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Biomedical subjects

D J Rissmiller

Publications and source records attributed to D J Rissmiller.

12 recordsLinked to original sources
PubMed2002

Use of the Beck Scale for suicide ideation with psychiatric inpatients diagnosed with schizophrenia, schizoaffective, or bipolar disorders.

To ascertain how useful the Beck Scale for Suicide Ideation (BSI; Beck & Steer, Manual for Beck Scale for Suicide Ideation (1991)) would be for assessing the severity of suicidal ideation in patients who were diagnosed with schizophrenia, schizoaffective, or bipolar disorders, 142 inpatients were asked to complete the BSI. Eight (6%) patients refused, and four patients (3%) were unable to complete the BSI because they were unable to concentrate. Of the 130 patients who completed the BSI, 53 (41%) had schizoaffective, 37 (28%) had paranoid schizophrenia, 30 (23%) had manic bipolar, and 10 (8%) had depressed bipolar disorders. The coefficient alpha for the BSI was .96, and its one-week test-retest reliability for a subsample of 15 inpatients was 0.88, p < 0.001. The BSI total scores were positively correlated with having ever attempted suicide, r = 0.46, p < 0.001. According to the BSI, 36 (28%) patients were classified as current suicide ideators. The results were discussed as supporting the use of the BSI with inpatients who are diagnosed with schizophrenia, schizoaffective, or bipolar disorders.

Adolescent↗
PubMed2001

A survey of use of a durable power of attorney to admit geropsychiatric patients.

Medical directors from 198 inpatient psychiatric facilities in 46 states completed a survey on the use of a durable power of attorney for health care to compel admission of unwilling patients with dementia. About half the facilities had a policy allowing use of a power of attorney for this purpose. Thirty-four percent believed that it was optional to use either a durable power of attorney or an involuntary commitment to force admission of demented patients, whereas 47 percent believed that such patients could be admitted against their will only through involuntary commitment.

Advance Directives↗
PubMed2000

Use of the Beck Depression Inventory-II with depressed geriatric inpatients.

To provide information about the clinical utility of the Beck Depression Inventory-II (BDI-II) [Beck, A.T., Steer, R.A., & Brown, G.K. (1996b). Manual for the Beck Depression Inventory-II. San Antonio, TX: Psychological Corporation] with geriatric inpatients, the BDI-II was administered to 130 psychiatric inpatients who were 55 years old or above and who were diagnosed with principal DSM-IV major depressive disorders (MDD) (N = 85, 65%) or adjustment disorders with depressed mood (N = 45, 35%). The internal consistency of the BDI-II was high (coefficient alpha = 0.90), and its total score was not significantly related to sex, age, or ethnicity. An iterated maximum-likelihood factor analysis found the Cognitive and Noncognitive dimensions which have been reported for the BDI-II by Steer and co-workers (Steer R.A., Ball R., Ranieri W.F., & Beck A.T. (1999). Dimensions of the Beck Depression Inventory-II in clinically depressed outpatients. Journal of Psychopathology and Behavioral Assessment, 55, 117-128) in a younger sample of clinically depressed psychiatric outpatients. The mean BDI-II total score of the 85 geriatric inpatients with MDD was also comparable to that of 42 younger (< or = 54 years old) inpatients with MDD. The results were discussed as supporting the use of the BDI-II with clinically depressed geriatric inpatients.

Acute Disease↗
PubMed1998

Prevalence of malingering in inpatient suicide ideators and attempters.

The purpose of the present study was to ascertain the prevalence of malingering by inpatients admitted to an urban hospital for suicidal ideation or attempt. Fifty-eight consecutively hospitalized suicidal patients were asked to participate, and of these 40 (70%) agreed to do so. Each patient was given an anonymous questionnaire asking whether they had lied or purposely exaggerated suicidal ideation to gain admission. A psychiatrist and masters-level psychologist, both blind to the patient responses, then rated each patient for suspicion of malingering. Each patient was also administered the MMPI-2 F, L, and K validity scales. Four patients (10%) indicated they had malingered and indicated that external incentives had motivated them to feign either suicidal ideation or a suicide attempt. None of the MMPI-2 validity scales correlated with self-reported malingering. The clinicians detected malingerers with 100% sensitivity, but the specificity rates were only 58% for the psychiatrist and 32% for the psychologist. The results indicate that some inpatients malinger about the extent of their suicidal intentions. The data demonstrate the difficulty inherent in detecting malingering by clinical interviewing and psychological testing.

Adult↗
PubMed1994

Factors complicating cost containment in the treatment of suicidal patients.

OBJECTIVE: The treatment of suicidal patients contributes to escalating mental health expenditures. Fiscal realities necessitate that cost-containment measures be implemented wherever possible. The authors reviewed the literature to delineate factors that impede cost containment for the treatment of suicidal patients and to outline strategies for controlling costs while improving the quality of care. METHODS: Psychological Abstracts and MEDLINE databases were reviewed. Retrieval and analysis focused on literature published between 1982 and 1992. RESULTS AND CONCLUSIONS: Five factors unique to the treatment of suicidal patients that impede cost containment were identified: the lack of a specific and cost-effective screening method to determine true risk of suicide, the high number of parasuicidal and malingering patients, revolving-door admissions of involuntary patients who become noncompliant with treatment after discharge, the adverse clinical consequences of further increases in existing discriminatory mental health benefits, and the medicolegal liability incurred in treating suicidal patients. The low frequency of completed suicides in relation to attempts and reported ideation indicates that most inpatients labeled suicidal are hospitalized unnecessarily. Thus inpatient treatment should be reserved for patients who make attempts of high lethality and patients with suicidal ideation who are at high risk because of other factors. Ideally, suicidal patients should be committed not to an inpatient facility but to a treatment network in which they can move appropriately between inpatient, day hospital, and outpatient care.

Cost Control↗
PubMed1994

Commitment decisions: identification of indeterminate cases.

Research shows that most involuntary commitments conform to legal criteria and that psychiatrists generally agree on which patients should be committed. There are many cases, however, that cause disagreement among psychiatrists making commitment decisions. No research has been done regarding types of cases causing disagreement. The authors developed 10 clinical vignettes termed "ambiguous case constructs" that could be proven to be indeterminate and explore what underlying themes these indeterminate cases might hold in common. A pilot study was conducted to develop a set of 10 clinical vignettes, which were found to be representative of psychiatric emergencies and likely to cause discordance among evaluating psychiatrists. These validated vignettes were then presented to 62 psychiatrists who were asked to determine the commitment disposition for each vignette patient. Seven of these vignettes elicited significant disagreement among respondents and were identified as indeterminate cases. The frequency and percentage of psychiatrists endorsing commitment for each vignette is listed. This study validates the existence of indeterminate cases which prompt disagreement among psychiatrists making commitment decisions. Upon retrospective review, disagreement evoked by the seven indeterminate cases is proposed to have originated from one of four themes. The implications for clinical practice are noted.

Adult↗
PubMed1993

Dimensions of suicidal ideation in psychiatric inpatients.

The computer-assisted version of the Beck Scale for Suicide Ideation (BSI; Beck, Steer & Ranieri, Journal of Clinical Psychology, 44, 499-505, 1988) was administered to 330 psychiatric inpatients diagnosed with mixed disorders. The BSI is a 19-item self-report instrument for measuring the intensity, duration and specificity of a patient's thoughts and plans about committing suicide. Of the 330 inpatients, 115 (34.8%) were classified as suicide ideators according to the BSI. Controlling for gender, a maximum-likelihood principal factor analysis of the partial intercorrelation matrix among the ideators' BSI items was conducted using an oblique rotation. Three factors were found that reflected Desire for Death, Preparation for Suicide and Active Suicidal Desire. The importance of assessing specific factors of suicidal ideation was discussed.

Adult↗
PubMed1993

Structure of the computer-assisted Beck Anxiety Inventory with psychiatric inpatients.

To determine the dimensions of self-reported anxiety in psychiatric inpatients, the Beck Anxiety Inventory (BAI; Beck & Steer, 1990) was administered by computer to 250 inpatients diagnosed with mixed disorders. An iterated principal-factor analysis was performed on the intercorrelations among the 21 BAI items using a Promax rotation. Two factors were found representing somatic and subjective symptoms of anxiety. These dimensions significantly matched those previously described by Beck, Epstein, Brown, and Steer (1988) for outpatients diagnosed with mixed psychiatric disorders. The generalizability of the somatic and subjective dimensions for inpatients and outpatients is discussed.

Adult↗
PubMed1986

Finding psychiatric diagnosis-related groups that work: a call for research.

Diagnosis-related groups (DRGs) are under consideration as a way to pay hospitals for psychiatric care. Yet psychiatric DRGs account for only 3% of the variation in how long patients stay in the hospital. This nearly random variation means that psychiatrists may be working under a payment system that will have little relation to clinical reality. The authors identify important flaws in the current psychiatric DRGs and describe an alternative approach that promises to reflect clinical reality much more accurately.

Diagnosis-Related Groups↗