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At least 1,351 records · Page 75Linked to original sources
PubMed1991

Patients who reoffend while on warrants of the Lieutenant-Governor.

Occasionally, psychiatric patients detained in institutions against their will or residing in the community under legal restraints elope and commit serious offenses. The authors looked at the frequency with which this occurred with patients on warrants of the Lieutenant-Governor in Ontario. Using the files of the Ontario Lieutenant-Governor's Board of Review, they examined the records and isolated such recorded incidents over a 16 year period. In spite of the limitations identified by the authors, their findings indicate a lower than expected occurrence. As well, they point to the risk management implications of certain diagnostic groups being treated in a less than secure setting.

Adult↗
PubMed1991

The dangerousness criterion for civil commitment: the problem and a possible solution.

The dangerousness criterion for civil commitment fails to specify which mental disorders justify commitment. This ambiguity is highlighted by the fact that there are patients with personality disorders or substance abuse who may be dangerous but for whom we have few effective treatments. A possible solution might be provided by adopting the American Psychiatric Association guidelines which consider severity of mental disorder and treatability in its criteria.

Commitment of Persons with Psychiatric Disorders↗
PubMed1991

[Judicial aspects of treatment of incompetent psychiatric patients who categorically refuse treatment].

Psychiatrists in particular face a clinical, legal and social dilemma in treating their patients who are likely to categorically oppose treatment. This article illustrates this dilemma in the context of Quebec's Bill 145, resulting in the care of psychiatric patients being increasingly referred to the courts. After presenting this legislation and a case, the authors illustrate the impact of this legislation in light of their own experience and similar legislation in the United States. The mechanisms proposed by Bill 145 have proved costly in several respects as well as cumbersome and ineffective. The authors propose the establishment of an administrative tribunal as an alternative to the current recourse to the courts.

Adult↗
PubMed1991

The role of the psychiatrist in dangerous offender hearings.

The current Canadian legislation regarding dangerous offenders is reviewed, with specific emphasis on the role of the required psychiatric testimony. It is suggested that, although this legislation as it is currently formulated could be viewed as an attempt to broaden the insanity defence, and permit the diversion of mentally ill offenders from a punitive to a therapeutic milieu, it enables the preventive detention of recidivist offenders. Some fundamental ethical issues which follow from this are identified, together with the issues which have dominated expert testimony in hearings held in British Columbia during the past 13 years.

Antisocial Personality Disorder↗
PubMed1992

[An inventory for the evaluation of dangerousness in mental patients].

The authors of the article propose an inventory for the systematic assessment of the dangerousness of psychiatric patients. This clinical tool is qualitative and is helpful in a case-by-case approach. The prediction of violent behaviour is discussed; quantitative and qualitative research perspectives are also mentioned.

Dangerous Behavior↗
PubMed1993

Tarasoff in the Canadian context: Wenden and the duty to protect.

The precedent-setting 1976 US court decision of Tarasoff v. Regents of the University of California established a "duty to protect" whereby psychotherapists are held responsible to protect the potential victims of their clients' violent behaviour. The purpose of this article is to review and discuss this duty in the context of Canadian law and the 1991 Alberta court decision of Wenden v. Trikha, Royal Alexandra Hospital and Yaltho. The current Canadian interpretation of the duty to protect and guidelines for avoiding such liability are presented.

Adult↗
PubMed1993

Misidentification delusions, facial misrecognition, and right brain injury.

Individuals suffering from misidentification syndromes may present with right hemispheric pathology and deficits in facial recognition. In addition, misidentification delusions have been associated with aggressive behaviour. The possible linkage between misidentification phenomena, facial recognition, and aggression is discussed, illustrated by the case of a patient suffering from an organic delusional disorder.

Agnosia↗
PubMed1993

Reasons for admission among six profile subgroups of recidivists of inpatient services.

The incidence pattern of medication and program non compliance, violent acts, suicide attempts and chemical abuse defined as reasons for hospital admission was evaluated in a total sample (n = 416) of recidivists and their six constituent profile subgroups (n = 272). The total sample was drawn from two different state-operated hospitals and two different time periods. The incidence pattern observed for the total sample in order of descending priority was medication non compliance, program non compliance, chemical abuse, violent acts and suicide attempts. The incidence pattern ordering and the relevant percentages of occurrence were observed for both hospitals. There were time period differences in the ordering and percentages of the reasons for admission which revealed an increase in both medication and program non compliance as well as chemical abuse in the more recent sample. There were also specific subgroup differences in the incidence pattern concerning some reasons for admission. These subgroup differences are discussed in detail.

Adult↗
PubMed1994

Capacity to stand trial: pitfalls of legal interpretation.

Legally, the concept of fitness to stand trial is fixed and absolute. Psychiatrists view fitness as a homeostatic functional capacity. The Ontario Court of Appeal recently set a precedent (Queen versus Taylor) for a standard of fitness to stand trial by interpreting the criteria for unfitness as defined in terms of Section 2 of the Criminal Code. They held that only a factual understanding of these criteria is required by the courts. A person suffering from acute psychotic symptoms with delusions which relate to the subject matter of the trial, who act contrary to their best interests and who are disruptive in their behaviour to the orderly flow of the trial may still fulfill the criteria for fitness to stand trial. The writer illustrates some important implications of this decision and suggests recommendations to current legal interpretations of a clinical capacity.

Adult↗
PubMed1995

[Male erotomania: a type of dangerous sexual harassment].

OBJECTIVE: The purpose of our study is to examine male erotomania and its consequences for women who are victims of it. METHOD: We studied the clinical characteristics of erotomaniacal men and the physical and psychic consequences to women who were their victims. RESULTS: The men we met have a severe paranoid thought disorder which combines jealousy, projection and interpretation. Their behaviour is characterized by escalating violence in their involvement with women by whom they believe they are loved. During their contacts with the erotomaniac, the victims develop adjustment disorders and anxiety. CONCLUSION: Our study leads us to conclude that erotomaniacs and their victims have symptoms and a clinical evolution identical to those found in harassing and violent ex-spouses. The positive response of some erotomaniacs to antipsychotic medication raises a therapeutic prospect for other violent men with the same thought disorders.

Adjustment Disorders↗
PubMed1997

Who applies to regional review boards and what are the outcomes?

OBJECTIVE: To determine the outcomes for patients following applications to regional review boards at an Ontario provincial psychiatric hospital for 1992 through 1994. METHOD: A retrospective casenote study examined frequency of readmission, time to next admission, status upon readmission, and episodes of dangerous behaviour perpetrated in the community for patients applying to review boards. RESULTS: Over 3 years, 116 hearings took place to review various certificates. Only 57% of applications reached a hearing. Of those, 69% were confirmed and 31% rescinded. A small group of patients made multiple applications to the review board. Median time to next admission for patients who had certificates of involuntary admission rescinded by the review board was 14 days, compared with 53 days for those who remained in hospital until the time of planned discharge. CONCLUSION: Review boards consume considerable resources, serve only a small proportion of patients, and contribute to the "revolving door" phenomenon.

Adolescent↗
PubMed2004

Sexual and nonsexual offenders with intellectual and learning disabilities: a comparison of characteristics, referral patterns, and outcome.

This article reports an evaluation of a community intellectual disability offender service over the period from 1990 to 2001. Men who committed sex offenses or sexually abusive incidents (n = 106) and men who committed other types of offenses and serious incidents (n = 78) are compared on personal characteristics, referral sources, forensic details, and outcome up to 7 years after referral. The cohorts are older than one would expect from the criminology literature, and, at about 33%, the incidence of mental illness is consistent with some previous studies. A greater proportion of sex offenders had criminal justice involvement and a formal disposal from court. Fire raising was not overly represented as an offense. There was a higher rate of reoffending in the nonsexual cohort, which persisted up to 7 years. Investigating only reoffenders, there was a considerable amount of harm reduction recorded up to 7 years, statistically significant up to 5 years following initial referral.

Adult↗
PubMed2005

Issues in violent risk assessment: lessons learned and future directions.

Realizing that the assessment of dangerousness with a yes/no format as a poor form of violent risk assessment has been the most important lesson learned about violence in the last 20 years. Further examining (a) what outcome and (b) how the indicators of the outcome should be measured has resulted in better violent risk assessment. The most promising methodological innovation in violent risk assessment has been the introduction of the receiver operating characteristic to assess the efficiency of risk prediction. In the future, the tension between prediction and explanation of violence will need to be maintained while focusing on a mechanism-driven strategy of risk management.

Antisocial Personality Disorder↗
PubMed2005

Advances in the assessment and prediction of interpersonal violence.

This article underscores the weakness of clinical judgment as a mechanism for prediction with examples from other areas in the psychological literature. Clinical judgment has as its Achilles'heel the reliance on a person to incorporate multiple pieces of information while overcoming human judgment errors--a feat insurmountable thus far. The actuarial approach to risk assessment has overcome many of the weaknesses of clinical judgment and has been shown to be a much superior method. Nonetheless, the static/historical nature of the risk factors associated with most actuarial approaches is limiting. Advances in risk prediction will be found in part in the development of dynamic actuarial instruments that will measure both static/historical and changeable risk factors. The dynamic risk factors can be reevaluated on an ongoing basis, and it is proposed that the level of change in dynamic factors necessary to represent a significant change in overall risk will be an interactive function with static risk factors.

Antisocial Personality Disorder↗
PubMed2005

Developments in the assessment and treatment of sexual offenders: looking backward with a view to the future.

This article provides a brief review of a number of key developments within the area of sexual offending over the past two decades. In addition, several directions for future research are discussed. The review presents information concerning several well-validated risk assessment instruments that are available. As well, some of the accumulating evidence concerning the efficacy of contemporary approaches to treatment with sex offenders is mentioned, as are theoretical developments within the field.

Dangerous Behavior↗