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Biomedical subjects

M J Mills

Publications and source records attributed to M J Mills.

At least 55 records · Page 3Linked to original sources
PubMed1985

Psychotic patients' understanding of informed consent.

Courts have found psychiatric patients to have the qualified right to refuse treatment. Particularly problematic is whether newly admitted psychiatric patients can comprehend information and give informed consent. The authors examined the ability of voluntary and involuntary psychotic patients to understand information about antipsychotic medication, related this assessment to psychopathology, and evaluated factors involved in hypothetical acceptance or refusal of treatment. Although most patients stated they had understood informed consent material, objective ratings did not support this. Impaired understanding was significantly associated with thought disturbance but did not affect hypothetical acceptance or refusal of antipsychotics. Legal status was not a significant factor.

Adult↗
PubMed1985

A brief test for measuring malingering in schizophrenic individuals.

The M Test, a brief test for measuring malingering of schizophrenic illness, contains true-false items describing actual symptoms of schizophrenia, bizarre attitudes and beliefs, and fake symptoms. Normal subjects rarely endorsed any of the items. The responses of genuinely ill schizophrenic inpatients were compared with those of normal subjects who had been asked to fake malingering after being educated about the symptoms of schizophrenia and forewarned about the purpose of the test. The test significantly discriminated between genuinely ill patients and malingerers. The test correctly identified 87.3% of the schizophrenic subjects and 78.2% of the malingering normal subjects.

Factitious Disorders↗
PubMed1985

The mental health commissionership: major changes over a decade.

During the past decade major changes have occurred in the role of the state mental health program director. Those changes have made that position more complex, more administrative, and less medical. The author discusses four themes in particular: the growing belief in the desirability of employing professional managers, the increasing requirements for quantitative information, the loss of confidence in the overriding treatment ideology of deinstitutionalization, and managerial constraints imposed by consent decrees. Such changes make the role of the commissioner more important, yet more difficult.

Community Mental Health Services↗
PubMed1985

Comparison of injectable molindone and haloperidol followed by oral dosage forms in acutely ill schizophrenics.

The comparative efficacy of molindone and haloperidol, given by injection for the first 2-3 days of hospitalization and then continued orally for up to 4 weeks, is reported from an ongoing double-blind study. Efficacy and side effects were assessed by the Brief Psychiatric Rating Scale, Clinical Global Impressions, Treatment Emergent Symptom Scale, and Target Symptom Ratings. Analyses based on the first 35 patients who entered the study indicate that both drugs were effective and well tolerated. There were slight advantages for molindone early during the injectable phase of treatment and for haloperidol late during the oral portion of the study, but these differences were not clinically significant. No significant differences in side effects were found between the two drugs.

Acute Disease↗
PubMed1984

Determination of anti-protease homogeneity.

Virgin and modified [single peptide bond between arginine (63) and isoleucine (64) is cleaved] soybean anti-trypsin was separated by chromatofocusing using a narrow pH range. The separation on anion-exchange and reversed-phase chromatography was less satisfactory. Anti-proteases isolated by affinity chromatography from Boophilus decoloratus were monitored for the formation of any modified protein, with chromatofocusing.

Animals↗
PubMed1984

Electroconvulsive therapy in Massachusetts.

A study of the use of electroconvulsive therapy in Massachusetts shows that between 1974 and 1980 ECT use decreased significantly in both public- and private-sector hospitals. This decline was particularly pronounced in public-sector hospitals. The average age of ECT-treated patients rose during the period; women received ECT more often than men; and bilateral ECT remained in more frequent use. Though ECT was most frequently prescribed for major depression, about 20% of those receiving it were diagnosed as having a dysthymic disorder. State regulation and advances in psychiatric treatment may partially explain the decrease in ECT use.

Age Factors↗
PubMed1984

Legal issues in psychiatric treatment.

This paper has presented a discussion of the three overlapping phases in the regulation of psychiatric treatment: consent, patients' rights, and physicians' duties. The concepts of consent are relatively well defined. Still, the courts sometimes utilize the rubric of consent to decide difficult cases (e.g., Clites). One can predict that litigation attempting to further define the specific aspects of consent for high-risk therapies will continue. Because of the court's decision in Youngberg, one can also predict that there will be more litigation as to the constituents of constitutionally-adequate treatment. Given the court's dicta in that case, about deferring to professional judgment, it is impossible to know how these cases will fare if and when they are reviewed by the Supreme Court. Given the court's decisions in Mills and Rennie, it is unlikely that the Supreme Court will be ruling on a broad constitutionally-based right to refuse treatment for some time. The most active interface of psychiatry and law is that detailing physicians' duties. In terms of dangerousness, the majority of cases require that psychiatrists attempt to protect victims, or classes of victims, when they believe that dangerous conduct is apt to occur. Still unclear is the extent to which the courts will inquire specifically into the clinical decision-making process to determine whether the physician "reasonably should have known" that the patient was dangerous. Also unclear is the extent to which the courts will find that physicians owe a duty to an ill-defined class. Still, a reasonable guess would be that other courts will find Lipari persuasive. Finally, with regard to specific treatment modalities, it is evident that physicians are being required to practice with an extra measure of care and caution when prescribing neuroleptics, ECT, or psychosurgery. One final note: Too often, physicians have been leery of the political process. Since many decisions with great impact on patients and practitioners are political, this author would urge physicians to engage in that process to secure more reasonable and more equitable medical regulation.

Antipsychotic Agents↗
PubMed1983

Family conflict, psychopathology, and dangerous behavior by schizophrenic inpatients.

Data supporting the hypothesis that history of severe discipline and parental conflict in childhood is related to current violence were obtained in a study of 100 schizophrenic inpatients. In addition to a relation between inpatient violence and degree of schizophrenic symptoms, inpatient assaults and other dangerousness measures were positively and significantly correlated with severity of parental discipline, especially involving the father, and with degree of family conflict, particularly fights between parents and others outside the home.

Conflict, Psychological↗
PubMed1983

Mental patients' knowledge of in-hospital rights.

The authors questioned 52 recently admitted patients about formally receiving information regarding patients' rights and about their knowledge of that information. Of the 13 day hospital patients, 12 recalled being given the information, but only 20 of 39 inpatients recalled receiving the information. Most patients, irrespective of their diagnosis or legal status, knew their rights. Surprisingly, comparison with a group of patients who did not receive information on their rights revealed no relationship between receiving this information and knowledge of patients' rights. On the basis of these and other findings, the authors discuss some difficulties with presentation of patients' rights and offer recommendations.

Adolescent↗
PubMed1983

Behavioral precipitants to civil commitment.

The authors examined retrospectively the prehospitalization behavior of 66 voluntary and involuntary psychiatric patients to determine precipitating factors in each person's hospitalization. Involuntary patients had engaged in dangerous acts directed against others more frequently than had voluntary patients. However, very little significant harm was caused by members of either group.

Commitment of Persons with Psychiatric Disorders↗
PubMed1983

Legal issues in outpatient treatment.

This overview reviews three major aspects of the interface between psychiatry and law: (1) legal issues in clinical management (e.g., civil commitment, the least restrictive setting principle, and informed consent), (2) management of client information, and (3) caveats for clinicians concerned with legal issues. It is suggested that periodic review of legal issues can increase both professional confidence and comfort, and that it will be necessary upon occasion for psychiatrists to enter the public debate on legal issues to help ensure the best interests of patients and of the profession.

Ambulatory Care↗