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Biomedical subjects

G J Maier

Publications and source records attributed to G J Maier.

At least 19 recordsLinked to original sources
PubMed1999

The aggressive patient/inmate: beyond denial.

The public is no longer willing to tolerate being repeatedly victimized by a small group of sexually and/or physically aggressive predators. These predators may be found among much larger groups of non-predatory inpatients in psychiatric hospitals or inmates in prisons. These institutionalized people deserve to be treated or incarcerated without fear of being victimized, as well. The U.S. Supreme Court has recently recognized the principle of protecting the public from such predation, in its Kansas v Hendricks decision. This paper details the philosophy, management, unit construction, legislative changes, and intervention strategies necessary to contain such predators and to propel them toward rehabilitation-once we have given up our denial about the existence of such people.

Aggression↗
PubMed1996

Managing threatening behavior. The role of talk down and talk up.

Table 3 demonstrates a relationship between DSM-IV Axis I and Axis II diagnoses and hot and cold threats. Patients with an Axis I diagnosis who make hot threats are often emotionally and cognitively out of control, trying to get back into control by threatening. In contrast, patients with an Axis II personality disorder, like most normal people, periodically reach an emotional threshold when they seem to "lose it." That is, they become so frustrated that they discharge their frustration by verbally abusing or threatening others, often as a prelude to disrupting the physical environment or actually physically attacking someone. Although patients with an Axis II diagnosis lose emotional control at times, they are able, in calm moments, to use cold threats as a way to manipulate the clinician to achieve a goal. Understanding these general diagnostic differences and related management approaches can help clinicians work safely in any setting.

Aggression↗
PubMed1994

A report on staff injuries and ambulatory restraints: dealing with patient aggression.

1. During a 6 1/2-year period on a unit designed for repetitively aggressive male patients, nursing staff members were the recipients of 95% of aggressions and 97% of serious injuries. 2. Two-point ambulatory restraints, called Preventive Aggression Devices (PADS) help liberate the patient from prolonged seclusion, but in a safe manner. 3. Patient aggression is underreported; there is a need for a standardized aggression reporting system across facilities.

Aggression↗
PubMed1993

Toward the therapeutic use of obscene language: a legal and clinical review.

Obscenity has been the subject of a series of court cases centered around the First Amendment, and its interpersonal effects have been studied by psychotherapists and communications theorists. But little has been written about the impact of the use of obscenity by patients in group settings to discharge their feelings and to dominate and harass staff and other patients. The authors argue that if staff are to be able to work effectively with patient populations who utilize obscenity routinely for these purposes, they must become more comfortable with its use, and to treat it as another symptom of the patients' interpersonal difficulties. Guidelines for the therapeutic use/management of obscenity on the ward are offered.

Erotica↗
PubMed1992

The tragedies in Madison.

Explore the source record for details and available documents.

Commitment of Persons with Psychiatric Disorders↗
PubMed1990

The Madison model.

Explore the source record for details and available documents.

Community Mental Health Services↗
PubMed1990

American forensic psychiatrists who work in state institutions.

The authors surveyed a sample of American forensic psychiatrists who work in state institutions. As a group, their respondents tended to be middle-aged, white men, who had little formal training in forensic psychiatry, felt somewhat alienated from their peers, yet who were Board certified in general psychiatry. They tended to be involved primarily in the direct treatment of patients, and most often expressed concerns about the care-and prominent lack of aftercare--received by forensic patients. They also perceived a sense of patient futility in the institutional forensic setting. The authors conclude by recommending that AAPL take a more active role in appealing to and representing such forensic psychiatrists.

Adult↗
PubMed1989

The impact of the right to refuse treatment in a forensic patient population: six-month review.

In December of 1987, the Wisconsin supreme court held that all involuntarily committed mental patients in the state had the right to refuse psychotropic medication unless a court held that they were incompetent to make treatment decisions. The authors studied the effects of this decision in a 165-bed forensic hospital over the first six months after implementation of the decision. They found that 29 percent of patients already on psychotropic medication initially refused further treatment as opposed to 75 percent of newly admitted patients. Of refusers, 32 percent eventually resumed taking medication voluntarily; courts overturned the refusals of all the 51 percent who maintained their refusals, after an average delay of over a month. The length of procedural delays actually increased over the six months of the study as the courts learned of the decision. The authors compare their findings with other reported studies of implementation of right to refuse treatment decisions and discuss differences between the right to refuse treatment for civilly and criminally committed patients.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Emerging problems for staff associated with the release of potentially dangerous forensic patients.

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.

Adult↗