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PubMed1991

Acquaintance rape and alcohol consumption on college campuses: how are they linked?

This article explores the links between acquaintance rape and alcohol consumption among college students. Both heavy drinking and acquaintance rape are serious problems on college campuses, and they frequently co-occur. Seven explanations for the relationship between alcohol consumption and acquaintance rape are provided: three of these explanations focus on alcohol consumption by the perpetrator and four focus on alcohol consumption by the victim. The need to conduct studies and develop prevention programs that address these issues is discussed.

Adolescent↗
PubMed1996

The heterosexual singles scene: putting danger into pleasure.

The juxtaposition of pleasure and danger has engaged many feminist theorists and researchers in the field of sexuality. This article presents a theoretical analysis of the ambiguous and complex relationship between 'pleasure', 'danger' and contemporary feminist theory. In doing so, it offers an understanding of the ways in which the categories of pleasure and danger operate within the discourses of heterosexuality to construct perceptions of risk in the context of HIV/AIDS. Data were collected from a study of the sexual attitudes and practices of 112 sexually-active, single, heterosexual adults (58 men and 54 women), aged 20 to 40 years (mean = 27 years) who agreed to be interviewed when approached at night-clubs and public "singles' bars around Melbourne, Australia. The qualitative analysis presented here is consistent with a poststructuralist feminism. First, we discuss how sexuality cannot be cast solely as pleasurable or dangerous. Second, we demonstrate how heterosexualized notions of pleasure and danger operate to provide misperceptions of risk from HIV/AIDS transmission. Third, we identify the ways in which the logic of identity functions to obscure risk within the discourse of heterosexuality, and finally we attempt to forge new ways of practising pleasure which disrupt heterosexist discourses and allow for pleasures which incorporate danger.

Adult↗
PubMedDate not supplied

Prehospital sedation with intramuscular droperidol: a one-year pilot.

OBJECTIVE: Combative patients pose a threat to themselves and prehospital personnel, and are at risk for sudden death. Droperidol is an antipsychotic and sedative agent that might be effectively utilized by paramedics to assist in the management of uncontrollably violent patients. METHODS: A prospective observational study of patients requiring sedation was conducted in an urban third-service emergency medical services system (55,000 calls per year). Patients were scored by paramedics on a five-point agitation scale with 5 being extremely combative (continuous, vigorous fighting against restraints) and 1 being somnolent (sleeping or sleepy). Eligible (score 4-5) patients received 5 mg of intramuscular droperidol on direct physician order. Data including vital signs and agitation scores were recorded at 5-minute intervals until hospital arrival. Adverse effects were also recorded. RESULTS: Fifty-three patients received droperidol (51 patients received 5 mg; two received 2.5 mg) during the study period. The average predrug agitation score was 4.7 (+/- 0.1 SD). The average 5-minute postdrug score was 3.9 (+/- 0.1 SD, 95% CI 3.7-4.1. The average 10-minute postdrug score was 3.3 (+/- 0.1 SD, 95% CI 3.1-3.6). The average hospital arrival score was 2.8 (+/- 0.1 SD, 95% CI 2.5-3.1). One patient became obtunded and required supplemental oxygen; no other patient experienced an adverse event after receiving droperidol. Sedation was ineffective in seven patients, three of whom had head injuries, and one of whom received 2.5 mg of droperidol per physician order. Paramedics sustained no needlestick exposures. CONCLUSION: Intramuscular droperidol contributed to effective and rapid prehospital sedation in this observational series of 53 combative patients.

Aggression↗
PubMed2004

"Antwone Fisher": how dangerous is "Dr Wonderful"?

OBJECTIVE: To describe the style of psychotherapy portrayed in the film "Antwone Fisher". The rationale for this examination is that prospective patients often have little idea about what the process of psychotherapy may involve; depictions of therapy in popular films and on television serve to "prime" our patients' expectations in this regard. CONCLUSIONS: The film in question shows a psychiatrist who might be readily perceived as unambiguously good by a lay audience, despite a number of clear therapeutic boundary violations occurring throughout the film. Although such positive depictions might enhance the public image of psychiatry, they have the potential to create unreal expectations within patients and to promote the acceptability of boundary violations.

Dangerous Behavior↗
PubMed2004

'Kindling theory' in arson: how dangerous are firesetters?

OBJECTIVE: This article aims to review the literature on firesetters particularly looking at recidivism rates. The early literature described firesetters as dangerous individuals. This article reviews the more recent empirical data to examine if it supports the early literature. METHOD: A literature review was performed examining papers which described firesetters with any reference to recidivism. These were divided into three broad categories based on where studies have been performed, namely in forensic psychiatric settings, the criminal justice system and general and psychiatric hospitals. RESULTS: The literature has been poorly focused and provides little help when assessing an individual firesetter. Risk factors associated with general criminology have been cited. CONCLUSIONS: The empirical literature cannot support the hypothesis that firesetters are inherently dangerous. More research should target different groups of firesetters and examining individual risk within that group with an aim of researching treatment for the different groups.

Brain↗
PubMedDate not supplied

Mental health practice: can philosophy help?

Traditionally, philosophy has been regarded as operating at a level above practical application. However, the discipline can offer mental health policy and practice some valuable aid. First, its logical rigour can help to clarify concepts and expose inconsistency and prejudice; second, its wealth of theory about morality can enrich the concepts that guide mental health practice. By avoiding simplistic solutions (such as reliance on the 'four principles' of biomedical ethics) those who turn to the discipline of philosophy may learn how to be more critical of accepted policies and practices.

Bioethics↗
PubMed2004

Use of seclusion in a psychiatric acute inpatient unit.

OBJECTIVE: To examine the rate and characteristics of seclusion among a group of patients admitted to an adult acute psychiatric unit as a precursor to planning an audit cycle and quality improvement project. METHODS: A retrospective chart review of all inpatient admissions to an adult acute unit over a 12 month period was undertaken with the use of a specially developed proforma. A comparison of secluded and non-secluded patients was described, and, where possible, statistically analysed. RESULTS: Four hundred and fifty admissions occurred during the study period, resulting in 140 episodes of seclusion. This represented a seclusion rate of 31% per admission. In contrast to patients who were not secluded, those secluded were more likely to be young, admitted involuntarily and with a diagnosis of schizophrenia. The most common indicator of seclusion was risk to others (74%) followed by risk to self (61%) and risk of absconding (55%). Length of time in seclusion ranged from 1 to 49 h with a mean of 9 h. Thirty-nine per cent of secluded patients were secluded on two or more occasions. Interventions including counselling, time out and medication were used in 71% prior to seclusion; however, in 29% no intervention was documented. Seclusion was more likely to occur in the evenings, when staff/patient ratios were lower. CONCLUSION: Seclusion remains an important part of psychiatric practice. As expected, the use of seclusion in an adult acute unit reflected indirect measures of illness severity. Its use needs to be carefully reviewed and monitored, representing as it does the greatest restriction on a person's freedom.

Acute Disease↗
PubMed2004

Changeability, confidence, common sense and corroboration: comprehensive suicide risk assessment.

OBJECTIVE: The authors, in collaboration with NSW Health, have recently developed a comprehensive suicide risk assessment framework. The present paper describes key concepts in the assessment of suicide risk by mental health professionals. METHODS: A framework for conducting a comprehensive suicide risk assessment was derived from the literature, incident analysis and clinical experience. The framework underwent a consultation process involving clinicians in NSW area mental health services. The aim was to provide clinicians with a standardized conceptual map for the assessment of suicide risk. A MEDLINE search was conducted for publications dealing with 'suicide' and 'suicide risk assessment' from 1980 to 2002. The recommendations from sentinel event reviews conducted in a NSW area mental health service in the period 1999-2002 were reviewed. The lessons from a visit to a coroner's relatives support group for people who had been bereaved by suicide also informed the development of the guidelines. RESULTS: A framework is proposed for the assessment of suicide risk. The framework promotes a reflective style of practice, encouraging clinicians to evaluate their assessment and its limitations. Risk assessment is always undertaken as part of a full clinical assessment and an evaluation of the person's current predicament and psychosocio-cultural context. The concepts of changeability, assessment confidence, common sense and the importance of corroboration are incorporated in the framework. CONCLUSIONS: Mental health clinicians can be guided by a framework in suicide risk assessment and documentation. The assessment of suicide risk can generate a suicide risk rating for which minimum standards of care can be mandated.

Clinical Competence↗
PubMed2006

Angry faces get noticed quickly: threat detection is not impaired among older adults.

Previous studies have found that younger adults detect threatening stimuli more quickly than other types of stimuli. This study examined whether older adults also show this adaptive threat-detection advantage. On each trial in the experiment, participants saw an array consisting of nine schematic faces. Eight of the faces were neutral; the ninth was neutral, angry, happy, or sad. Participants indicated whether there was a discrepant face in each array. Both older and younger adults were significantly faster to correctly detect a discrepant face when it signaled threat than when it signaled happiness or sadness. There was no age difference in this threat-detection advantage, indicating that this automatic process is maintained among older adults.

Adolescent↗
PubMed1986

Forensic social work in a mental health setting.

In forensic social work, a relatively new field of practice, significant contact between social work and the law is prominent. A statewide program of services to forensic psychiatric patients in Maryland demonstrates the principles and issues involved in forensic work and the widespread applicability of social work concerns in the criminal justice and mental health systems.

Adult↗
PubMed1987

Decision making in psychiatric emergencies.

Social workers increasingly are being required to assist clients in emergency situations. Such conditions typically require rapid decision making and quick action. In this article, the processes practitioners use in their interventions in psychiatric emergencies are examined. This examination is based on concepts derived from cognitive psychology and decision-making theory. Implications for practice and training also are discussed.

Crisis Intervention↗
PubMed1994

Confidentiality after Tarasoff.

Following the Tarasoff decision, many social workers believe that they have a duty to warn third parties of the danger posed to them by clients. However, a careful analysis of this decision and the cases and statutes that have followed indicates that social workers' duty under the law is circumscribed. This article describes social workers' duty under the law and outlines standards of care for assessing and responding to threats of harm. It places the duty to protect third parties into the larger context of social workers' ethical and legal obligation to protect confidentiality.

Adult↗
PubMed1996

Documentation of client dangerousness in a managed care environment.

The rapid growth of managed care has accelerated the evolution of the clinical record. Previously used for process notations, global assessment, and treatment planning, the record is increasingly used to demonstrate accountability to third-party payers and to the legal system. This article discusses the documentation of accountability in the case of potential client suicide or violence toward others.

Dangerous Behavior↗
PubMed1984

Liberty, beneficence, and involuntary confinement.

My purpose in this paper is to show that current legal criteria for paternalistic involuntary psychiatric confinement of the mentally ill are both too narrow and too broad. I do this by first developing a principle of justified paternalistic interference with adults, which I take to be acceptably protective of individual liberty, but which does not require unnecessary sacrifices of individual welfare. After offering an analysis of current legal criteria for involuntary confinement, I argue that an acceptable theory of paternalistic interference reveals that those criteria (1) exclude some cases where confinement would be morally permissible, and (2) allow paternalistic confinement of many whose detention is not morally justifiable.

Aged↗