions and is enforced by criminal law sanctions. As to crimes influenced by alcohol, drunken driving is by far the most important and best researched field. Next, the article turns to the role of alcohol with regard to severe common crimes such as murder or child abuse. Finally, the issue of drunkenness as a defence is raised and the treatment of alcoholics as a criminal law sanction discussed.

Accidents, Traffic↗
PubMed2006

Caregiver cognitive status and potentially harmful caregiver behavior.

The association between caregiver cognitive status and potentially harmful caregiver behavior was assessed in a sample of 180 caregiver-care recipient dyads. Compromised cognitive status was identified in 39% of these informal caregivers. Beyond variance explained by demographic factors, amount of care provided, care recipient cognitive status, and caregiver depressed affect, care recipients reported more frequently being subjected to potentially harmful caregiver behavior when their caregivers evidenced compromised cognitive status. While preliminary, critical areas of caregiver cognition appeared to be deficits in language comprehension and memory. Results indicate that compromised cognitive status is common among informal caregivers of impaired elders and that this may adversely influence the quality of care they provide.

Adult↗