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PubMed1999

Thoughts of harming infants in depressed and nondepressed mothers.

BACKGROUND: Thoughts of harming the infant and other disturbing cognitions are frequently described in anecdotal reports on postpartum depression. These cognitions have not been examined empirically. METHODS: 100 clinically depressed mothers with a child under 3 years were evaluated and compared to a control group of 46 nondepressed mothers. RESULTS: 41% of depressed mothers compared to 7% of control mothers admitted to thoughts of harming their infant. Fear of being alone with the infant and inability to care for the infant were assessed only in depressed mothers and occurred less frequently. More than half of depressed mothers had problems in one of these three areas. CONCLUSIONS: Thoughts of harming the infant are common in depressed mothers. Demographic variables, psychosocial stressors and psychiatric variables do not help predict which mothers are likely to experience thoughts of harm or fear of being alone with the infant. These cognitive and affective disturbances may be one pathway by which maternal depression affects infants. LIMITATIONS: The control group was not given the full diagnostic interview. Consequently, the groups were not selected by identical procedures. Also fear of being alone with the infant and difficulty caring for the infant were not assessed in the control group.

Child Abuse↗
PubMed1997

Sociodemographic predictors of violence.

A representative sample of 25 years of research relating sociodemographic variables to violence is reviewed. Generalizations from those studies are applied to the authors' more recent research on domestic violence. Factors limiting the ability of the studies to be synthesized into a more meaningful whole are identified. Strategies to enhance the value of future studies are discussed.

Adolescent↗
PubMed1993

The incidence of battery in an urban emergency department.

STUDY OBJECTIVE: To determine the incidence of battery against emergency department medical staff by patients or visitors. DESIGN: Prospective descriptive study over a nine-month period. SETTING: A university-affiliated ED Level I trauma center with an annual census of approximately 64,000 located in a major metropolitan area. PARTICIPANTS: All staff members who had been punched, kicked, grabbed, pushed, or spat on by a patient or visitor while on duty in the ED. INTERVENTIONS: Questionnaire that was completed after the incident. RESULTS: During the study period, there were 19 instances of violence against staff by patients. Staff members were punched six times, kicked seven times, grabbed three times, pushed once, and spat on twice. Blows usually were sustained on the face or head (seven) or on the extremities (seven). In only four cases were hospital incident reports filled out, and in no case was there an injury serious enough to require ED treatment or disability leave. The assailant was usually male (15 of 19, 79%) and usually on a psychiatric or substance abuse detainment (15 of 19, 79%). CONCLUSION: This study suggests that instances of battery in an urban university hospital ED usually are not serious and are committed by patients on a psychiatric or substance abuse detainment.

California↗
PubMed1998

Perceived risks associated with mental illness: beyond homicide and suicide.

This paper presents an exploratory study of factors of perceived risk related to people who experience serious mental illness. The study focuses upon four stakeholder groups: service users, their carers, mental health professionals and the general public. The development of a questionnaire to examine risk perceptions is described along with the data collection techniques employed in the study. A large number of data sets (n = 1076) was obtained from the four groups of stakeholders (n = 550). Factor analysis of the data produced six factors of perceived risk: underclass, medical disempowerment, threat, vulnerability, self-harm and dependency. This suggests that stakeholders have a wider perception of risk than perceptions defined through current policy. These factors are subsequently examined in relation to a range of independent variables of which gender is the most significant variable in the perception of risk. The findings support results from studies of other forms of risk where women have been found to perceive risks greater than men.

Adult↗
PubMedDate not supplied

Development of the drug abuse screening test for adolescents (DAST-A).

The development and initial validation of the Drug Abuse Screening Test for Adolescents (DAST-A) is summarized. The DAST-A, derived from a modification of the original adult version called the Drug Abuse Screening Test (DAST: Skinner, 1982), was psychometrically tested in a study group of adolescent inpatients. The DAST-A demonstrated good internal consistency, high test-retest reliability, unidimensional factor structure, and good concurrent validity. Using the classification system of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 1994), DAST-A scores of greater than 6 yielded sensitivity, specificity, and positive predictive powers of 78.6%, 84.5%, and 82.3%, respectively, in differentiating adolescent psychiatric inpatients with and without drug-related disorders. These findings suggest that the DAST-A holds promise as a drug abuse screening measure in psychiatrically impaired adolescent populations.

Adolescent↗
PubMed1998

Fatal accidents due to train surfing in Berlin.

This study was undertaken for the purpose of analysing under the aspect of legal medicine, fatal accidents due to train surfing in the local transport system of Berlin (S-Bahn and underground). The period of investigation was from 1989 through 1995, with 41 train surfing accidents, among them 18 with fatal outcome. Evaluation included those 14 deaths which were forensically autopsied. It was based on autopsy records of Berlin-based university institutes (Humboldt University and Free University) as well as the Brandenburg State Institute of Legal Medicine. Also used were data obtained from the Berlin Transport Police Record. The casualties were aged between 13 and 25 years, most of them between 16 and 20. The male-female gender ratio was 13:1. Accidents occurred above all in the warmer season of the year, most of them between 20:00 h and midnight. More than 50% of all cases were affected by alcohol, but centrally acting medicaments or other addictive drugs were not noticed at all. Most of the fatal accidents occurred to users of the Berlin S-Bahn network. Older train models were the preferred surfing objects due to their structural peculiarities. Collision with close-to-track obstacles and slipping from the train proved to be the major sources of danger. An analysis of injuries revealed polytraumatisation but for one exception, with craniocerebral injuries being the most common and severest events. The longest survival time amounted to 24 h. As the psychosocial causes of high-risk behaviour of adolescents will hardly be controllable, withdrawal of technical, that is structural design possibilities appears to be the most important approach to prevention of accidents in the future. This demand is met by the new series of the Berlin S-Bahn. The model of the old series, suitable for surfing, still accounts for about 10% of the rolling stock and is to be decommissioned in 1998.

Accidents↗
PubMed2002

Juvenile justice mental health services.

As the second century of partnership begins, child psychiatry and juvenile justice face continuing challenges in meeting the mental health needs of delinquents. The modern juvenile justice system is marked by a significantly higher volume of cases, with increasingly complicated multiproblem youths and families with comorbid medical, psychiatric, substance abuse disorders, multiple family and psychosocial adversities, and shrinking community resources and alternatives to confinement. The family court is faced with shrinking financial resources to support court-ordered placement and treatment programs in efforts to treat and rehabilitate youths. The recognition of high rates of mental disorders for incarcerated youth has prompted several recommendations for improvement and calls for reform [56,57]. In their 2000 annual report, the Coalition for Juvenile Justice advocated increased access to mental health services that provide a continuum of care tailored to the specific problems of incarcerated youth [58]. The specific recommendations of the report for mental health providers include the need for wraparound services, improved planning and coordination between agencies, and further research. The Department of Justice, Office of Juvenile Justice and Delinquency Prevention has set three priorities in dealing with the mental health needs of delinquents: further research on the prevalence of mental illness among juvenile offenders, development of mental health screening assessment protocols, and improved mental health services [59]. Other programs have called for earlier detection and diversion of troubled youth from juvenile justice to mental health systems [31,56]. Most recently, many juvenile and family courts have developed innovative programs to address specific problems such as truancy or substance use and diversionary or alternative sentencing programs to deal with first-time or nonviolent delinquents. All youths who come in contact with the juvenile justice system should be screened and, when necessary, assessed for mental health and substance abuse disorders. The screening should occur at the youth's earliest point of contact with the juvenile justice system and should be available at all stages of juvenile justice processing. Whenever possible, youth with serious mental health disorders should be diverted from the juvenile justice system [58]. If delinquent youths do not receive the necessary evaluation, treatment, and rehabilitation, they face the real prospect of further incarceration in adult correctional facilities. Improved screening and treatment require better interagency collaboration, established standards of care, and continuing research on the mental health needs of youth in the juvenile justice system. Better mental health care for youth in the juvenile justice system supports the goal of rehabilitation. Mental health professionals should support these efforts as the appropriate response to meet the challenges of the new century.

Adolescent↗
PubMed2003

The hazards and prevention of driving while sleepy.

In the present paper the literature bearing on the association between sleepiness and driving is reviewed and the current state of prevention is discussed. Sleepiness may be a factor in about 20% of motor vehicle accidents and studies carried out in controlled environments suggest that the most common changes in driving performance attributable to sleepiness include increased variability of speed and lateral lane position. Higher-order functions including judgement and risk taking may also deteriorate. Moreover, prolonging wakefulness even by a few hours may produce deterioration in driving performance comparable to that seen in drivers with blood alcohol concentrations at levels deemed dangerous by legislation. The majority of prevention efforts to date have focussed on short-term solutions that only mask underlying sleepiness and it is suggested that more emphasis be directed toward primary prevention efforts such as educating drivers about the importance of getting sufficient sleep and avoiding circadian performance troughs. Finally, the important role that health professionals can play in the identification, treatment, and education of sleepy drivers is highlighted.

Accidents, Traffic↗
PubMed2000

Risk and protection: the discourse of confinement in contemporary mental health policy.

Confinement has regained respectability in the discourses of contemporary UK mental health policy. This development reflects concern about violent offences by people with mental health problems and is rooted in claims about the 'failure' of community care. Confinement is presented as a strategic response to the risks and dangers posed by particular fractions of the population of mental health service users. Using two key policy statements issued by the Department of Health and associated discussions in the health services management press, the confinement theme is explored and assessed. The paper notes its emergence as a consequence of the spatial impacts of deinstitutionalization and its specific origins in response to violent offences by people with mental health problems. The notion that the growing emphasis on confinement presages a return to the asylum is considered and rejected. Rather, the paper stresses the importance of discourses of protection, safety, risk and dangerousness in understanding the turn to confinement.

Commitment of Persons with Psychiatric Disorders↗
PubMed1997

Managing risk in the city: the role of welfare professionals in managing risks arising from vulnerable individuals in cities.

Modern cities depend on individualism and the process of contracting. Contracts between individuals contribute to stability and order in cities. However, this is challenged by risks and uncertainties especially those relating to vulnerable individuals who are unable or unwilling to enter into contractual relations. This paper focuses on the role of caring professions and the impact of new strategies for managing risks related to vulnerable adults and children, especially the shift from managing risk in institutions to managing risk in the community. This paper is based on research funded through the ESRC Risk and Human Behaviour Programme.

Adult↗
PubMed1984

Serum creatine phosphokinase levels and assaultive behaviour of psychotic patients.

Serum creatine phosphokinase (CPK) levels were compared with assaultive behaviour by 46 psychiatric patients. Significant relationships were found between CPK level and violent behaviour prior to admission and CPK level and seclusion as a danger to others while in hospital. No relationship was found between CPK level and assaultiveness while in hospital.

Adult↗
PubMed1979

Variations in referral pattern to the psychiatric services by general practitioners.

Referral rates to psychiatric services in North-East Scotland by 147 individual urban and rural general practitioners were calculated. Among city doctors, the greater the number of years since qualification the more patients were referred. Single-handed city doctors also had very high referral rates. Subsequent interviews were conducted with 76 general practitioners. Topics covered included reasons for referral to psychiatric services. Psychotics, severely depressed patients, alcoholics and violent patients were the most frequently referred groups.

Alcoholism↗
PubMed2004

Characteristics and circumstances of homicidal acts committed by offenders with schizophrenia.

BACKGROUND: While men with schizophrenia are at higher risk of displaying homicidal behaviours compared with the general population, very little is known about the circumstances related to the triggering of such violent acts among offenders with schizophrenia. The main goal of the present investigation was to describe the surrounding context, psychotic symptoms, target characteristics and other circumstantial factors associated with homicidal acts committed by men with schizophrenia, with or without an additional antisocial personality disorder (APD). METHOD: Comprehensive clinical and research interviews, as well as multiple sources of information including reports from social workers and police officers, criminal records, witness statements and questionnaires completed by friends, acquaintances and family members were used to determine specific characteristics surrounding the homicidal acts. RESULTS: Overall, a significant majority of homicides were considered as the consequence of psychotic symptoms; they mostly involved someone who knew the offender; and they usually occurred in a private residence. However, the subgroup of offenders with both schizophrenia and APD were less likely to be judged as responding to psychotic symptoms; they assaulted a non-relative more frequently, and they were more likely to have used alcohol and to be involved in an altercation with the victim prior to the incident than offenders without APD. CONCLUSION: Even for such extreme acts as homicides, the circumstances affecting the occurrence of violence among offenders with schizophrenia may differ when an additional APD diagnosis is present, which would have important implications for prevention and treatment programmes.

Age Factors↗
PubMed1999

Risk and dangerousness.

The task of improving the ability of clinicians to predict which of their patients will be violent has come to be seen as one of establishing the relative merits of actuarial and clinical prediction. The meaning of these terms is unclear. 'Clinical' is usually defined by exclusion, that is, as something other than actuarial. The term 'actuarial' is often used to refer to the techniques of risk prediction in financial services. In the psychiatric and psychological literature relating to the assessment of dangerousness, three further meanings have emerged. That whereby actuarial refers to any mathematical means of combining information is the most widely accepted. Whichever definition is employed, the conclusion of most reviews has been that the future is actuarial. It is argued here that, while mathematical approaches have been successful in showing that risk factors for violence in the general population apply also to the mentally disordered, important questions remain unanswered. Mathematical methods address only one form of probability, that which arises from chance. A development of another form of probability, that which arises from causes, offers the prospect of improved risk assessment in psychiatry. It also offers a definition of clinical prediction that is not based on exclusion.

Dangerous Behavior↗