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PubMed2005

Lack of motivation for treatment in emergency psychiatry patients.

BACKGROUND: A lack of motivation for treatment on the part of patients is a major problem for emergency psychiatric services. Little is known about its determinants. The aim of this study was to investigate determinants of treatment motivation in emergency psychiatric patients. METHOD: A cross-sectional study of 719 patients was made. Motivation for treatment and other clinical variables were assessed using the Severity of Psychiatric Illness scale and the Brief Psychiatric Rating Scale. RESULTS: In all, 47% of patients were not motivated for treatment and they also had severe clinical problems. Lack of motivation was associated with danger to others [odds ratio (OR) 2.03; confidence interval (CI) 1.21-3.40], substance abuse (OR 1.71; CI 1.09-2.67), suspiciousness (OR 1.4; CI 1.19-1.64), grandiosity (OR 1.19; CI 1.01-1.4), anxiety (OR 0.74; CI 0.64-0.86), and GAF score (OR 0.98; CI 0.96-0.99). CONCLUSIONS: Lack of motivation for treatment is a common phenomenon among severely mentally ill patients seen by emergency psychiatric services. Lack of motivation was associated with danger and paranoid symptoms. Motivational techniques as well as involuntary treatment may help to overcome problems due to lack of motivation in these patients.

Adolescent↗
PubMed1998

The growing belief that people with mental illnesses are violent: the role of the dangerousness criterion for civil commitment.

In response to a controversy concerning whether the stigma of mental illness has declined significantly in the United States in the past several decades, we assessed changes in public perceptions that mentally ill people are violent. Specifically, we compared answers to an open-ended question regarding respondents' understanding of the term "mental illness" from two nationally representative surveys, one conducted in 1950 and one in 1996. In an earlier paper, we reported the finding that perceptions of violence not only failed to decrease but actually increased significantly between 1950 and 1996. In this paper, we explore the possibility that the dangerousness criterion for involuntary commitment, widely adopted in the United States beginning in the 1960s, has contributed to the unexpected increase in perceptions that mentally ill people are dangerous. We find that, among respondents who mention violence in their description of a mentally ill person, the percentage who use "dangerous to self or others" phrasing to indicate this belief increased substantially, from 4.2% in 1950 to 44.0% in 1996. Moreover, eliminating these respondents from consideration, there was a slight decrease in perceptions of violence between 1950 and 1996. We discuss the possibility that the adoption of the dangerousness criterion, which was intended to protect the civil liberties of mentally ill persons, may also have had the unintended consequence of increasing the stigma of mental illness in the United States.

Adolescent↗
PubMed2004

[How dangerous are patients with mental disorders?].

The question of potential violence on the part of people with a mental disease has caused considerable controversy in recent decades. While in the eighties the prevailing opinion was that they have no increased risk of aggression, recent studies, especially from Scandinavia and Canada, show a moderate but reliable coherence between violent crime and paranoid and schizophrenic diseases. The danger of people with a mental disease is assessed essentially through the following five study-approaches: Studies to assess the criminal rate of hospitalised patients, the prevalence of mental disorder, studies on prisoners who are committed to a psychiatric facility, and long-term analyses of cohorts. Special emphasis is attached to investigations on homicides. Other investigative questions are concerned with the influence of psychopathological symptoms, the importance of comorbid disturbances and sociological aspects. The studies agree that the risk of violence is decisively increased in people who suffer from schizophrenia, through additional substance abuse, comorbidity with personality disorders, absence of treatment and social desintegration. An unprejudiced approach to this sensitive theme of aggression in people with schizophrenia with regard to further effective prevention and therapy is required.

Aggression↗
PubMed2005

Psychiatric disposition of patients brought in by crisis intervention team police officers.

BACKGROUND: As part of an effort to improve police interactions with mentally ill citizens, and improve mental health care delivery to subjects in acute distress, the University of Louisville, in conjunction with the Louisville Metro Police, established the crisis intervention team (CIT). CIT is composed of uniformed officers who receive extensive training in crisis intervention and psychiatric issues and who are preferentially called to investigate police calls that may involve a mentally ill individual. METHODS: In an effort to determine the characteristics of the individuals brought to the emergency psychiatric service (EPS) by CIT officers, a comparative (CIT vs. mental inquest warrant [MIW, a citizen-initiated court order to bring someone for psychiatric evaluation because of concerns regarding dangerousness] vs non-CIT/non-MIW), descriptive evaluation was performed. RESULTS: With the exception of a higher rate of schizophrenic subjects brought in by CIT (43.0% vs. 22.1%, non-CIT, P = .002), the demographics, diagnosis, and disposition of CIT-referred subjects were not different in any way from non-CIT patients. Subjects referred on MIWs were more likely to be admitted to a psychiatric hospital than non-MIW patients (71.6% vs. 34.8%, P < .0001), but CIT-referred hospitalization rates were not different from hospitalization rates of self-referred subjects (20.7% vs. 33.3%, ns). CONCLUSIONS: CIT officers appear to do a good job at identifying patients in need of psychiatric care.

Commitment of Persons with Psychiatric Disorders↗
PubMed2005

Reasonable partiality in professional relationships.

First, two aspects of the partiality issue are identified: (1) Is it right/reasonable for professionals to favour their clients' interests over either those of other individuals or those of society in general? (2) Are special non-universalisable obligations attached to certain professional roles? Second, some comments are made on the notions of partiality and reasonableness. On partiality, the assumption that only two positions are possible--a detached universalism or a partialist egoism--is challenged and it is suggested that partiality, e.g. to family members, lies between these two positions, being neither a form of egoism, nor of impersonal detachment. On reasonableness, it is pointed out that 'reasonable' is an ambiguous concept, eliding the notions of the 'morally right' and the 'rational.' Third, a series of practical examples are taken from counselling, medicine, law, education and religious practice and some common principles are abstracted from the cases and discussed. These include truth-telling, confidentiality, conflicts of interest between clients and particular others and between clients and society. It is concluded that while partiality can be justified as a useful tool in standard cases, particular circumstances can affect the final verdict.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Examining the science and practice of violence risk assessment with female adolescents.

While the field of violence risk assessment among adult males has progressed rapidly, several questions remain with respect to the application of forensic risk assessment tools within other populations. In this article, we consider the empirical evidence for the assessment, prediction, and management of violence in adolescent girls. We discuss limitations of generalizing violence risk assessment findings from other populations to adolescent girls and point out areas where there is little or no empirical foundation. Critical issues that must be addressed in research prior to the adoption or rejection of such instruments are delineated. Finally, we provide practice guidelines for clinicians currently involved with adolescent females within risk assessment contexts.

Adolescent↗
PubMed2005

Predictions of future dangerousness in capital murder trials: is it time to "disinvent the wheel"?

Although recent U.S. Supreme Court decisions regarding the death penalty (e.g., Atkins v. Virginia, 2002) have renewed interest in mental health issues, one topic that has not received much attention recently is the ongoing use of expert testimony to support claims that defendants represent a "continuing threat to society." In this article, we (a) review prior research relevant to determining the accuracy of clinical predictions that capital defendants will commit future acts of criminal violence; (b) summarize new data from current and former death row inmates in Texas that bolster the claim that such predictions are gross overestimates of risk; and (c) review extant research addressing the potential utility of various risk assessment instruments that increasingly are being used to reinforce clinical predictions in capital trials. Despite significant recent advances in the field of risk assessment, clinical assertions that a defendant is likely to commit future violent acts appear to be highly inaccurate and ethically questionable at best. Moreover, available research offers little support for the claim that the accuracy of these predictions will be appreciably improved by relying on more structured risk assessment measures that have some demonstrated predictive validity in other contexts.

Adolescent↗
PubMed2005

Gender and risk assessment accuracy: underestimating women's violence potential.

Understanding factors that contribute to mental health professionals' (MHPs') accuracy in assessing patients risk of violence can inform efforts to improve accuracy and to integrate risk assessment technology with practice. Based on a sample of 147 clinicians who assessed 680 patients in a psychiatric emergency room, this study investigates the influence of patient gender, MHP gender, and their potential interaction on MHPS' risk assessment accuracy. The results indicate that MHPs of both genders are particularly limited in their ability to assess female patients' risk of future violence. This finding was not limited to a particular professional group and was not attributable to gender-related differences in violence. Implications for future research on the judgment processes that may underlie MHPs' limited accuracy with women and for training programs in violence risk assessment are discussed.

Adult↗
PubMed1992

Why are experts not better in judging the danger of filmed traffic conflicts?

Earlier studies on the subject of subjective judgment of traffic conflicts showed that untrained subjects can reliably judge the dangerousness of filmed traffic conflicts. It was concluded that these judgements were based on a concept of dangerousness. In line with these findings two experiments were conducted. Experiment 1 tested the hypothesis that traffic experts (traffic engineers trained to evaluate and improve traffic safety) and lay people use the same concept of dangerousness when judging filmed conflicts. Experiment 2 investigated which aspects of the conflicts are considered by experts when making these judgements. The results show that (i) experts and lay people are equally reliable in judging traffic conflicts, (ii) experts base their judgement on the same concept of dangerousness, (iii) experts do not base their judgement on aspects that they themselves regard as important for the conflict, (iv) a weak relation is found between violations of traffic regulations and judgements of dangerousness.

Accidents, Traffic↗
PubMed1995

Behavioural characteristics and involvement in different types of traffic accident.

Recent research has shown risk of road traffic accident involvement to be associated with the tendency to commit driving violations, fast driving, and a lack of thoroughness in decision making. It has also been shown that three broad types of accident can be used to categorise more than 70% of drivers' brief written descriptions of their accidents. These categories are "shunts" (rear-end collisions), right-of-way violations, and loss-of-control accidents. Furthermore, for each accident type the role of the reporting driver may be defined as active (striking) or passive (struck) depending on the position of his/her vehicle. This paper reports two studies examining the extent to which measures of tendency to commit violations (measured by the Driver Behaviour Questionnaire (DBQ)), frequency of fast driving (measured by the Driving Style Questionnaire (DSQ)) and thoroughness in decision making (measured by the Decision Making Questionnaire (DMQ)) are associated specifically with involvement in each of the main accident types. The results showed that a high DBQ-violation score was associated with accidents in general, both active and passive, and specifically with active loss-of-control accidents and passive right-of-way accidents. High DSQ-speed and low DMQ-thoroughness were associated with active but not passive accidents, high DSQ-speed with active right-of-way violations, and low DMQ-thoroughness was specifically associated with active shunts and active right-of-way violations. The implications of these results are discussed.

Accidents, Traffic↗