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PubMed1989

U.S. and Soviet perspectives on the diagnosis of schizophrenia and associated dangerousness.

During a visit of U.S. senior mental health and forensic experts to the Soviet Union to assess recent changes in Soviet psychiatry, a symposium was held to discuss the U.S. and Soviet concepts of the diagnosis of schizophrenia and dangerousness associated with psychiatric illness. The basic conclusion from this exchange was that significant differences exist between the countries in both areas, as the U.S. conceptualization of schizophrenia and associated dangerousness is considerably narrower than that of Soviet practice. Clearly, future scientific exchange is warranted to examine these conceptual differences in an effort to establish a better empirical basis for assessing the most appropriate medical treatment and legal disposition for patients.

Cross-Cultural Comparison↗
PubMed1989

Dangerousness and commitment of the mentally disordered in the United States.

This article describes recent developments in mental health laws in the United States, especially as they relate to uses of the concept of "dangerousness" in the civil and criminal commitment of the mentally ill. In addition to providing a brief overview of the U.S. legal system and noting the importance of the Rule of Law, we review the historical development and current status of the relevant laws, provide some basic epidemiological statistics, and refer to some of the considerable body of extant empirical research in the field.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

On social dangerousness of mental patients.

The relationship of the definition of social dangerousness and its application to mental patients is explored from a criminology perspective wherein social dangerousness is described as a universal concept used to assess damage done to society; and a socially dangerous individual is defined as having the potential to commit an offense. The risk of social dangerousness of mental patients is high and typically occurs during the first 4 years of the illness. It is dependent upon complex interactions between psychopathologic phenomena, environmental stimuli, and personality characteristics of the patient; and detection requires a general definition of the dangerous psychotic state and an elaboration of the methods for diagnosis.

Antisocial Personality Disorder↗
PubMed1994

Dispelling the stigma of schizophrenia: what sort of information is best?

This study investigated what type of information reduces stigmatization of schizophrenia. Subjects were presented with one of six varying descriptions of a hypothetical case in which a target individual had recovered from a mental disorder. Subjects were asked if they knew someone with a mental illness. Those individuals who had no previous contact perceived the mentally ill as dangerous and chose to maintain a greater social distance from them. In general, knowledge of the symptoms associated with the acute phase of schizophrenia created more stigma than the label of schizophrenia alone. In contrast, more information about the target individuals post-treatment living arrangements (i.e., supervised care) reduced negative judgments. Implications for public education and future research are discussed.

Activities of Daily Living↗
PubMed2000

Pathology, danger, and power: women's and physicians' views of pregnancy and childbirth in Weimar Germany.

This article shows how the very real risks of reproduction were culturally constituted by expectant mothers and physicians in Germany following the first World War. Both saw a strong potential for maternal and fetal death and injury. However, expectant mothers and physicians differed in the extent to which they regarded risk as contingent or inherent. Most physicians believed that pregnancy and childbirth first became dangerous in conjunction with a wide variety of other ailments, including complications specific to pregnancy. This view of pathology held a promise of prevention or at least treatment. Physicians further participated in inventing new, modern understandings of pathology, which also encompassed factory work as a reproductive hazard. Expectant mothers, in contrast, viewed pregnancy and childbirth as inherently dangerous based on their experiences and those of the women they knew, which not infrequently involved illness, disability, or close encounters with death. Many of them also held the ancient idea that a woman could harm the foetus with her imagination. As a result, though women varied in their beliefs (influenced by class, education, region, and religion), as a group they feared childbirth. Paradoxically, competition among lay and medical ideas gave women new options while also gradually enhancing medical authority.

Dangerous Behavior↗
PubMed1998

Violent mass shootings in Sweden from 1960 to 1995: profiles, patterns, and motives.

During the past few decades, violent mass shooting in Sweden has increased rapidly. In the 36 years between 1960 and 1995, fourteen such occasions were recorded, during which 32 people were killed and 57 were wounded. The 14 offenders were men between the ages of 17 and 61 years. In the 20 years from 1960 to 1979, five shootings were committed by five offenders, leaving 10 dead and 13 wounded; in the 16 years between 1980 and 1995, there were nine different shootings committed by nine offenders, with 22 dead and 44 wounded. Seven of the shootings were classified as mass shootings, six as spree shootings, and one as a serial shooting. In all but four of these cases, the firearms used were illegal weapons. The four legal firearms belonged to an unemployed young laborer, an officer, a former United Nations (U.N.) soldier, and a member of the Swedish military volunteer corps. Of those killed, 68.8% were strangers to the offender; among the wounded, the corresponding figure was 89.5%. Profiles of the offenders and of the victims were studied. The psychiatric diagnoses among the offenders and the measures taken to prevent the increase in mass shooting in Sweden are presented.

Adolescent↗
PubMed1993

Risk behaviour, anti-HIV and anti-hepatitis B core prevalence in clinic and non-clinic samples of gay men in England, 1991-1992.

OBJECTIVE: To describe the sexual risk behaviour of and HIV and hepatitis B antibody prevalence in gay men in England. DESIGN: Cross-sectional. RESPONDENTS: Gay men recruited from community settings (bars, clubs, gay organizations) and genito-urinary clinics in London, Manchester, the Midlands and Bristol; men who participated in an earlier study. METHODS: Interview including demographic information, sexual behaviour, partner type and health service use. Subjects donated saliva, which was screened for antibodies to HIV-1 by immunoglobulin G (IgG) antibody capture enzyme-linked immunosorbent assay (GACELISA) and to hepatitis B core (HBc) antigen by IgG antibody capture radioimmunoassay (GACRIA). RESULTS: Ninety-four out of 580 (16.2%) men were HIV-antibody-positive; 6.2% of men aged < or = 25 years were positive versus 19.5% of men aged > or = 26 years. HIV-antibody prevalence was highest in London (21.1%), and twice that previously reported outside London (10.5%). Ninety-four out of 568 (16.5%) men were HBc-antibody-positive; 6.9% of men aged < or = 25 years were positive versus 19.7% of men aged > or = 26 years. Anti-HBc prevalence was highest in London (19.8 versus 12.7% outside London). Manual workers were more likely to be anti-HBc-positive, as were men who reported recent high-risk intercourse. Sexually transmitted diseases associated with frequent partner change (gonorrhoea, non-specific urethritis) were reported. CONCLUSION: The HIV epidemic in gay men in England continues, particularly outside London, where prevalence was double that of previous studies. We found relatively high rates of infection in young men whose main sexual experience has been in a time of unprecedented awareness of AIDS. Our data on hepatitis B suggests that further pro-active immunization programmes are urgently required. These findings add to concerns about provision of interventions targeting gay men.

Adult↗
PubMed1993

Sex role separation in sexual diaries of homosexual men.

OBJECTIVE: To measure types of sex role prevalence in common and risk-related behaviours among gay men for modelling HIV transmission. DESIGN: Cohort study of 385 homosexually active men recording sexual diaries over 1-month periods. METHODS: Measures of incidence of behavioural sex roles for masturbation, fellatio, anal intercourse and anilingus by relationship type, derived from 1-month sexual diary data. RESULTS: Low behavioural role rigidity for masturbation and fellatio, but higher rigidity for anal intercourse and anilingus. Participants with no regular partner showed a relatively low frequency of anal intercourse, whereas those in closed relationships showed a high frequency. CONCLUSION: Although anal intercourse shows a certain degree of behavioural role rigidity, this rigidity is not large enough to conclude that gay men exclusively engage in either an active or a passive role. Typical rates for exclusive active and passive roles for anal intercourse during the month the diaries were recorded were in the range of 12-15%; the dual role was significantly higher.

Adolescent↗
PubMed2000

Ethics in sports medicine.

Sports medicine physicians are not exempt from the ethical challenges of medical practice merely because their patients are robust and healthy. In fact, precisely because the patients with sports injuries are so healthy the moral issues remain subtle. Many ethical issues in sports medicine come about because the traditional relationship between doctor and patient is altered or absent. In the current review, several routine topics in biomedical ethics, including doctor and patient confidentiality, informed consent, the care of minors, medical advertising and use of innovative treatments, will be studied from the sports medicine perspective. Hypothetical case histories will be presented, along with an analysis of the underlying ethical issues. The goal of this analysis is not to offer answers to these moral questions, but to increase awareness and promote contemplation of the correct course of action.

Athletic Injuries↗
PubMed1998

Is diagnosis relevant in the hospitalization of potentially dangerous children and adolescents?

OBJECTIVE: This study tests the assumption that psychiatric diagnosis facilitates clinical evaluations of need in emergency care before and after controlling for danger. METHOD: The data are from structured crisis assessments completed by emergency clinicians in four ethnically diverse locales (N = 653). Clinician-assigned diagnosis was categorized as adjustment, disruptive, mood, psychotic, and other, and a Danger scale score reflected danger to self or others. RESULTS: Mood and psychotic disorders significantly increased hospital rates in multivariate analyses which controlled for demographic characteristics, site, and danger when relevant. The model with the best fit included both diagnosis and danger. CONCLUSIONS: Decisions should be linked to verifiable ratings of need and attention to danger, and its measurement should complement the current focus on diagnosis.

Adolescent↗