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PubMed1998

Homicide or suicide: the killing of suicidal persons by law enforcement officers.

This paper presents 15 deaths of suicidal persons in Oregon and Florida who, by their behavior, sufficiently provoked law enforcement officers into killing them. Four deaths were certified as suicide, one as undetermined and ten as homicide. All of the deaths are individually described in detail and their case characteristics are presented in a table. The method of study is a descriptive analysis of the case characteristics, including 21 variables which are determined to be relevant to the classification of death. The variables were grouped into six categories: (a) personal information; (b) criminal behavior during the fatal incident; (c) dangerous behavior during the fatal incident; (d) toxicological data; (e) mental illness information; and (f) certification data. From the analysis, reasons for the opinions on manner of death classification are presented. All incidents were perceived as life-threatening to law officers, family members, or hostages. All victims were male except one, and all were Caucasian except two. All victims resisted arrest and verbally threatened homicide during the fatal incident. Two-thirds of the victims took hostages. All victims possessed an apparent handgun or other weapon (knife, iron bar). All victims posed their weapon and threatened others during the incident, 60% of victims actually used the weapon with apparent intent to inflict damage to others. 40% of victims were intoxicated with alcohol but other drug-involvement was uncommon. Seven of 15 had previous suicide attempts, 40% had medically documented psychiatric diagnoses and 60% had reasonable historical evidence of psychiatric diagnoses, most commonly depression or substance abuse. One of the co-authors presents the case for some of the deaths to be certified as suicides, whereas two present the case for all to be certified as homicide. A brief discussion of psychiatric issues is also presented concerning individuals who use others to commit suicide and who may engage in dangerous and/or criminal behavior to do so. A major conclusion is that there is lack of a unified opinion on death certification procedures for individuals who have provoked law enforcement officers to kill them. For such cases, it is recommended that professional organizations of medical examiners/coroners develop guidelines to promote consistency in death certification practices including manner of death classification and selection of death certificate wording so that "police-assisted suicide" may be appropriately reported and studied.

Adolescent↗
PubMed2003

The amygdala, social behavior, and danger detection.

The amygdala is a distinctive portion of the anterior temporal lobe that has been implicated in a variety of functions including expression of fear, modulation of memory, and mediation of social communication. While work on the rodent amygdala often deals with emotion, much of the research in nonhuman primates and in man deals with its role in the perception of social signals, such as facial expressions, and the maintenance of social position, such as in primate dominance hierarchies. We have established a program of research that has as its major goal the definition of neural systems that underlie species-typical social communication. A first phase of the program was launched on the premise that the amygdala is essential for species-typical social behavior. We sought to examine in more detail the impairments of social behavior that followed discrete, bilateral lesions of the amygdala. We found, however, that mature rhesus monkeys with bilateral lesions of the amygdala not only were capable of species-typical social behavior, but actually engaged in more affiliative social interactions. The lesioned animals also demonstrated a striking lack of fear of normally fear-inducing stimuli such as replicas of snakes. In a second, ongoing series of studies in the infant rhesus monkey, we are examining whether the amygdala is essential for gaining social knowledge during development. Infant animals that receive bilateral lesions of the amygdala at two weeks of age and are raised by their biological mothers demonstrate all expected social behaviors for their ages. These animals, like the adults, demonstrate a lack of fear of objects such as snakes. However, unlike the adults, they demonstrate more fear when placed into novel social situations. The results from these studies are most consistent with the conclusion that the amygdala is not necessary for species-typical social behavior or for gaining social knowledge during development. We hypothesize that the amygdala is a critical component of a system that evaluates the environment for potential dangers. As such, it has a modulatory role on social behavior-that is, it typically inhibits social interaction with novel conspecifics while they are evaluated as potential adversaries. This perspective predicts that hyperactivity of the amygdala would be associated with increased fear or anxiety and may contribute to disorders such as social phobia.

Affect↗
PubMed1992

Coping with the disruptive college student: a practical model.

This article offers some practical suggestions for college faculty and administrators who must deal with disruptive students. It emphasizes the need for well-defined codes of student conduct and clear procedures for dealing with disruptive behavior, and considers why university officials may be reluctant to deal with disciplinary problems related to psychiatric disturbances. The author discusses the distinction between disruptive and dangerous behavior, looks at the use of mandatory psychiatric withdrawals, makes recommendations for conditions of re-enrollment, and suggests how a campus mental health service can be useful in dealing with the problem.

Administrative Personnel↗
PubMed2003

Mentoring and monitoring: the use of unit watch in the 4th Infantry Division.

A unit watch is an intervention used by Army mental health care clinicians to assist soldiers in regaining mastery over impulsive or dangerous behaviors. Although widely used, it is controversial because of concerns for soldiers' safety and lack of formal study into its efficacy as a treatment option. A retrospective chart review conducted at the 4th Infantry Division Mental Health Section gathered demographic and diagnostic information on soldiers placed on unit watch during the year 2000. The results showed the intervention to be used most commonly with young, junior-grade enlisted soldiers without serious psychiatric diagnoses. Its effectiveness appeared to arise from increased social support during times of stress (mentoring) as well as close observation of the soldier by unit members to discourage impulsive or dangerous behavior and ensure immediate assistance if necessary (monitoring). This article will discuss these benefits as well as highlight potential problems and suggest areas for further study.

Adult↗
PubMed2005

Variation in patient routine costliness in U.S. psychiatric facilities.

BACKGROUND: The Balanced Budget Refinement Act of 1999 included a Congressional mandate to develop a patient-level case mix prospective payment system (PPS) for all Medicare beneficiaries treated in PPS-exempt psychiatric facilities. Payment levels by case mix category have been proposed by the government based on claims and facility cost reports. Because of claims data limitations, these levels do not account for patient-specific staffing costs within a facility's routine units, nor are certain key patient characteristics considered for higher payment. AIMS OF THE STUDY: This study uses novel primary data to quantify heretofore unmeasured differences in daily staffing intensity on routine units among Medicare patients. The data are used to test for compression (or narrowing) in case mix payment weights that would result from using only Medicare claims and facility cost reports to quantify daily routine costliness. METHODS: Primary data on patient and staff times in over 20 activities were collected from 40 psychiatric facilities and 66 psychiatric units, nation-wide. Patient times were reported on all inpatients on each shift over a 7-day study period. A resource intensity measure (in Registered Nurse (RN)-equivalent minutes) was constructed on a daily basis for 4,149 Medicare and 4,667 non-Medicare patient days. The routine measure is converted into daily cost using cost report per diems and ancillary costs added using submitted claims. Descriptive tables isolate key cost drivers for Medicare patients. Classification and Regression Trees (CART) clustering identifies 16 potential case mix groups. Multivariate regression is used to compare case mix, day-of-stay, and facility effects using 4 alternative measures of daily routine and ancillary costs. RESULTS: Patient daily routine intensity of care is found to vary by a factor of 3 or more between the top and bottom 10% of days. Medicare patient days were 12.5% more staff intensive than non-Medicare days, which may have been due to age and other differences. Older dementia and "residual diagnosis" patients are more intensive while schizophrenia and substance-related patients are less intensive. Age, psychiatric and medical severity, deficits in Activities in Daily Living (ADLs), dangerous behaviors, and electroconvulsive therapy (ECT) also contribute substantially to higher staffing intensity. Other patient characteristics were insignificant within broad diagnostic groups. Routine costs based on a single facility per diem produced narrower case mix cost differences--often by a factor of 2 or more--for 10 of 12 groups with significantly higher costs. Adding patient-specific ancillary to uniform per diem costs only marginally decompressed costs. Day of-stay costs were similarly compressed when using only cost reports. DISCUSSION: Claims-based costing using Medicare cost reports unduly compresses (narrows) estimates of inter-group case mix cost differences. Also, by not capturing ADL deficits and dangerous behaviors, administrative data sets fail to identify small, but very resource intensive, patient groups. ECT treatment regimens, although rare, significantly increase costs on a daily basis. IMPLICATIONS FOR HEALTH POLICIES: Medicare's recently proposed prospective payment system for psychiatric inpatients uses claims-based costing methods based on widely available administrative data. Consequently, fewer high cost groups are identified due to non-reported patient characteristics such as ADL deficits. Moreover, inter-group relative cost differences are likely understated. It is also possible that any standardized dollar amount applied to group relative weights is understated because Medicare patients appear more intensive per day on routine units. IMPLICATIONS FOR FUTURE RESEARCH: Larger primary samples of special psychiatric units (e.g., med-psych, child/adolescent) could improve estimates of daily routine costliness. Larger samples could also support stronger tests of case mix and cost differences by facility type and teaching status. Medical records information on non-Medicare patients could quantify any systematic differences in average daily costs holding case mix constant. Similar primary studies of psychiatric patients treated outside PPS-exempt units in acute general hospitals could result in a fully integrated payment system for all mentally ill Medicare patients, thereby avoiding payment inefficiencies and inequities.

Activities of Daily Living↗
PubMed2005

The smell of danger: a behavioral and neural analysis of predator odor-induced fear.

The odors of predators used in animal models provide, in addition to electric footshock, an important means to investigate the neurobiology of fear. Studies indicate that cat odor and trimethylthiazoline (TMT), a synthetic compound isolated from fox feces, are often presented to rodents to induce fear-related responses including freezing, avoidance, stress hormone and, in some tests, risk assessment behavior. Furthermore, we report that different amounts of cat odor impregnated on small-, medium-, or large-sized cloths impact the display of fear-related behavior when presented to rats. That is, rats exposed to a large cat odor containing cloth exhibit an increase in fear behavior, particularly freezing, which remains at high levels in habituation tests administered over a period of 7 days. The large cloth also induces a long-lasting increase in avoidance behavior during repeated habituation and extinction tests. A review of the brain regions involved in predator odor-induced fear behavior indicates a modulatory role of the medial amygdala, bed nucleus of the stria terminalis, and dorsal premammillary nucleus. In addition, the basolateral amygdala is involved in fear behavior induced by cat odor but not TMT, and the central amygdala does not appear to play a major behavioral role in predator odor-induced fear. Future research involving the use of predator odor is likely to rapidly expand knowledge on the neurobiology of fear, which has implications for understanding fear-related psychopathology.

Amygdala↗
PubMed1971

Reduction of dangerously aggressive behavior in a severely retarded resident through a combination of positive reinforcement procedures.

A severely retarded resident was released from a timeout chair only occasionally for brief periods of time. Under the timeout contingency alone, the subject made a choke response within minutes of being released. Attention, such as hugs, smiles, and candy was then increased, first by providing it non-contingently and continuously as long as there were no aggressive responses and then, by making it contingent upon incompatible responses. Under conditions of timeout plus increased attention, choking decreased aburptly. Grabbing responses, which increased when choking was reduced, were also reduced under conditions of timeout plus attention. Unrestrained time was gradually increased and all extra attention, i.e., more scheduled attention than provided other residents, was gradually withdrawn. When the resident was unrestrained all day and all extra attention was withdrawn, grabs and, to a lesser extent, chokes increased. Both were again reduced to a manageable level by scheduling several brief periods of attention each day. Hence, the program resulted in quick reductions that endured when the program was largely withdrawn. The changes in aggressive responding as a function of the presence and absence of extra attention suggest the importance of extra "positive reinforcement" in programs based upon positive reinforcement procedures and dealing with retarded residents for whom positive reinforcers may be scarce.

Journal Article↗
PubMed2003

Embedded health behaviors from adolescence to adulthood: the impact of tobacco.

Prevention of cancer risk behaviors before they become embedded in an individual's life is crucial. Health-related behaviors should be viewed for their embeddedness, critical aspects of which are (a) the complexity of the behavior itself; (.b) factors, both biological and psychological, within the individual communicator; (c) and external situational or sociocultural factors. The more extensively a behavior is embedded, the more difficult it will be to alter. Relative levels of embeddedness of the risk behavior and its entanglement with other nonrisky behaviors will evolve and change throughout one's life course. Smoking across the life span provides an excellent example of a thoroughly integrated, embedded behavior. How smoking is embedded with other behaviors changes from adolescence, where biological factors may be less salient and habit strength less pronounced, through adulthood, where habit strength is greater but health concerns are a more predictive factor. Researchers can produce more focused communication interventions by examining how health-endangering behaviors are embedded among benign behaviors or among other potentially dangerous behaviors. Ideally, the pattern of health behavior embeddedness should be analyzed prior to developing intervention communication strategies.

Adolescent↗
PubMed1984

Assessing the operation of secure care programs in New York State facilities.

In 1980 New York State's Office of Mental Health began operation of a program designed to provide a secure treatment unit at each of the 23 state psychiatric centers. As part of a research project to assess the operation of the units, demographic and hospitalization data were gathered on all clients residing on, and admitted to, the 14 operational units over a five-month period in 1982. Clinical data and information on program operation were also obtained. Results indicated that the units were generally functioning as planned, primarily serving young male civil patients referred for assaultive behavior. The patients were significantly more likely to have been involved in incidents of dangerous behavior and to have been in restraint or seclusion than were patients on comparison wards. The study also found that the secure units had been effective in reducing the rate of such incidents for the patients served. However, some data suggested the presence of an inappropriate population on certain units.

Adult↗
PubMed1994

Substance use, risky behaviors, and victimization among a US national adolescent sample.

Data from the National Adolescent Student Health Survey were used to study the interrelations among substance use, risky (dangerous) behaviors, and victimization among 8th and 10th graders. Pearson correlations indicated significant associations between substance use and both higher levels of risky behaviors (e.g., hitchhiking, going on a blind date) and victimization among adolescents. Regression analyses indicated the potency of risky behaviors as a predictor of victimization for male adolescents, and a significant risky behavior by illicit drug use interaction for female adolescents. Results are discussed with regard to potential short- and long-term health consequences of risky behaviors and violent victimization for psychological development in adolescence and adulthood.

Adolescent↗
PubMed1987

The clinical significance of command hallucinations.

Patients with command hallucinations (voices ordering particular acts, often violent or destructive ones) are commonly assumed to be at high risk for dangerous behavior. The authors reviewed 789 consecutive inpatient admissions. Of 151 patients with auditory hallucinations, 58 (38.4%) heard commands. The presence of auditory hallucinations was significantly associated with diagnosis, demographic variables, and use of maximal observation and seclusion. However, patients with command hallucinations were not significantly different from patients without commands on demographic and behavioral variables, including suicidal ideation or behavior and assaultiveness. These findings suggest that command hallucinations alone may not imply greater risk for acute, life-threatening behavior.

Adult↗
PubMed1998

[Delirium tremens in Israel].

We discuss pathogenetic aspects (biochemical, pharmacological) of delirium tremens (DT) in accordance with the acute clinical processes, the development of psychosis, and preventive treatment used in the various stages. A typical patient, a 33-year-old man, and the difficulties in diagnosis and treatment are presented and conclusions from the dangerous behavior of the patient are drawn.

Adult↗
PubMed1983

The impact of deinstitutionalization on California's state hospital population.

Deinstitutionalization has dramatically reduced the state psychiatric hospital population in California from 37,000 in 1955 to only 2,500 at the present time. In 1980 and 1982 the California Department of Mental Health conducted two surveys to assess demographic characteristics, psychiatric diagnosis, health status, and behavioral traits of state hospital patients. The results indicate that most patients are young, male, and diagnosed as schizophrenic and frequently engage in dangerous behaviors. The various patient subpopulations exhibited few differences in diagnostic distribution, although Hispanics did have a significantly higher rate of substance use. The author posits that the current hospital population constitutes a "hard core" of patients who may be difficult to place in community treatment facilities.

Adolescent↗
PubMed1994

A cognitive model of dangerous delusional misidentification syndromes.

The hallmark of the delusional misidentification syndromes is the presence of a misidentification delusion of the self or others. Delusional misidentification may present with an increased risk for dangerous behaviors. Individuals suffering from delusional misidentification syndromes may express hostility in ways ranging from serious verbal threats to homicidal acts. The causes of dangerous misidentification delusions remain for the most part undetermined. In this article, we report a series of six cases of individuals who harbored dangerous misidentification delusions. These individuals were studied phenomenologically and forensically. They were also studied biologically, including neuropsychological testing. A cognitive hypothesis aimed at explaining dangerousness and delusional misidentification is proposed. Implications of the hypothesis for further research are briefly outlined.

Adult↗
PubMed1989

Relationship between preadmission threats and later violent behavior by acute psychiatric inpatients.

The medical charts of 253 patients admitted to an acute psychiatric inpatient unit were reviewed for evidence of threats of violence within the two weeks before admission and violent behavior during the first three days of hospitalization. Fifty-eight percent of the patients who had made threats before admission required seclusion for dangerous behavior in the hospital, and 32 percent of the patients who had made threats physically assaulted someone in the hospital. The association between preadmission threats and subsequent violence was especially strong among schizophrenic patients. Compared with schizophrenic patients who did not threaten others, those who had made preadmission threats were more likely to be physically and verbally assaultive and were more likely to require seclusion. Manic patients who had made threats were more likely than those who had not made threats to be verbally assaultive while in the hospital.

Adolescent↗
PubMed1981

Emergency control measures for psychiatric inpatients.

This survey of a large number of patients in psychiatric hospitals found that emergency medication, seclusion or restraint, and one-to-one supervision were used infrequently. However, certain types of patients, namely the young and those in hospital for less than 2 years, were more likely to have received these control measures, Furthermore, psychiatric diagnosis was related to the use of these measures probably as a reflection of the effectiveness of treatment for these disorders. It appeared that these measures were justified based on the fact that patients receiving these controls were more likely than those not receiving controls to manifest active psychosis as well as dangerous behaviors such as physical and sexual assault, fire-setting, and deliberate self injury.

Adolescent↗
PubMed1993

College students' views of excessive drinking and the university's role.

Views of college students (N = 133) regarding excessive drinking were explored in terms of the amount of drinking which constitutes a drinking problem, the behaviors that indicate a student has been drinking excessively, and university alcohol policies that students would endorse. Students accepted levels of drinking by peers that markedly exceed definitions of excessive drinking by experts. A sizable minority of students refuse to label very dangerous behaviors associated with excessive drinking as indicating a drinking problem. The views of male and female students differed only marginally. Since students seem to define excessive drinking in ways that differ from professionals, it is suggested that student affairs personnel need to plan programs that recognize the students' views, otherwise students may continue to believe that while excessive drinking is bad, their level of drinking cannot lead to any problems.

Adolescent↗
PubMed1997

[Mental and behavior disorders in the aged: attempt at classification and relationship with caregivers' burden].

BACKGROUND: To measure the relation between different disorders of the elderly and the carer's burden. METHOD: A cross-sectional study was carried out by a questionnaire administered to carers of dependent elderly living at home. Mental and behavioral disorders were measured by the Zarit "Memory and behavior problems check list" (MBPC); carer's burden was measured with the Zarit "Burden Inventory" (BI). A principal components analysis was performed to make groups of disorders with the MBPC items and the relation between these groups and the carers' burden was determined by a multiple regression analysis. RESULTS: The analysis was performed with 190 files. Six groups of disorders were individualized: memory and orientation problems, aggressive or dangerous behaviors, regressive behaviors, disruptive behaviors, wandering, mood disturbance and agitation. These 6 factors explain 43.2% of the variance of the carer's burden. Each factor is linked to the BI score and 3 behavioral typologies are specially related to the carers BI: regressive behaviors (R = 0.49), disruptive behaviors (R = 0.51), and mood disturbance with agitation (R = 0.53). CONCLUSION: This study shows that it is possible to differentiate specific behavioral typologies in elderly, which explain a limited part of the carer's burden.

Age Factors↗