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Biomedical subjects

R Weinstock

Publications and source records attributed to R Weinstock.

At least 55 records · Page 3Linked to original sources
PubMed1991

Dangerous mentally disordered criminals: unresolvable societal fear?

The average person fears dangerous criminals, especially those suffering from mental illness. Existing mental health and criminal justice systems provide social control for some of these dangerous individuals, but may be inadequate to deal with those mentally disordered offenders who were not found not guilty by reason of insanity (NGI). In California, innovative laws have attempted to address this problem. However, putative lack of efficacious treatment of mentally ill criminals, insufficient economic support, and individual liberty concerns loom as limiting factors in solving the criminal and psychiatric recidivism problem posed by non-NGI dangerous mentally disordered offenders.

California↗
PubMed1990

Psychiatric patients and AIDS: the forensic clinician perspective.

A survey was completed by American Academy of Forensic Sciences (AAFS) Psychiatry and Behavioral Science members regarding their opinions on acquired immunodeficiency syndrome, (AIDS)-related issues. A considerable range of opinions was found, probably reflecting such differences in society. There was general agreement that psychiatric hospitals should not be allowed to refuse AIDS patients and that education about AIDS is useful for psychiatric patients. There was also support for notifying the public health department, known sexual contacts, and hospital staff about human-immunodeficiency virus (HIV)-seropositive patients.

AIDS Serodiagnosis↗
PubMed1989

Clinical flexibility and confidentiality: effects of reporting laws.

Legal constraints upon therapeutic flexibility, resulting in breaches of confidentiality, can promote counterproductive effects upon patients and society. Conflicts can be created for mental health professionals who sometimes must choose between maximum self-protection and doing what they believe is ethical. A survey of forensic psychiatrists indicated that most believe they face ethical problems created by some ambiguities in current reporting statutes if they are interpreted to mandate reporting and warning. Emphasis is given: (1) to the ethical choice faced by therapists as to whether rigidly to report and warn to limit liability in all Tarasoff-type situations and in some ambiguous child abuse situations, or to take an alternative action when it is clinically indicated for the benefit of a patient and/or society; (2) to the importance of understanding the distinction between potential criminal liability for failure to report under many child abuse laws, and the risk only of civil liability in Tarasoff-type cases; and (3) to appreciate the flexibility permitted by current "Tarasoff" laws. Our case histories demonstrate that mandated erosion of therapeutic confidentiality can present serious problems for patients and others. Suggestions are included for modifications in the current reporting statutes, focusing on the perspective that clinical flexibility is an essential adjunct to community protection as well as to effective therapy.

Adult↗
PubMed1989

Factitious AIDS in a psychiatric inpatient.

This article reports the case of a 28 year-old female presenting to a psychiatric inpatient unit with depression and a history of acquired immune deficiency syndrome (AIDS). Although medical assessment was negative for AIDS, psychiatric evaluation and psychological testing were consistent with a presentation of factitious disorder. This case illustrates the need to be on the alert for individuals admitted to psychiatric units who report they have AIDS or its related conditions.

Acquired Immunodeficiency Syndrome↗
PubMed1989

An HIV-infected psychiatric patient: some clinicolegal dilemmas.

The acquired immune deficiency syndrome (AIDS) crisis has raised many clinical and forensic dilemmas for the health-care system. Psychiatrists may encounter particular problems when evaluating and treating human immunodeficiency virus (HIV) infected patients. The authors present a case of an HIV seropositive, bipolar, intravenous drug abusing patient who participates in unsafe sexual practices to illustrate clinicolegal dilemmas involving dangerousness, involuntary hospitalization, confidentiality, and Tarasoff-like duty.

Acquired Immunodeficiency Syndrome↗
PubMed1989

Capgras syndrome and dangerousness.

This article discusses Capgras syndrome and its association with harmful and potentially harmful behaviors. Phenomenological and psychodynamic analysis of a series of cases will highlight danger signals that may be present in Capgras patients.

Adult↗
PubMed1989

Perceptions of ethical problems by forensic psychiatrists.

A survey was undertaken of the opinions of two groups of forensic psychiatrists to determine their views regarding forensic ethical issues. Although AAPL has made significant strides for our profession by adopting ethical guidelines, some important issues have not yet been addressed, as revealed by our survey. Included were items heretofore considered too "controversial" for incorporation into guidelines, as well as items from the APA ethical framework. All APA items were evaluated as addressing ethical problems. The majority of respondents also viewed most of the "controversial" items as confronting relevant ethical problems, thereby suggesting their inclusion, in some form, in the profession's guidelines. They also appeared to favor retention of many traditional medical ethical values when functioning as a forensic psychiatrist. Clear selective discrimination existed among differing death penalty facets. Since AAPL at present does not wish to conduct its own ethics hearings, the AAPL guidelines as well as the items supported in this paper's survey would best be translated into a form consistent with the APA framework. In this way, AAPL's guidelines and also the new suggested items could readily be coordinated within the APA framework and could play a role in the APA local district branch enforcement process.

Capital Punishment↗
PubMed1988

Ethical considerations of clinical use of Miranda-like warnings.

Psychiatrists and other psychotherapists are not generally required to provide Miranda-like warnings to their patients. Even so, many psychotherapists issue such warnings before encountering clinical situations that frequently arise in general clinical practice and have potential involvement with the legal system. Ethical considerations of whether to utilize Miranda-like warnings in common clinical situations such as involuntary hospitalization, the duty to warn and protect, and suspected child abuse reporting, are explored.

Adult↗
PubMed1988

Controversial ethical issues in forensic psychiatry: a survey.

A survey was conducted of members of the Psychiatry and Behavioral Science section of the American Academy of Forensic Sciences (AAFS) to determine their ethical concerns about controversial items. Issues were included in the survey from the American Psychiatric Association (APA) and AAFS Code of Ethics. Strong support was found for those issues. Some AAPL items from a previous version of their guidelines did not receive support. Fortunately, they have been modified in a later AAPL draft, after AAPL received this survey's results. Clarification was obtained on some ambiguous items from a previous AAFS survey. The present survey showed strong support for addressing in forensic psychiatry's ethical guidelines some issues previously considered too controversial.

Codes of Ethics↗
PubMed1988

Child abuse reporting trends: an unprecedented threat to confidentiality.

Some recent interpretations of the child abuse laws are creating serious and unprecedented erosions of therapist/patient confidentiality. In contrast to the Tarasoff decisions and laws, the child abuse statutes introduced a new element of mandatory reporting which permits no discretionary alternatives and presents prospects of criminal penalties for failure to report. A recent development suggests a possible requirement for therapists to violate confidentiality for the sole purpose of punishing perpetrators. Overinterpretations of the laws by some child protective services have led to recommendations that long past child abuse must be reported, even when no current child is in danger. The California Attorney General's Office has issued a clarification stating that the child abuse statute refers to children and not to adults molested as children. A survey of forensic psychiatrists and psychologists shows that most perceived an ethical problem in reporting adults molested as children when no child is presently in danger, and the purpose of the report is solely for maximal legal self-protection. The survey indicates that fears induced by rigid and intimidating child abuse laws can influence therapists to act in ways most consider unethical. Recommendations are made for improving the current child abuse laws so that they accomplish their goals more effectively.

Adolescent↗
PubMed1986

Ethical concerns expressed by forensic psychiatrists.

A survey was made of American Academy of Forensic Sciences (AAFS) forensic psychiatrists to evaluate whether there is concern among them about potential ethical problems in criminal justice work. Of the respondents, 93.8% had encountered such problems. The main concerns indicated were about those psychiatrists who become a "hired gun," become an advocate, do not give an honest opinion, or have problems with confidentiality. The need for ethical guidelines and further debate about ethical issues is presented.

Capital Punishment↗
PubMed1985

Physicians' confusion demonstrated by competency requests.

A study was performed at a Veteran's Administration (VA) Hospital of the requests for competency evaluations made by medical and surgical services to a psychiatric consultant service. Since less than half the requests were found to be appropriate and specific, this study emphasizes the need for forensic psychiatrists to educate our nonpsychiatric colleagues about the problems engendered by confusion regarding competency. To do so, psychiatrists as well as other physicians and mental health professionals must be trained in discriminating between different types of competencies and the criteria appropriate for each. Because of continuing legal developments, it is becoming increasingly essential to be precise not only about the specific purpose for a competency request but also about the criteria necessary for evaluating different types of competencies. Forensic psychiatrists could play an important role in the education process to clarify the confusion. This study highlights the need for clarity and education concerning competency issues.

Adult↗
PubMed1984

Low T-lymphocyte ratios in homosexual men. Epidemiologic evidence for a transmissible agent.

To investigate risk factors for immunologic abnormalities among homosexual men, T-lymphocyte helper/suppressor (OKT4/OKT8) ratios were determined in 78 healthy Danish homosexual men. Ratios in 26 men (33%) were low (less than 1.00). Visiting the United States in 1980 to 1981 was a strong (7.7-fold) risk factor for having a ratio less than 1.00. Among nine travelers who visited only once, the risk of having a low ratio increased significantly if the visit had occurred in 1981. A risk of similar magnitude (6.9-fold) was found among the three men who had not been to the United States but who reported homosexual contact with a Danish man who became ill with Kaposi's sarcoma. Risk of low ratios did not correlate with age or years of homosexual activity. Promiscuity was not a significant risk factor, but these men generally had fewer sex partners than that which has been reported from the United States. Neither nitrite inhalant use nor cytomegalovirus antibody (prevalence or titer) was associated with low ratios. These data support the hypothesis that a transmissible biologic agent may be etiologically responsible for the low helper/suppressor ratios in homosexual men.

Adult↗
PubMed1984

Antisocial personality--diagnosis or moral judgment?

Antisocial personality is a problem-filled diagnosis. Even when diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) II manual, it was replete with value laden terminology. DSM III makes repeated criminal behavior central and includes a list of other behaviors that do not always truly imply an antisocial personality. In order to test the possibility that factors other than those listed in the manual may often influence the diagnosis, the prevalence of required characteristics in patients diagnosed antisocial personality was compared with the prevalence of required characteristics in another personality disorder, schizoid personality. The study involved a hospitalized Veteran's Administration (VA) population, employing DSM II criteria, which was used by the VA at that time. The difference was statistically highly significant. Examination of the case histories suggests that dislike of the patients or negative moral judgments about their actions frequently were involved in making a diagnosis of antisocial personality. It is therefore crucial that moral judgments not be disguised as scientific ones, and the meaning of an antisocial personality diagnosis as utilized by clinicians needs to be seriously questioned.

Adolescent↗
PubMed1984

Competence to give informed consent for medical procedures.

This study shows that referrals to psychiatry for evaluation for competence to give informed consent generally were made on patients who refused medical treatment. In this sample of referred patients, the only patients found to be incompetent to give informed consent were those with organic brain syndromes. No one with either schizophrenia or depression was found to be incompetent. It is possible that schizophrenic and depressed patients may generally be competent to give informed consent to medical treatment. This finding might be true notwithstanding the fact that many such patients have been found in other studies to be incompetent to consent to voluntary psychiatric treatment. For example, a patient may have delusions that others can read his mind and thoughts, but he still can understand that he needs dialysis for renal failure. Alternatively, it may be relatively rare that an emergency procedure is necessary before a patient's psychosis can be brought under control and consequently internists and surgeons themselves may prefer to wait. The significance of the results is unclear. Because of active interest in the doctrine of informed consent for psychiatric and medical patients by both physicians and attorneys and the few studies within this population, there is a strong need for more study regarding competence to give informed consent. Further study is especially important for psychotic patients for whom psychiatric consultation is not requested.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗