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PubMed1992

The neglect of prevention in psychiatry.

The prevention of mental disorders has been neglected but the public health burden now is too high for this to continue. Nearly one half of all mental and neurological disorders are amenable to primary prevention. Effective measures could be applied even in countries with few resources. By and large these measures all rely on available knowledge and commonly involve sectors other than health. This paper calls attention to the opportunities that offer but that have been so far largely unheeded.

Dangerous Behavior↗
PubMed1992

Psychiatrists and their patients--confidential information in the wake of spycatcher.

This article examines a recent decision of the English Court of Appeal. It concerned a psychiatrist who examined and reported on a convicted murderer in a secure hospital. The report was commissioned by the patient's solicitors as evidence in support of his release. The report was emphatically unfavourable and the doctor insisted that it be revealed to the hospital authorities. The solicitors refused and litigation ensued. The courts were forced to rule on the conflict between the patient's right to privacy and the public interest in revealing the report.

Adult↗
PubMed1994

Stalking and the pathologies of love.

Fourteen patients with pathologies of love (erotomania) are presented; all stalked the object of their disordered affections. These cases were encountered in forensic practice and were personally assessed, and in most cases managed, by the authors. Victim impact reports or depositions made by the objects of these patients' unwanted attentions were available. All patients indulged in stalking behaviours which included following, loitering in the victim's vicinity, approaching, telephoning, and sending letters. The objects of the patients' affections were threatened in five cases, violently assaulted in five--one fatally--and sexually attacked in seven cases. Those believed to stand in the way of their delusional love were also on occasion the victims of violence. This series is unusual in the degree of intrusiveness and overt violence, which probably reflects the forensic context in which the cases were encountered. The cases comprise a particular group of erotomanics who exhibit stalking and violent behaviour. The erotomanic syndromes often went unrecognised and the threat to the peace and safety of the objects of their affections was not always given proper weight. The clinical importance of this sub-group of stalkers is emphasised, as is their relevance in the legislative, and judicial, responses to stalking.

Adult↗
PubMed1997

A reassessment of the link between mental disorder and violent behaviour, and its implications for clinical practice.

OBJECTIVE AND METHOD: This review examines the central studies which, over the last decade, have investigated the association between mental illness and rates of violent behaviours. The clinical and public policy implications of such research is then examined. RESULTS: Recent research appears to have established a modest association between having a mental illness and an increased propensity to violence. CONCLUSIONS: The increased risk of violence is mediated, in part at least, by the active symptoms of illness. The most effective response to the risks of dangerous behaviour in the mentally ill is not to return to policies of greater control and containment but to improve the care, support and treatment delivered to patients in the community. Those at high risk need to be targeted for priority follow-up and intensive support. We need, as a profession, to become as aware of the risks in our patients of violence towards others as we currently are of the risks of suicidal behaviour. We also need to develop responses which effectively manage such patients, to their benefit and ultimately to the benefit of potential victims.

Australia↗
PubMed1998

Length of stay, leave and re-offending by patients from a Queensland security patients hospital.

OBJECTIVE: The release of patients from a security patients hospital has been the subject of public controversy. The present study uses empirical data to examine the length of stay, leave, and re-offending of patients from a security hospital. METHODS: Survival analysis was used to examine factors that may be predictive of length of stay and time under restriction, as well as time to first overnight leave. Data on re-offending were obtained from a variety of sources and were compared with seriousness of index offences. RESULTS: Consistent with international research, patients with more serious offences had longer hospitalisations. Patients with more serious offences were also hospitalised for longer periods before leave was granted. Compared with international studies, re-offending was in the lower range. CONCLUSIONS: Despite concerns raised in the media regarding patient 'dangerousness', time spent in hospital and the granting of leave, patients with serious offences were more likely to be hospitalised longer, which suggests decision makers do take into account public safety.

Adult↗
PubMed1991

Combined substance abuse and psychiatric disorders in homeless and domiciled patients.

Although homelessness in patients with combined addictive and psychiatric illness is a common problem, little has been reported about the epidemiology of homelessness in this patient population. The authors, in a study of 100 dually diagnosed patients admitted to a large metropolitan psychiatric hospital, found that a large portion of patients (N = 46) were homeless at the time of admission. Alcohol and crack/cocaine were the most frequently used drugs. Interestingly, there were no significant differences on most parameters between those who were homeless and those who were not. The authors observed that among the disadvantaged, inner-city dually diagnosed, many move in and out of the homeless state, seriously compromising their chances for recovery. Self-help treatment programs were more commonly used by homeless than domiciled patients. The homeless population may therefore be amenable to treatment in 12-step groups, as are domiciled patients.

Adolescent↗
PubMedDate not supplied

Twenty years after Tarasoff: reviewing the duty to protect.

Since the Tarasoff decision by the California Supreme Court in 1974, mental health clinicians have struggled to balance their duty of confidentiality to their patients against the duty to protect third parties from potential violence. This article explores the development of this issue over the last 20 years, with a focus on ways that Tarasoff has and has not affected clinical practice. Reviewing the evolution of case and statutory law, we discuss appropriate clinical responses for the mental health practitioner who faces a potential "duty to protect" situation.

Confidentiality↗
PubMed1985

Hospital staff's perceptions of the alcoholic.

Hospital staff's perceptions of the characteristics of alcoholics were investigated by means of a questionnaire containing a set of 23 semantic differential scales on which they rated four types of patient: "the Alcoholic," "the Nondrinker," "the Drug Addict," and "the Heavy Drinker." Factor analysis of the responses showed that types of patients were perceived in terms of three dimensions. Stability, Dangerousness, and Self-Assertiveness. In comparison with heavy drinkers, alcoholics were perceived by hospital staff in general as unstable, harmless, and self-effacing, though clerks tended to see them as more dangerous than did professionals. These perceptions are considered in relation to the respondent's own frequency of drinking. Finally, the explanation of these findings and their implications for clinical education and policy are discussed.

Adult↗
PubMed1986

Perceptions of deviant stereotypes by alcoholism, mental health, and school personnel in New Zealand and the United States.

The present study examines the ideologies regarding deviance held by alcoholism workers (AW), mental health service providers (MH), and school personnel (SP) in the United States (U.S.) and New Zealand (N.Z.). The two countries subscribe to different sociopolitical systems. The U.S. can be viewed as an individualistic/capitalistic society; N.Z. can be characterized as a social welfare state. It was anticipated that sociopolitical differences would result in differing ideologies regarding deviant persons. It was also anticipated that each group of service providers would, because of their training histories, evidence different ideologies, for example, that the AW sample would differ significantly from the MH sample. No specific predictions concerning these differences were attempted.

Alcohol Drinking↗
PubMed1987

Young driver risk taking: a description of dangerous driving situations among 16- to 19-year-old drivers.

Dangerous drinking and driving situations contribute heavily to morbidity and mortality among older adolescents. One hundred ninety-two high school drivers related 662 dangerous driving incidents (430 by males, 232 by females) in which they were involved in the preceding 6 months. Dangerous driving incidents were characterized by reckless intent, driving late at night, riding with other peers involving alcohol and drugs, reporting impaired driving, and distractions in the car. Adolescent drivers are commonly involved in dangerous drinking-driving situations with peers and without significant consequences. There are points along the continuum leading up to, during, and after such events that offer opportunities for significant prevention and intervention. Such strategies are reviewed.

Accidents, Traffic↗
PubMed1998

Pitfalls of bungee jumping. Case report and review of the literature.

A case of cervical spine injury related to bungee jumping is presented. Surgical intervention resulted in resolution of the patient's quadriparesis. The incidence of serious injury connected with this pastime is not inconsiderable, and it is recommended that safer jumping practices be followed. Inspection of bungee equipment and certification of instructors is now voluntary but should be mandated. Jumping heights should be limited and the use of air cushions encouraged.

Adult↗