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Biomedical subjects

J R Ciccone

Publications and source records attributed to J R Ciccone.

At least 19 recordsLinked to original sources
PubMed1995

Teaching forensic psychiatry to psychiatric residents.

This study outlines current trends in the education of psychiatric residents in forensic psychiatry. As general psychiatrists are more frequently confronted with issues pertaining to psychiatry and the law, residency training in these areas becomes increasingly important. In order to study the educational experience of psychiatric residents in forensic psychiatry, a survey was sent to all residency training directors in the United States and Canada. The findings of the study included a description of didactics and experiential rotations in forensic psychiatry, the background of those teaching forensics, inclusion of key topics in the curriculum, and the training directors' opinions of both the importance of forensic education and the inclusion of these specific topics in the curriculum.

Canada↗
PubMed1995

Involuntary hospitalization and police referrals to a psychiatric emergency department.

This study compares the demographic and clinical characteristics of police referrals with referrals from other sources to the psychiatric emergency department of a university hospital and the demographic and clinical characteristics of police referrals who were involuntary hospitalized with police referrals who were discharged from the emergency department (ED). In our study, 182 cases were seen in the psychiatric ED over the one-month period; 32 (17.6%) were police referrals. Police referrals were not more frequently hospitalized than referrals from other sources. Police referrals were, however, more likely to have been violent towards others preceding admission (59.4% versus 20.0%; chi 2 = 20.8; df = 1; p < .01) and to be intoxicated on presentation (31.3% versus 10.7%; chi 2 = 91; df = 1; p < .01). Police referrals also were significantly more likely to be violent in the psychiatric ED than referrals from other sources (37.5% versus 3.4%, chi 2 = 36.5, df = 1, p < .01) and to be restrained or secluded (34.4% versus 4.0%; chi 2 = 28.8; df = 1; p < .01). Involuntarily hospitalized police referrals were significantly more likely to be suffering from a major psychiatric disorder than police referrals not hospitalized (83.3% versus 11.8%; chi 2 = 14.7; df = 1; p < .01). They also were significantly more likely to have been violent towards other ED (66.7% versus 23.5%; Fisher test, p < .05) and to have been restrained or secluded in the ED (58.3% versus 23.5%; Fisher test, p < .05) than police referrals who were not admitted.

Adolescent↗
PubMed1993

Medication refusal and judicial activism: a reexamination of the effects of the Rivers decision.

OBJECTIVE: In 1986 New York State courts in Rivers v. Katz mandated judicial review of cases in which involuntarily hospitalized psychiatric patients formally refuse medications; previously only a clinical-administrative review was required. In an earlier study the authors found that formal refusals of medications declined significantly in the year after the Rivers decision and that length of time between refusal and its resolution increased. To determine whether these effects were maintained over time, data for the second year after the Rivers decision were examined. METHODS: Chi square analysis and analysis of variance were used to compare data from both a private and a state-operated hospital for the year before the Rivers decision with data from the first and second years after. RESULTS: The significant declines in the number of patients formally refusing medications were maintained in the second year after Rivers at both hospitals, as were the significant increases in the length of time to resolution. In the second year, judges continued to uphold the treating psychiatrists' recommendations. The decline in the refusal rates was not found to be part of a broader trend that had been manifest before the Rivers decision. CONCLUSIONS: The sharp decline in refusals resulted in fewer patients having their medications reviewed by others not directly involved in their care. Increased time to resolution has diminished quality of care and has resulted in increased patient decompensation and staff injuries.

Adult↗
PubMed1992

Murder, insanity, and medical expert witnesses.

Recent advances in the ability to study brain anatomy and function and attempts to link these findings with human behavior have captured the attention of the legal system. This had led to the increasing use of the "neurological defense" to support a plea of not guilty by reason of insanity. This article explores the history of the insanity defense and explores the role of the medical expert witnesses in integrating clinical and laboratory findings, eg, computed tomographic scans, magnetic resonance scans, and single-photon emission computed tomographic scans. Three cases involving murder and brain dysfunction are discussed: the first case involves a subarachnoid hemorrhage resulting in visual perceptual and memory impairment; the second case, a diagnosis of Alzheimer's disease; and the third case, the controverted diagnosis of complex partial seizures in a serial killer.

Aged↗
PubMed1990

Right to refuse treatment: impact of Rivers v. Katz.

This article examines the impact of the New York court decision, Rivers v. Katz, which in June 1986 dramatically changed the state procedure for responding to involuntarily committed psychiatric patients who formally refused psychopharmacologic treatment. The court rejected the medically administered review process that had been used to respond to involuntarily committed psychiatric patients who formally refused medication, and replaced it with a judicial determination of competent and "substituted judgment" provided by the court. Post-Rivers, the rate of patients consistently refusing treatment decreased, and the time from refusal to resolution increased. The clinical, legal, and economic implications of the Rivers procedure are discussed.

Adult↗
PubMed1987

The insanity defense: asking and answering the ultimate question.

The authors address the main questions in the insanity defense debate: Should it be abolished? Should psychiatrists participate as expert witnesses? Is the profession damaged by such testimony? Is there a logical leap between providing psychiatric findings and providing an opinion to the ultimate question? Because the free will/determinism model underlying the current insanity defense positions can be used to argue either side of the debate, it does not supply any rational answers. The authors reframe the discussion, using a systems approach, and suggest answers to these questions that are in line with the clinical realities and on a firmer philosophic ground.

Expert Testimony↗
PubMed1984

Forensic psychiatry and applied clinical ethics: theory and practice.

The authors briefly describe and then apply a new method--applied clinical ethics--for identifying and working with ethical problems. This method, starting from the clinical context, develops ethical constructs that may be tested in clinical practice and revised if required. The work was done in the context of a combined university-county forensic psychiatric service. The authors discuss three of the identified ethical issues: effects of deinstitutionalization, countertransference with forensic populations, and prediction of dangerousness. They discuss the basis for developing ethical norms from clinical experience and suggest ethical guidelines for medical practice.

Adolescent↗
PubMed1980

Effects of lithium on evoked potentials and performance during sustained attention.

Two versions of the continuous performance test (CPT) differing in complexity were administered to 15 patients with bipolar affective disorder, manic type before and after treatment with lithium. Reaction time, performance accuracy, and the late positive component (LPC) of the event related potential evoked by the task were measured concurrently. Lithium treatment decreased errors of commission on both CPT tasks, although the difference was significant only for the simpler task. Reaction time was significantly increased by lithium treatment on the more difficult CPT task, LPC amplitude to the target stimulus on the difficult CPT was significantly increased by lithium. The data are interpreted as consistent with an attention-enhancing effect of lithium, coupled with a general reduction in the tendency to respond to stimuli.

Adult↗