Biomedical subjects

Barbara E McDermott

Publications and source records attributed to Barbara E McDermott.

5 recordsLinked to original sources

PubMed2006

The review panel process: an algorithm for the conditional release of insanity acquittees.

The release of insanity acquittees requires making informed decisions regarding both the presence and severity of an individuals' mental illness and the dangerousness of these individuals. This study evaluated the usefulness of employing structured assessments of mental health and violence risk factors in the conditional release decision-making process. All persons found Not Guilty by Reason of Insanity at East Louisiana Mental Health System, Forensic Division who underwent a review panel between July 1, 1997 and July 1, 1999 were included in this study. The Classification and Regression Tree analysis was utilized to arrive at cutpoints that would optimize the predictive ability of the decision tree analysis. The results indicated that the Community Outpatient Treatment Readiness Profile score was the strongest predictor -- all patients receiving a score of 62 or greater on this scale were recommended to remain at the facility. When women were recommended for release, it was to civil facilities and with moderate levels of symptoms. For males with moderate symptoms, low PCL-R scores were associated with recommendations for release, whereas high scores were associated with recommendations for continued commitment. Our data suggests that algorithms may be useful to governing bodies when making release decisions.

Adult↗

PubMed2005

Clinical and legal characteristics of inmates with bipolar disorder.

Individuals with bipolar disorder are at an increased risk of criminal arrest compared with those in the population at large. The combination of manic symptoms and substance abuse seem to be the primary illness factors for this increased risk, and the public mental health system has faced challenges in treating these patients successfully in community settings. To decrease the risk for arrest in bipolar patients, clinicians can screen and refer patients for substance use disorders, stabilize mania in hospital settings, and take measures to improve outpatient adherence in the postmanic hospitalization period. Psychiatric advance directives, new developments in civil commitment law, and mental health courts are legal mechanisms that may be critical in preventing the criminalization of those with bipolar disorder.

Bipolar Disorder↗

PubMed2005

Relationship between criminal arrest and community treatment history among patients with bipolar disorder.

OBJECTIVE: This study examined the relationship between criminal arrest and gender, substance use disorder, and use of community mental health services among patients with bipolar I disorder. METHODS: Los Angeles County's computerized management information system was used to retrospectively identify all inmates with a DSM-IV diagnosis of bipolar I disorder who were evaluated over a seven-month period in the psychiatric division of Los Angeles County Jail and had a history of psychiatric hospitalization in the community. Patients without a history of arrest who were involuntarily hospitalized in the community and treated for bipolar I disorder over the same seven-month period served as a comparison group. The use of community mental health services that inmates received before their arrest was quantified and compared with the services that patients in the comparison group received before their involuntary hospitalization. RESULTS: Patients who had been arrested (N = 66) were more likely than patients in the comparison group (N = 52) to be male (55 percent compared with 31 percent) and to have a history of substance use disorder (76 percent compared with 19 percent) but were less likely to have a history of treatment while under a mental health conservatorship (8 percent compared with 29 percent). In contrast to patients in the comparison group, patients who had been arrested were hospitalized more frequently (a mean of 3.4 hospitalizations per year compared with a mean of 1.1 hospitalizations per year) and had a briefer average length of stay (a mean of 9.2 days compared with a mean of 16.4 days). CONCLUSIONS: In contrast to patients in the comparison group, patients who had been arrested were more likely to be male, to have comorbid substance use disorder, and to have a treatment history characterized by more frequent, briefer hospitalizations.

Adolescent↗

PubMed2005

Capacity of forensic patients to consent to research: the use of the MacCAT-CR.

The ability of psychiatric patients and prisoners to provide informed consent to participate in clinical research has given rise to much debate. Forensic psychiatric patients present a particular concern regarding their competence to consent to research, as they are both patients and prisoners. The primary goal of this research was to evaluate whether, by employing structured assessments of capacity to consent to research, we could determine if this combined vulnerability leads to differences in competence from the published abilities of nonforensic psychiatric patients. Subjects deemed incapable of providing informed consent scored differently and lower than the other consent groups on three aspects of the decision-making process. Diagnosis evidenced only a slight relationship to decision-making abilities, and this difference was only in the ability to understand the basic procedural elements of the research. Psychiatric symptoms were modestly related to decision-making. Positive symptoms were associated with poorer performance on the Understanding subscale of the MacCAT-CR, and negative symptoms were associated with lowered performance on the Reasoning subscale. These results are in accord with several published studies of nonforensic psychiatric patients and suggest that concerns regarding both forensic and nonforensic psychiatric patients' ability to provide informed consent may be unwarranted, especially in patients with few active symptoms.

Brief Psychiatric Rating Scale↗

PubMed2004

Clinical and legal correlates of inmates with bipolar disorder at time of criminal arrest.

BACKGROUND: In an effort to determine illness factors associated with criminality among bipolar patients, we identified bipolar arrestees housed in the psychiatric division of the Los Angeles County Jail who had a history of psychiatric treatment in the Los Angeles County community mental health system. METHOD: Los Angeles County's computerized management information system was utilized to retrospectively identify all inmates evaluated over a 7-month period from July 1999 to Jan. 2000 with a DSM-IV diagnosis of bipolar I disorder, their symptoms at time of arrest, and the nature of community treatment preceding arrest. Criminal history was assessed using Sheriff's Department legal records. Demographic and clinical characteristics of these inmates were compared with characteristics present in a group of hospitalized bipolar patients without a history of arrest in Los Angeles County. RESULTS: Of the 66 inmates identified as having a clear diagnosis of bipolar disorder with previous community treatment in the Los Angeles County Mental Health system, the majority were manic (49/66, 74.2%) and psychotic (39/66, 59%) at time of arrest. Manic arrestees were recently released from community inpatient treatment and most were not involved in outpatient treatment postdischarge. The bipolar inmates had significantly higher rates of comorbid substance abuse than did the hospitalized bipolar patients without an arrest history (75.8% [50/66]) vs. 18.5% [10/54]). CONCLUSIONS: The results of this study suggest that manic symptoms place bipolar patients at significant risk for criminal offending and arrest. Intensive treatment intervention by the community mental health and criminal justice system may be needed, particularly in the immediate postmanic hospitalization period, in order to prevent incarceration of patients with bipolar disorder.

Adolescent↗