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PubMed1978

Homicide and community-based psychiatry.

The authors studied the records of all persons convicted of homicide or found not guilty by reason of insanity during the uears 1963 through 1975, 6 years before and after the opening of the community-based psychiatric facility, in Albany County, New York. Using the Fisher Exact Probability Test, a statistically significant increase was found for those found not guilty by reason of insanity (p = .041) and those with a history of mental illness found guilty (p = .036). Other factors, including age of the perpetrator, use of alcohol, and relationship to the victim, were also examined. The authors caution against sweeping indictments of community-based psychiatry and urge that the study be repeated elsewhere.

Adult↗
PubMed1981

Patterns of seclusion. A prospective study.

The clinical use of seclusion was studied prospectively on two acute treatment units of a university hospital. The incidence, frequency, duration, precipitant, and type of seclusion were documented for 59 secluded patients through 107 episodes and compared to 159 nonsecluded controls on a variety of demographic, diagnostic, and legal variables. Chronicity, legal status on admission, and race were patient characteristics correlated with the incidence of seclusion. Mental status and diagnosis were not significantly related to the incidence or the frequency of seclusion. Seclusion was used primarily to contain physical assault upon staff. There was no relationship between the precipitating event and duration of seclusion, nor any change in duration or restrictiveness of seclusion with repeated episodes. These findings differ markedly from previous reports. The clinical bias toward increased use of seclusion with committed, chronic, and black patients, as well as the independence of cause and duration of seclusion raise legal issues already being pursued in federal courts.

Adult↗
PubMed1984

Who are the "committed?" Update.

In 1977, Herjanic et al. (Tomelleri, C.J., Lakshminarayanan, N., and Herjanic, M. Who are the "committed?" J. Nerv. Ment. Dist., 165: 288-293, 1977) described all patients court committed to an acute urban mental health facility in St. Louis, Missouri, from July 1, 1973 to June 30, 1975. On January 2, 1979, major revisions in the civil commitment statutes of the state of Missouri went into effect. By the same method and at the same mental health center, this study describes all patients who reached the stage of a court hearing from July 1, 1980 to June 30, 1982 under the new civil commitment law. The following observations are made: a) 4 per cent of the total population of admitted patients reached the stage of a court hearing under the old civil commitment law but only 2.4 per cent reached the same stage under the new civil commitment law; b) only 3 per cent of the petitions for commitment were rejected by the probate court under the old civil commitment law in contrast to 30 per cent under the new civil commitment law; c) among court-committed patients only, the mean length of hospitalization decreased from 122 days under the old civil commitment law to 51 days under the new civil commitment law; and d) the proportion of committed patients requiring readmission increased from 22 per cent under the old civil commitment law to 50 per cent under the new civil commitment law. In this study, 595 hospitalizations were reviewed.

Adolescent↗
PubMed1984

A crisis triage rating scale. Brief dispositional assessment of patients at risk for hospitalization.

The authors have developed a brief rating scale to expedite the rapid screening of emergency psychiatric patients who require hospital admission from those who are suitable for outpatient crisis intervention treatment. The interviewers used this scale to assess and score the patient rapidly on the basis of three factors: dangerousness, support system, and motivation or ability to cooperate. The authors report on and discuss the use of the scale in a preliminary study of 300 cases and in a prospective study of 122 patients who were followed for 6 months after they were evaluated. They found that those who scored below a median point on the scale required hospitalization and those who scored higher were suitable for crisis intervention as outpatients.

Ambulatory Care↗
PubMed1985

A comparison of patient and staff attitudes toward seclusion.

The purpose of this study was to compare directly the attitudes of patients and staff members toward seclusion. To make such a comparison, a questionnaire consisting of 24 items was given to adult psychiatric inpatients and staff members of a state mental hospital. The results showed that the two groups differed greatly in their attitudes over a wide range of topics; many staff members did not realize how much and in what ways seclusion affects patients. It was concluded that appropriate training of both groups is needed to make seclusion less traumatic and more efficient.

Adolescent↗
PubMed1986

Studies in involuntary civil commitment and involuntary electroconvulsive therapy.

On January 2, 1979, the state of Missouri enacted new mental health laws. In this tandem study the impact of the change in law at an acute urban mental health center in St. Louis, Missouri, was examined in two specific areas: involuntary civil commitment and involuntary electroconvulsive therapy (ECT). The first part of this examination was conducted by comparing all patients (N = 86) who were referred to court to determine their need for involuntary civil commitment from July 1, 1980, to June 30, 1982, to a nonadjudicated control group (N = 87). The second part of this examination was conducted by comparing all patients (N = 19) who were referred to court to determine their need for involuntary ECT from July 1, 1979, to June 30, 1983, to a voluntary ECT recipient control group (N = 24). A large series of statistical comparisons were made. The major finding to emerge from these data was that clinicians were selectively referring to court a group of patients with histories of recurrently becoming both dangerous and noncompliant with hospitalization. In addition, it appears that voluntary ECT is used conservatively and involuntary ECT is used very conservatively.

Adult↗
PubMed1991

Outpatient commitment for "revolving door" patients: compliance and treatment.

This paper describes the use and effectiveness of outpatient commitment in inducing compliance with treatment among chronically mentally ill "revolving door" patients, those who recurrently become dangerous and revolve though civil commitment courts as well as state mental hospitals. Patients characteristics, treatment modalities, and mental health center actions to ensure compliance are described. Comparison of those patients ordered to outpatient commitment with those having other court dispositions (involuntary hospitalization and release) indicates that outpatient commitment induces compliance and leads to treatment maintenance even after the court order terminates.

Ambulatory Care↗
PubMed1992

Civil commitment and arrests. An investigation of the criminalization thesis.

This study examined one part of the criminalization thesis, which holds that the dangerousness standard of reform civil commitment law has led to the frequent arrest of mentally ill persons. It followed a large statewide sample of civil commitment candidates for 6 months through arrest records to observe their number and type of arrests. It found that: ex-candidates were seldom arrested; over half of arrests were accounted for by a few with multiple arrests; the nonviolent and those released were no more likely to be arrested than the violent and those committed; and charges were more often for the less serious offenses, but not predominantly for nuisance offenses [corrected].

Adult↗
PubMed1979

Status of the physician-patient privilege.

While in most states information physicians obtain from the about patients is confidential and cannot be disclosed without the patient's permission, a recent California Supreme Court decision affirms that when the doctor reasonably believes his patient can cause violent harm to third persons, he had an overriding duty to warn the third parties and appropriate authorities. Such possible violent harm may be direct, such as physical assult, or indirect, such as an automobile accident resulting from driving while taking certain drugs. The duty to break the privilege of confidentiality does not apply when the injury is likely to be self-inflicted or involve only property damage.

California↗
PubMed2005

Utility of social cognition and insight in the prediction of inpatient violence among individuals with a severe mental illness.

The purpose of this study was to assess the utility of social cognition and insight in the prediction of violence in a psychiatric inpatient sample. Violence history, demographic information, symptomatology, neuropsychological functioning, social cognition (i.e., attributional style), and insight were assessed in 29 inpatients with severe mental illness. Greater posttest violence was associated with greater pretest violence, less education, greater psychiatric distress, neuropsychological impairment, and hostile attributional and personalizing biases. Hierarchical multiple regression analyses showed that history of violence contributed the most variance to posttest violence. Hostile attributional and personalizing biases were also uniquely associated with posttest violence. Overall, this study supported the modest utility of attributional style measures in the prediction of inpatient violence. The predictive value of insight in this context appears limited.

Adult↗
PubMed2005

Risk factors for HIV infection in injection drug users and evidence for onward transmission of HIV to their sexual partners in Chennai, India.

OBJECTIVES: Determining HIV prevalence in injection drug users (IDUs) and their regular sex partners in Chennai, India. METHODS: A total of 226 IDUs and their regular sex partners were enrolled during April-July 2003. After informed consent was obtained, a semistructured questionnaire was administered and serum was tested for HIV antibody. RESULTS: The HIV seroprevalence was 30% (68/226) in IDUs and 5% in their regular sex partners (11/226). While in 25% of couples only the male partner was HIV positive, 5% of the couples were concordant for HIV infection and 70% were HIV negative. Fifty-seven percent of the HIV-positive IDUs and 45% of the HIV-infected women thought that they had "no chance" or "very little chance" of getting HIV, reflecting low HIV risk perception. More than 20% IDUs reported borrowing or lending of injection equipment. In univariate analyses "sex" and "condom use" with sex workers had no bearing but "more than twice a day injecting frequency," "history of incarceration," "tattoos," "recruitment from northern part of the city," and ever-injecting drugs in drug-selling places had significant association with HIV infection in IDUs. In an adjusted model, the odds of HIV infection were 2 times higher among IDUs who had ever injected drugs in drug-selling places and 6 times higher in those who were recruited from the northern part of central Chennai. CONCLUSION: Reducing sharing of injection equipment and unsafe tattooing through targeted and environmental interventions, increasing HIV risk perception, and promoting safer sex practices among IDUs and their sex partners are urgent program needs.

Adult↗
PubMed2006

Ethical issues in the evaluation and treatment of death row inmates.

PURPOSE OF REVIEW: To summarize recent ethical analyses of psychiatrists' participation in the evaluation and treatment of death row inmates. RECENT FINDINGS: Psychiatric participation in death penalty cases remains highly controversial in the United States, whereas there appears to be a more worldwide consensus that it is ethically inappropriate. SUMMARY: Psychiatrists working in death penalty settings are functioning in a complex ethical arena, and must consider the implications of their decisions to participate and/or abstain from various activities with great care and attention to the circumstances of the individual cases at hand.

Capital Punishment↗
PubMed1999

Emergency psychiatric assessments: do outcomes match priorities?

The targeting of scarce mental health resources is currently organised around three broad areas: treating severe mental illness; reducing suicide; and obviating risk to the wider community. High priority clients are those who present with either psychotic symptoms, or who are perceived to be high risk to self or others. This study examined records of emergency assessments at a mental health trust in the south-east of England over a three-month period (n = 336) to see whether clients with these characteristics are more likely than others to be offered hospital admission or treatment. It was found that clients presenting with psychosis are much more likely to be offered admission than those assessed as non-psychotic, that those assessed as a suicide risk are also significantly more likely to be offered admission, and that those assessed as presenting a risk to the public at large are no more likely to be admitted than those presenting no risk. This investigation indicates that the emergency service of the trust studied is addressing the first two target areas, but may be underperforming in the third.

Adult↗
PubMed1999

Q methodology, risk training and quality management.

The results of a Q methodological study of professional understandings of the notion of risk in mental health services within the UK are discussed in relation to the relevance for staff training and quality assurance. The study attempted to access the diversity of understandings of risk issues amongst a multi-professional group of staff (n = 60) attending inter-agency risk training workshops in 1998. Q methodology is presented as both an appropriate means for such inquiry and as a novel experiential technique for training purposes. A tentative argument is advanced that the qualitative accounts generated by Q research could assist in systematic reviews of quality, complementing the singularly quantitative approaches typically represented in the audit process.

Attitude of Health Personnel↗