Biomedical subjects

K L Appelbaum

Publications and source records attributed to K L Appelbaum.

4 recordsLinked to original sources

PubMed1992

Privilege and discharge decisions for psychiatric inpatients with dysphagia.

Psychiatric patients have an increased risk for choking compared with the general population because of risk factors such as medication side effects and food gorging. A state hospital program for managing patients with dysphagia, or difficulty swallowing, includes interventions such as modified diets, mealtime monitoring, and adjusting psychotropic medications. Clinicians may find it difficult to make decisions about privileges and placement for dysphagic patients who do not comply with dietary modifications in unsupervised settings. For many such patients, close supervision and even placement on a locked ward may seem necessary. The authors recommend a risk-benefit approach: clinicians must balance the safety afforded by restrictions against the benefits of increased privileges or placement in a less restrictive setting. Quality of life and patients' preferences must also be considered.

Activities of Daily Living↗

PubMed1992

Are pretrial commitments for forensic evaluation used to control nuisance behavior?

The shift to dangerousness-oriented civil commitment criteria has led to speculation that mentally ill persons who do not meet those criteria are being hospitalized under criminal commitment statutes. Using data on patients' psychiatric symptoms at admission to a state hospital in Massachusetts, the authors retrospectively assessed whether patients charged with minor criminal offenses who were committed for evaluation of competence to stand trial would have met civil commitment criteria. The data suggest that most mentally ill patients who were criminally committed could have been civilly committed. However, a relatively greater proportion of persons with substance abuse, mental retardation, or other conditions who did not meet civil commitment criteria for mental illness were committed for pretrial evaluation.

Adult↗

PubMed1991

A model hospital policy on prosecuting patients for presumptively criminal acts.

Evidence suggests that violence by psychiatric inpatients, especially in public-sector hospitals, may be on the rise. The authors present a model policy developed at a state hospital for deciding whether to prosecute presumptively criminal assaults by patients. The policy addresses the circumstances under which it is ethically permissible to file a criminal complaint while emphasizing the need to use clinical interventions first and to consider the clinical sequelae of prosecution. The authors also review criticisms made of the policy, which reflect opposing views that prosecution is unjustified and that the policy unduly restricts the use of prosecution. In the first six months after the policy became effective, state hospital staff considered filing charges against five patients, but no case progressed beyond the first steps in the implementation procedure.

Confidentiality↗

PubMed1990

Criminal defendants who desire punishment.

Some defendants desire to be punished. Sometimes psychotic motivations underlie punishment-seeking behavior; sometimes they do not. The defendant's clinical status is relevant to his competency to stand trial and to waive other rights. These issues are illustrated by presentation of a case of a defendant who sought punishment. The importance of psychiatric assessments of these defendants is emphasized.

Adult↗