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Biomedical subjects

R L Binder

Publications and source records attributed to R L Binder.

At least 37 records · Page 2Linked to original sources
PubMed1997

The impact of hospitalization on clinical assessments of suicide risk.

OBJECTIVE: Clinicians' assessments of patients' suicide risk at admission to and discharge from a psychiatric hospital were examined to learn how clinical estimates of risk changed over the course of hospitalization and to identify which demographic and clinical characteristics were associated with higher estimates of risk at admission and discharge. METHODS: Seventy-one treating physicians evaluated risk of self-harm of 241 patients at admission to and discharge from a short-term inpatient unit. Risk within the next week (short-term risk) and within the next year (long-term risk) was estimated. At discharge and admission, the physicians also rated patients' symptoms using the Brief Psychiatric Rating Scale. Nurses rated self-directed aggression during hospitalization with the Overt Aggression Scale. RESULTS: Ratings of short-term risk were lower at discharge than at admission, whereas ratings of long-term risk showed relatively little change. At both discharge and admission, the estimated risk of self-harm was associated with a history of suicidal behavior and with acute symptoms, such as depression, anxiety, and emotional withdrawal. At discharge, the estimated risk was also associated with substance abuse, severity of psychosocial stressors, and living alone. CONCLUSIONS: Clinicians appeared to view their hospital-based interventions as influencing variables relevant to short-term risk of suicide but as having little impact on long-term risk. Implications are discussed for management of suicide risk and for medicolegal assertions regarding prevailing community practices that are made in litigation alleging negligent release of patients from hospitals.

Adolescent↗
PubMed1996

Application of the Tarasoff ruling and its effect on the victim and the therapeutic relationship.

OBJECTIVE: The Tarasoff case and subsequent court decisions and legislation in many jurisdictions established a duty to protect the intended victims of patients who pose a serious threat of violence. An approach that has been legally sanctioned is to warn the intended victim. This study examined the effects of such warnings on the warned persons and on the therapeutic relationship. METHODS: All second-, third-, and fourth-year psychiatric residents (N = 46) in a university-based psychiatric residency program in San Francisco were interviewed about their experiences related to issuing Tarasoff warnings. RESULTS: Almost half of the residents (N = 22) reported having issued a Tarasoff warning. Most warnings were issued for patients seen in inpatient units and emergency rooms. In almost half of the cases, the resident was unable to contact the intended victim but did report the threat to a law enforcement agency. In almost three-fourths of the cases in which the intended victim was contacted, the individual already knew of the threat. The most common reaction among those warned was anxiety mixed with thankfulness; most expressed an intent to modify their behavior to increase safety. The second most common reaction was denial that the patient would ever hurt them. Clinicians reported that in most cases issuing the warning had a minimal or a positive effect on the psychotherapeutic relationship. CONCLUSIONS: Many of the anticipated negative effects of the Tarasoff decision have not materialized.

Adolescent↗
PubMed1996

Is adaptive coping possible for adult survivors of childhood sexual abuse?

Thirty adult women survivors of childhood sexual abuse who believed they were functioning well were selected through advertisements in local newspapers and presentations at an incest-survivor support group. Subjects were assessed by a battery of structured diagnostic interviews and standardized psychological measures, including the MMPI, the Trauma Symptom Checklist-40, and the Dissociative Experiences Scale. The results showed the existence of a subgroup of survivors of childhood sexual abuse who do not have devastating long-term psychological effects. Better adult psychological functioning was predicted by certain characteristics of the abuse, the family system, and the survivors.

Adaptation, Psychological↗
PubMed1996

Impact of a smoking ban on a locked psychiatric unit.

BACKGROUND: This study prospectively evaluated the impact of a complete smoking ban on a locked psychiatric unit. METHOD: The setting was a 16-bed inpatient unit with 83% (134/162) involuntary patients, no off-unit smoking area, no possibility of granting smoking passes, and a mean length of stay of 2 weeks. The effect of a complete smoking ban was measured by surveys of both staff and patients before and after the ban. In addition, objective indicators of ward disruption were measured, including rates of aggression, use of p.r.n. medications, need for seclusion and restraints, elopement, and discharges against medical advice. RESULTS: Although staff initially expressed concern about the ban's potential negative impact, after it began, t tests revealed that staff were significantly (p < .05) less concerned about patients' needing more medication, becoming restless, being too fragile to cope with withdrawal, leaving the unit against medical advice, or trying to elope. Staff were significantly (p < .02) more positive about the ban than were patients. Although patients, overall, had negative views toward the new policy, their opinions were somewhat less negative after its implementation. Rates of assaultive behavior, use of seclusion and restraints, use of p.r.n. medication, and against-medical-advice or elopement discharges did not change after the ban was in effect. When polled, 78% (40/51) of the staff voted to keep the ban. CONCLUSION: This study found that staff anticipated negative consequences to a total smoking ban; however, their attitudes changed after it began. The ban had no significant impact on the ward milieu, and although patients were not in favor of it, they felt less negative over time.

Adult↗
PubMed1995

Benzoyl peroxide: an integrated human safety assessment for carcinogenicity.

Topical benzoyl peroxide has been used in the treatment of acne for over 30 years, with no reports of adverse effects that could be related to skin carcinogenesis. Two case-control epidemiological studies have found a lack of association between the specific use of benzoyl peroxide and skin cancer. In addition to these findings in humans, 23 carcinogenicity studies in rodents with benzoyl peroxide, including 16 employing topical application, have yielded negative results. An increase in skin carcinomas was reported in 1 study in which benzoyl peroxide in acetone was applied to the skin of SENCAR mice for a 1-year period; however, this study did not employ adequate control groups to fully understand the unusual findings, and the results were inconsistent with those of 6 other similar studies. While benzoyl peroxide is not a complete carcinogen in animals and has weak or no mutagenic potential, it has been found to be a tumor promoter in mouse skin using experimental two-stage models of carcinogenesis. Consistently positive results have been obtained in tumor promotion studies in which SENCAR mice were exposed to initiating doses of potent experimental carcinogens followed by promotion with benzoyl peroxide in acetone. Negative results have been obtained in similar studies with commercial formulations. However, the results of promotion studies with benzoyl peroxide do not carry significant weight for human safety assessment as evidenced by (i) the absence of demonstrated carcinogenicity in humans of a number of rodent tumor promoters despite long-term human exposure; (ii) the observation that tumor promotion in mouse skin occurs only under specific experimental conditions and predominantly in highly sensitive strains; (iii) clinical use scenarios markedly different from the conditions resulting in tumor promotion in mouse skin; and (iv) the significant physiological differences between mouse and human skin. Thus, to date, available scientific evidence does not allow the results of these rodent promotion studies to be meaningfully applied to human safety assessment. As such, significant scientific progress must be made before human safety estimations can be derived from rodent promotion data.(ABSTRACT TRUNCATED AT 400 WORDS)

Acne Vulgaris↗
PubMed1995

Correlates of accuracy in the assessment of psychiatric inpatients' risk of violence.

OBJECTIVE: The authors evaluated characteristics of patients whom clinicians accurately assessed as being at high or low risk for violence and patients for whom clinicians overestimated or underestimated the risk. METHOD: At admission, physicians estimated the probability that each of 226 psychiatric inpatients would physically attack someone during the first week of hospitalization. Nurses rated assaultive behavior in the hospital with the Overt Aggression Scale. Acute symptoms were rated with the Brief Psychiatric Rating Scale. RESULTS: For the group as a whole, assessed levels of risk were substantially related to later physical aggression (sensitivity = 67%, specificity = 69%). Multinomial logit analysis showed that patients with psychotic disorders such as schizophrenia, organic psychotic conditions, and mania were more likely to be accurately assessed by clinicians as being at high risk (true positives) than to be true negatives or false positives. A recent history of violence was associated with higher estimated risk but did not distinguish true positives from false positives. An admission mental status characterized by low levels of hostility, uncooperativeness, and suspiciousness and high levels of depression, guilt, and anxiety differentiated true negative patients from others, but symptom profiles did not differ among true positives, false positives, and false negatives. Clinical judgments emphasizing gender and race/ethnicity were associated with predictive errors: nonwhite and male patients tended to be false positives. CONCLUSIONS: While clinicians can accurately classify the potential for violence in the majority of patients at admission, systematic errors characterize inaccurate assessments of the risk. Awareness of these patterns may help improve assessment of the risk of violence in clinical practice.

Adult↗
PubMed1994

Ornithine decarboxylase expression in cutaneous papillomas in SENCAR mice is associated with altered expression of keratins 1 and 10.

The patterns of expression of ornithine decarboxylase (ODC) and a number of keratinocyte differentiation products were examined in early papillomas by immunocytochemistry as an initial effort to develop phenotypic markers of the early stages of mouse skin tumorigenesis. Tumors were induced in SENCAR mice by initiation with 7,12-dimethylbenzanthracene, followed by once or twice weekly promotion treatments with 12-O-tetradecanoylphorbol-13-acetate. The patterns of immunocytochemical staining observed in early papillomas, collected after 7 weeks of promotion, were compared to those obtained with control skin and large, hyperkeratotic papillomas, collected after 23 weeks of promotion. In groups receiving 12-O-tetradecanoylphorbol-13-acetate, constitutive and induced ODC expression were evaluated either several days or 4.5 h after the last treatment, respectively. The major differentiation products in suprabasal keratinocytes are keratins, K1 and K10. These keratins were normally expressed in mildly hyperplastic epidermis, but staining became patchy in markedly hyperplastic epidermis. In early papillomas, K1 staining was patchy, and K10 staining occurred in very limited focal areas or was negative, such that the absence of staining delineated the lesions. Antibodies to the basal cell keratins, K5 and K14, stained both basal and suprabasal cells in hyperplastic epidermis and papillomas. Similarly, an antibody to keratin K6, which is expressed under conditions of hyperproliferation, uniformly stained the basal and suprabasal layers of hyperplastic epidermis and papillomas, demonstrating that the staining patterns observed with the antibodies to K1 and K10 were specific. Expression of ODC in the histologically normal skin of control mice was detected only in the hair follicles and depended on the hair cycle. Staining for induced ODC in mice treated with 12-O-tetradecanoylphorbol-13-acetate once weekly for 7 weeks was intense and diffuse throughout the suprabasal layers of the epidermis. In early and large papillomas, staining for constitutively expressed ODC was intense and diffuse in suprabasal cells. This intense staining for ODC occurred consistently in areas with decreased K1 and K10 expression, and, therefore, was associated with an altered pattern of differentiation. High constitutive ODC expression and decreased K1 and K10 expression will be useful phenotypic markers for studying the early stages of tumorigenesis in mouse skin.

9,10-Dimethyl-1,2-benzanthracene↗
PubMed1994

The relationship between acute psychiatric symptoms, diagnosis, and short-term risk of violence.

OBJECTIVE: Previous research on violence and mental disorder has typically focused on the relationship between diagnosis and risk of violence or between symptoms within a particular diagnostic category and risk of violence. The authors' goal was to evaluate whether the pattern of symptoms associated with short-term risk of violence varies depending on patients' diagnoses. METHODS: Subjects were 330 patients with a variety of diagnoses who were hospitalized on a university-based, locked psychiatric inpatient unit. At hospital admission, physicians rated patients' symptoms using the Brief Psychiatric Rating Scale. Nurses rated whether patients became violent during hospitalization by completing the Overt Aggression Scale at the end of each shift. RESULTS: Assaultive patients had different symptom patterns than nonassaultive patients. Symptoms patterns varied significantly across diagnostic groups, and the symptom patterns associated with violence also varied significantly across diagnostic groups. Higher levels of hostile-suspiciousness, agitation-excitement, and thinking disturbance were generally associated with violence, although these symptoms were less predictive of assaultiveness among schizophrenic patients than among patients in other diagnostic groups. CONCLUSIONS: Symptom profiles represent a useful level of analysis for understanding the relationship between violence and psychopathology. However, the value of particular symptom profiles as indicators of imminent violence varies with diagnosis.

Acute Disease↗
PubMed1994

Staff gender and risk of assault on doctors and nurses.

Clinical staff on acute psychiatric inpatient units often are asked to provide care for potentially violent patients. Documentation of which staff are at greatest risk of being assaulted is a necessary step in developing interventions to reduce that risk. The present study evaluated the relationship between staff gender and the risk of becoming a victim of assault while taking into account the professional discipline of the staff victims. The sample included all medical staff (n = 120) and nursing staff (n = 83) who worked on a short-term psychiatric unit between August 1988 and May 1991. Seventy-two percent of the medical and nursing staff were female and 28 percent were male. Five hundred ten assaults were directed toward medical and nursing staff during the study period. Staff gender was not significantly associated with the risk of being a victim of violence for the staff as a whole, the doctors, or the nurses. Staff discipline, however, was strongly associated with risk of assault. Nurses as a group were significantly more likely to be assaulted than were doctors. The findings suggest that violent behavior is a significant occupational hazard on acute inpatient units, and that the role relationship with the patient is more important than the gender of the clinician as a predictor of who is most likely to be assaulted. The authors discuss the implications of the findings for administrative decisions regarding staffing.

Analysis of Variance↗
PubMed1994

Patterns of recall of childhood sexual abuse as described by adult survivors.

Issues concerning the phenomenon of delayed recall of childhood trauma have arisen in forensic settings. For example, the courts have had to address the issue of delayed recall because of legislation extending the statute of limitations for bringing lawsuits related to childhood sexual abuse. Many states now allow victims to bring suit for up to three years after their memory returns. This paper describes patterns of recall of childhood sexual abuse as recounted by 30 adult women survivors in a nonforensic setting. Eleven of the women described remembering their childhood sexual abuse after a period of amnesia. Examples are given of the types of circumstances that were associated with the delayed recall of the abuse. Implications for assessment in clinical and forensic settings are discussed.

Adult↗
PubMed1992

Sexual harassment: issues for forensic psychiatrists.

The number of civil lawsuits related to sexual harassment is increasing. The author bases this paper on her experience as an expert witness in 28 sexual harassment cases over the last 10 years. She delineates the psychological and legal issues about which forensic psychiatrists may be consulted. These include issues related to helping a jury determine the veracity of the complaints of harassment, the psychological effects of the harassment, the prognosis, and the treatment for women who have been harassed. The author gives examples of cases where psychiatric testimony was given to help in the decision making about damages related to the psychological effects of sexual harassment.

Employee Grievances↗
PubMed1991

Clinical assessment of the risk of violence among psychiatric inpatients.

OBJECTIVE: The authors evaluated the reliability and validity of a probabilistic approach to clinical assessment of short-term risk of violence. METHOD: At admission, nurses and physicians independently rated the probability that each of 149 psychiatric patients would physically attack someone during the first week of hospitalization on a university-based locked inpatient unit. Ward behavior was measured with the Overt Aggression Scale. RESULTS: There was a moderate level of agreement between nurses' and physicians' assessments of risk. Ratings of ward behavior showed an increase in the proportion of assaultive patients as the level of estimated risk of violence increased. Although the overall rate of assaults was overpredicted, there was a close correspondence between clinical estimates of patients' chances of becoming violent and the proportion of patients within each risk level who later displayed some type of inpatient aggression. CONCLUSIONS: The reliability and validity of short-term estimates of the risk of violence among acutely disturbed inpatients may be higher than past violence research has suggested. These findings provide preliminary support for the utility of a probabilistic approach to assessment of the risk of violence.

Adolescent↗
PubMed1991

Involuntary patients' right to refuse medication: impact of the Riese decision on a California inpatient unit.

On June 22, 1989, the California Supreme Court allowed the Appellate Court decision in the right to refuse treatment case, Riese v. St. Mary's Hospital to stand. The court ruled that absent a judicial determination of incompetence, antipsychotic drugs cannot be administered to involuntarily committed mental patients in non-emergency situations without their informed consent. Much concern was expressed by the California Psychiatric Association and the California Alliance for the Mentally Ill about the decision's negative impact on patient care. In this paper, the authors review the decision, elucidate the anticipated concerns about the impact of the decision, and then describe the decision's actual impact on an acute inpatient unit in California. The authors report that Riese hearings were held on 7 percent of admissions to their locked inpatient facility. Only 1 percent of the patients were found to be competent to refuse medications. The authors give clinical examples of patients who were affected by the Riese decision and review the benefits and risks of this decision from the perspective of actual clinical practice.

Adult↗