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PubMed1983

Dangerous patients.

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Dangerous Behavior↗
PubMed1984

Preventing assaults on a psychiatric inpatient ward.

Although appropriate evaluation, management, and treatment of violence-prone patients will tend to reduce the incidence of aggressive acts on a psychiatric ward, such measures are not enough to prevent eruptions of violence. The author discusses several specific preventive steps that staff of psychiatric units can take to reduce the likelihood that assaults will occur: forming and maintaining a social norm against violence, recognizing and managing countertransferential reactions among both staff and patients, ensuring responsible involvement by psychiatrists during violent incidents, thoroughly assessing a patient's potential for assault, and paying prompt attention to the significance of an assault for the involved patient, other patients, and staff.

Aggression↗
PubMed1985

The insanity defense: a difficult necessity.

The author considers the merits of the insanity defense in light of three premises. First, a defendant's sanity must be taken into account both in assessing culpability and in assigning punishment for a crime. Second, all members of society must be protected against harmful acts. And third, it is the responsibility of psychiatrists to assess, but not to predict, the existence of mental illness. After briefly discussing the limitations of expert testimony and the adversarial demands of the judicial system, the author concludes that the insanity defense should be retained but altered, and that psychiatrists should bear the burdens of advocating for the mentally ill.

Commitment of Persons with Psychiatric Disorders↗
PubMed1985

Obviously ill patients.

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Commitment of Persons with Psychiatric Disorders↗
PubMed1985

The obviously ill patient in need of treatment: a fourth standard for civil commitment.

The three relatively standard criteria currently contained in most state civil commitment laws (danger to self, danger to others, and gravely disabled) have forced many obviously ill patients to deteriorate to the point of dangerousness before receiving treatment, to become criminalized, or to wander the streets untreated. After discussing the origins of present civil commitment laws and the plight of obviously ill patients, the author details the cooperative effort of several groups in Wisconsin to codify a fourth standard for civil commitment that would ensure that obviously ill patients receive treatment with proper procedural and due process safeguards. Other statutory alternatives to remedy the plight of obviously ill patients are also discussed.

Commitment of Persons with Psychiatric Disorders↗
PubMed1985

The chronic mentally ill and the criminal justice system: when to call the police.

Certain mentally ill patients who repetitively commit minor crimes as part of their lifestyle rather than because of psychotic thinking are best managed by a cooperative effort between the criminal justice and the mental health systems. This effort, which is based on the belief that such patients should be dealt with as any other responsible citizen who commits a crime, involves educating and supporting the patients, the patients' families, and criminal justice professionals throughout the entire judicial process. The involvement of the criminal justice system is not a substitute for treatment by the mental health system, nor should arrest or incarceration be used simply because mental health treatment is unavailable.

Chronic Disease↗
PubMed1985

A retrospective study of alcohol use by VA psychiatric inpatients.

Psychiatric inpatients are prone to the use of alcohol, often in attempts to self-medicate. A retrospective review of patient records in a Veterans Administration neuropsychiatric facility identified 28 patients for whom use of alcohol was documented while they were in the hospital; the number of episodes totaled 47. The patients tended to be young and unmarried and to have a diagnosis of schizophrenia. The study found a trend toward underreporting of alcohol use by hospitalized patients because staff believe it to be an accepted part of adult life in American society. Possibly because staff do not identify alcohol use as a serious problem for psychiatric inpatients, it is not considered in treatment planning. The authors conclude with recommendations for management of inpatients who use alcohol.

Adult↗
PubMed1986

An innovative approach to assessing outcome of long-term psychiatric hospitalization.

The failure of research on long-term hospital treatment to show consistent relationships between length of stay and treatment outcome may reflect a need for more refined measures to evaluate long-term treatment. The authors developed an individualized method of assessing improvement in patients' major areas of impairment over the course of treatment. Using the new approach and two more traditional methods, the authors evaluated the outcome of 37 discharged long-term patients of a private psychiatric hospital who had been rated at admission and discharge on 21 variables related to ego function; affective symptoms; risk of suicide, self-destructiveness, and violence; substance abuse; level of treatment alliance; and, at discharge only, on overall level of improvement. Although the traditional methods failed to show a correlation between length of stay and most of the variables, the individualized approach found that a longer hospital stay was related to greater improvement in areas of most impaired functioning.

Adult↗
PubMed1986

In again, out again: preliminary evaluation of a state hospital's worst recidivists.

The hospital records of the nongeriatric population of a state hospital (N = 191) were examined to identify the institution's worst recidivists. Twelve patients with a total of 276 admissions were found; six were diagnosed as schizophrenic and six as having a personality disorder. The two diagnostic subpopulations differed most strongly on reasons for their admissions and on treatment received in the hospital. The author proposes that other treatment approaches be applied to the two groups while further research is done.

Adult↗