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PubMed1987

Validity of scoring 'dangerous answers' on a written certification examination.

The American Board of Anesthesiology (ABA) investigated the possibility that selection of a disproportionately high number of incorrect "dangerous answers" by candidates who would otherwise pass the board's written certification examination might relate to dangerous clinical practice by the candidates. In that case, scoring the examination for dangerous answers would provide an alternate scoring method. Twenty-nine multiple-choice questions in the 1983 written examination were identified by a panel of judges as containing incorrect answers with "truly, not potentially" dangerous consequences. The 1,036 candidates who passed the 1983 examination selected an average of 1.6 dangerous answers, and the 1,413 who failed the examination selected an average of 3.4 (p less than .001). Ninety-two candidates who passed and who selected four or more dangerous answers were tracked through the certification process to learn whether labeling them as "smart but dangerous" was justified. Reports of their clinical competence from their residency programs did not relate dangerous behavior for any of these candidates. The 86 of these 92 candidates who subsequently took the ABA oral examination had pass rates that were identical to those of all candidates in 1983 and that were completely independent of the candidates' absolute and relative frequency of choosing dangerous answers. It is concluded that selection of dangerous answers in a multiple-choice test is the result of lack of information rather than a purposeful action and implementation of the scoring system for dangerous answers would likely be unjustified and unfairly punitive.

Achievement↗
PubMedDate not supplied

Placement challenges: implications for long-term care of dementia sufferers.

Caregivers and long-term care staff seek appropriate placements for dementia sufferers, but there is little empirical research to guide such decision-making. However, recent national trends in mental health care have emphasized the placement of persons with serious mental illness in privatized, community-based residences. This body of empirical research has indicated that persons with psychosis, substance use disorder, assaultive behavior, and medication noncompliance have shorter tenure in these residential settings. These findings are also important for other, more traditional health care settings, as the patients discharged from community residences may require assistance on occasion from such other settings. This study continues the inquiry into the characteristics of patients with serious mental illness, who have shorter tenure in community residences. Dangerous behaviors, treatment-resistant psychosis, medical illnesses, and social-interpersonal skill deficiencies were common causes for discharge in this study. Since there remains a paucity of published empirical studies on the issue for patients with Alzheimer's disease and other dementias, we present the implications of, and guidelines for, addressing these issues in dementia sufferers in long-term care settings.

Aged↗
PubMedDate not supplied

[The behavioral risk factors for contracting HIV infection in the intravenous administration of narcotics in abusers of psychoactive substances in the city of Rostov-on-Don].

150 persons (drug users) who had applied to the department of psycho-social consultations and voluntary tests for the presence of HIV infection and STD of the Regional AIDS Control Center, as well as partners of HIV-infected addicts in the intravenous use of drugs, were examined. Out of 150 examined persons 63 were found to be positive for HIV infection. Among dangerous behavioral patterns, characteristic of drug addicts introducing drugs intravenously, the practice of repeated aspiration of the drug into syringes from the dose of the drug solution, common for the whole group of addicts, was noted as the most widespread habit.

HIV Infections↗
PubMed1999

Sociodemographic and personal characteristics of adolescents engaged in weight loss and weight/muscle gain behaviors: who is doing what?

BACKGROUND: Prevalence rates of behaviors aimed at weight loss and weight/muscle gain among adolescents were examined across sociodemographic and personal anthropometric variables to provide insight into these behaviors and identify high-risk subgroups. METHODS: A statewide representative sample of 7th, 9th, and 11th grade public school students from Connecticut completed a classroom-administered survey on adolescent health in 1995-1996. The study sample in the present analysis included 9,118 adolescents. RESULTS: The most frequently reported weight control behavior was exercise followed by dieting. Disordered eating (vomiting, diet pills, laxatives, or diuretics) over the previous week was reported by 7.4% of the girls and 3.1% of the boys. Steroids were used by 0.5% of the girls and 2.3% of the boys. Girls in the highest BMI category were at greatest risk for disordered eating behaviors while boys in the lowest BMI category were at greatest risk for steroid use. African American and Hispanic girls were less likely than Caucasians to diet and exercise, but were more likely to report behaviors aimed at weight gain. Relatively high rates of disordered eating behaviors were reported by African American and Hispanic boys. Older girls reported slightly more dieting and disordered eating and less exercise than younger girls. Youth from low socioeconomic backgrounds were at greater risk for disordered eating than youth from high socioeconomic backgrounds. CONCLUSIONS: The findings suggest a need to widen our scope of thinking with regard to who is concerned with their body shape/size and at risk for engaging in potentially dangerous behaviors aimed at either weight loss or muscle gain.

Adolescent↗
PubMed1997

The use of seclusion in psychiatry: a literature review.

This article reports on a literature review of the practice of seclusion in psychiatric inpatient facilities. Attention is paid to the moral debate on seclusion. Most publications consider seclusion as a necessary intervention to manage problem behavior. The first part of the article deals with definitional aspects leading toward concept clarification. The review shows differences in definitional aspects, motives for seclusion, hospital characteristics, and patient characteristics. Data on frequency, incidence, and duration appear to be widely divergent. The experiences of patients who have been secluded are mostly negative, but positive reactions are also reported. In the publications of the last decade, there is emphasis on the contribution of hospital characteristics to trends in use of seclusion. Finally, it is concluded that seclusion is an effective way to manage (potentially) dangerous behavior and that seclusion is an intervention that may create therapeutic possibilities for care.

Humans↗
PubMed2005

The knowledge of pedagogic students on suicidal behaviors in adolescents.

Suicide, taking one's own life, seems to be in contradiction with the will to live. However, it is not so obvious, as there is not the same patterns of behavior for all people. People differ from one another as far as reactions, behavior, and actions are concerned. Some are mobilized, others are discouraged by failures. It is often thought that suicidal behavior occurs due to a mental disorder. The purpose of the study was to check the knowledge of IV-year-students of Pedagogy and Psychology of The University in Bialystok concerning suicidal behavior. Danger of suicidal phenomenon among young people was also to be noticed and discussed. The examination was conducted in the group of 50 students of the IV year of Pedagogy and Psychology of The University in Bialystok in 2002. Students, 21-25 years of age, comprised the most numerous group. Women were the majority (84%) while men were 16%. The examination tool was the questionnaire of 29 open and closed questions. The analysis of the results points to the fact that making a decision of suicide is a result of long reflections expanded in time. Personal and family problems are most common causes of suicidal behavior given by the responders. Social isolation and bad mental condition were behaviors indicating the will to commit suicide. Lonely people, chronically ill, emotionally immature and the young people were those of the high risk groups. According to the examined students, pain connected with physical suffering may influence suicidal behavior.

Adolescent↗
PubMed1995

[Anabolic steroid abuse and mental disorder].

The literature on the psychiatric aspects of anabolic steroids (AS) abuse in the United States is reviewed. Since the 1980s the use of AS has become prevalent among adults and adolescents who are concerned with muscle size and strength, and the abuse of these agents is regarded as a serious drug problem. Researchers noticed that illicit, high-dose use of AS may produce not only somatic adverse effects but behavioral changes. Several studies using psychometry and questionnaires suggested that characteristic psychological phenomena such as increased aggression and irritability may be observed in AS abusers. Although the evidence determining the addictive potential of AS is limited, some authors provide evidence that the long-term use of AS may lead to a mental disorder which meets the DSM-III-R criteria of psychoactive substance abuse. Detailed case reports of AS-induced mental disorders are scarce, but characteristic symptoms, particularly major mood disturbances, have been recognized. Violent crimes committed by abusers taking large doses of AS have also been highlighted. In these cases the dangerous behavior appears to have been induced by aggression, grandiosity, and rage. This review indicates that empirical data specifying psychiatric effects of AS are not sufficient at present, and more attention needs to be paid to trends in AS abuse in Japan.

Adolescent↗
PubMed1997

Characteristics of elderly psychiatric patients retained in a state hospital during downsizing: a prospective study with replication.

OBJECTIVE: This study examined the clinical characteristics of elderly inpatients associated with retention in a large state hospital during a period of rapid reduction in the inpatient census. DESIGN: During the first year of the study all inpatients age 65 or greater were individually evaluated. Patients remaining in the hospital during the second year were reevaluated and followed for an additional year. Separate statistical analysis of the data allowed for replication of findings. SETTING: The study was conducted at Pilgrim Psychiatric Center, the largest state hospital in New York State. PARTICIPANTS: The entire inpatient population over the age of 65 were included in the study (N = 806). The average age of the sample was 76 years and 70% were assigned a lifetime research diagnosis of schizophrenia. The majority of patients were hospitalized for long periods (mean = 33.9 years) and had significant cognitive impairment. MAIN OUTCOME MEASURES: Cognitive functioning was assessed on the Clinical Dementia Rating Scale. Severity of psychiatric symptoms was evaluated on the PANSS. Occurrence of dangerous behavior and medical and psychiatric treatment were obtained from the patients' medical histories. MAIN RESULTS: The findings, replicated across assessments, were that patients retained had more severe symptoms of excitement, hostility and impulsive behavior than those discharged, while uncooperativeness, delusions, grandiosity and suspiciousness were also more severe in those retained than those discharged. CONCLUSIONS: Elderly patients who are very difficult to place are so characterized because of behavior disorders that are difficult to manage rather than psychotic symptoms, cognitive impairment or medical disorders.

Aged↗
PubMed2004

Inducible syncope in anorexia nervosa: two case reports.

OBJECTIVE: Syncope is a potentially dangerous symptom of anorexia nervosa that is usually attributed to bradycardia, dehydration, or hypoglycemia. METHODS: This study describes two adolescents, one male and one female, with recurrent self-induced syncope associated with isometric exercise. RESULTS: In one patient, Holter monitoring showed that isometric exercise led to increasing bradycardia followed by asystolic pauses accompanied by presyncopal symptoms. DISCUSSION: We hypothesize that inducible syncope in these two patients is due to increased vagal tone and baroreceptor sensitivity. Physicians should be aware that patients with anorexia nervosa may be able to induce syncope with isometric exercise and that this potentially dangerous behavior needs to be addressed during treatment.

Adolescent↗
PubMed1986

[AIDS: each and every one's responsibility].

AIDS is posing challenges at various public health related levels, epidemiological, clinical, social, ethical, legal. In the current absence of possibilities of curative treatment or of vaccine, it is essential to provide sufficient information on the available preventive measures. Given the increase in the numbers of seropositive persons, and the recognition that heterosexual relations area significant transmission route in case of multiple, illknown partners, the need is to actively promote the sale and use of condoms (male preservatives), in risk situations in general (and not only to homosexuals and drug addicts). Among others, a proportion of youth have dangerous behaviors in this regard. Public health leaders as well as those in the social, educational and political fields must adopt a clear stance encouraging the practice of this preventive measure which, literally, can save one's life.

Acquired Immunodeficiency Syndrome↗
PubMed2005

Improving mental health assessment and service planning practices for older adults: a controlled comparison study.

This study evaluated the effectiveness of a guided assessment and service planning intervention in improving the clinical practices of non-physician community mental health providers caring for older persons. Thirteen agencies, 44 clinicians, and 100 consumers (age 60 and older) were assigned to the intervention or a comparison group receiving usual care. Baseline interviews of clinicians and chart reviews found that clinicians' routine evaluation and service planning practices showed inattention to key domains such as substance abuse (over 33% of clinicians), suicide risk and dangerous behaviors (over 40%), and caregiver burden and risk of neglect or abuse (over 75%). At 1-year follow-up, the intervention was associated with increased rates of routine assessments of major symptom, functioning, and support domains. There was also significant improvement in the specificity of treatment planning within the intervention condition. Implications for quality improvement are discussed.

Aged↗
PubMed2000

Delirium and Agitation.

Delirium is a syndrome of altered state of consciousness and global cognitive impairment with diverse causes. It is common in the medically or surgically compromised patient and is associated with significant morbidity and mortality. The primary goal of treatment is to identify and correct the underlying cause of the delirium. Treatment includes protecting the patient from accidental self-harm, initiating pharmacotherapy to manage disruptive and dangerous behavior and symptoms of psychosis, and providing supportive and educational therapy for the patient and family. Physical restraints may need to be used for patients at immediate risk of injuring themselves or someone else until pharmacologic management can be initiated. Antipsychotics such as haloperidol with or without lorazepam are the treatment of choice. Environmental factors that may exacerbate delirium also need to be controlled. Patients should be reoriented and may benefit by having familiar or favorite objects present, such as family pictures. Sleep-wake disturbances must be corrected, and visual and auditory impairments must be addressed. Because family members can have a calming effect, provide frequent reorientation, and give the patient a sense of safety, family should be encouraged to be present if at all possible.

Journal Article↗
PubMed1999

Walker inlet-closure strap for unsteady patients with lower-extremity amputations.

Some patients with lower-extremity amputations who use a walker fall backwards after advancing too far forward into the walker's base of support. In a pilot study of 14 patients with unilateral lower-extremity amputations who stepped into the forward two thirds of the walker base, this problem was corrected by using a knee-high elastic strap to close the open posterior "inlet" of the walker. Without the strap, the stance-phase position of the leading ankle was in the forward third of the walker base for 8 subjects and in the middle third for 6. With the walker strap, the ankle position was in the middle third for one subject, in the posterior third for 6, and at or behind the walker inlet for 7 (p < .0002). This simple intervention appears to correct the potentially dangerous behavior of stepping too far into the walker base.

Accidental Falls↗
PubMed2000

Reward deficiency syndrome: genetic aspects of behavioral disorders.

The dopaminergic and opioidergic reward pathways of the brain are critical for survival since they provide the pleasure drives for eating, love and reproduction; these are called 'natural rewards' and involve the release of dopamine in the nucleus accumbens and frontal lobes. However, the same release of dopamine and production of sensations of pleasure can be produced by 'unnatural rewards' such as alcohol, cocaine, methamphetamine, heroin, nicotine, marijuana, and other drugs, and by compulsive activities such as gambling, eating, and sex, and by risk taking behaviors. Since only a minority of individuals become addicted to these compounds or behaviors, it is reasonable to ask what factors distinguish those who do become addicted from those who do not. It has usually been assumed that these behaviors are entirely voluntary and that environmental factors play the major role; however, since all of these behaviors have a significant genetic component, the presence of one or more variant genes presumably act as risk factors for these behaviors. Since the primary neurotransmitter of the reward pathway is dopamine, genes for dopamine synthesis, degradation, receptors, and transporters are reasonable candidates. However, serotonin, norepinephrine, GABA, opioid, and cannabinoid neurons all modify dopamine metabolism and dopamine neurons. We have proposed that defects in various combinations of the genes for these neurotransmitters result in a Reward Deficiency Syndrome (RDS) and that such individuals are at risk for abuse of the unnatural rewards. Because of its importance, the gene for the [figure: see text] dopamine D2 receptor was a major candidate gene. Studies in the past decade have shown that in various subject groups the Taq I A1 allele of the DRD2 gene is associated with alcoholism, drug abuse, smoking, obesity, compulsive gambling, and several personality traits. A range of other dopamine, opioid, cannabinoid, norepinephrine, and related genes have since been added to the list. Like other behavioral disorders, these are polygenically inherited and each gene accounts for only a small per cent of the variance. Techniques such as the Multivariate Analysis of Associations, which simultaneously examine the contribution of multiple genes, hold promise for understanding the genetic make up of polygenic disorders.

Attention Deficit Disorder with Hyperactivity↗
PubMed1999

Phenomenology and treatment of psychotic disorders in the psychiatric emergency service.

The emergency evaluation of a psychotic patient calls on all of the skills of the psychiatrist. The immediate control of dangerous behavior takes place at the same time that clinicians evaluate patients for delirium. A screening physical examination, a brief mental status examination, and a high index of suspicion for medical diseases are essential tools in the first few minutes of a patient's stay in the psychiatric emergency service. Drugs of abuse are often part of a patient's presentation. Here, too, the first task is to rule out delirium, particularly from sedative or alcohol withdrawal. As soon as a patient's condition is stabilized, the psychiatrist should review all of the available information, develop a working diagnosis, and initiate definitive treatment of the presumed disorder. With fewer emergency patients being hospitalized and with shorter lengths of hospital stay, these initial decisions acquire increasing significance for patient outcome.

Delirium↗