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Biomedical subjects

S Rachlin

Publications and source records attributed to S Rachlin.

At least 19 recordsLinked to original sources
PubMed2001

Characteristics of patients in restraint: six year analysis of the Assaulted Staff Action Program (ASAP).

Emergency service providers, including mental health care providers, are often called upon to impose restraint procedures. These procedures may result in physical injury and psychological distress and provide a unique opportunity for emergency mental health personnel to be of assistance. Reviews of the literature on restrained patients have suggested that clinical variables studied need to be added to demographic factors in order to better clarify those at high risk for restraint procedures. This study compared restrained and non-restrained subjects on basic demographic variables and the clinical variables of histories of violence toward others, personal victimization and substance use disorder. The clinical variables did not enhance the prediction of the use of restraints. The implications for reducing the use of restraints, for needed emergency mental health services and future research directions are explored.

Adult↗
PubMed1997

Discovery of OT4003, a novel, potent, and orally active cys-LT1 receptor antagonist.

The present paper describes the structural modifications leading to the discovery of a new series of quinoline-containing cys-LT1 receptor (LTD4 receptor) antagonists. A structural optimization with respect to the in vitro receptor binding, the in vivo brochoconstriction, and the toxicological effect in the form of peroxisomal proliferation was performed in order to achieve the target compound OT4003. OT4003 ((S)-(+)-E-2-(3-(2-(7- chloroquinolin-2-yl)ethenyl)phenylaminomethyl)-phenoxyl++ +-hexanoic acid) was found to be a potent and selective inhibitor of [3H]LTD4 specific binding to guinea pig lung membranes (IC50 2.4 +/- 1.0 nM), and also a potent, orally active, antagonist of LTD4 induced bronchoconstriction in guinea pigs [ED50 0.14 (ED16 0.1-ED84 0.4) mg/kg; 4 h pretreatment]. The enantiomerically pure OT4003 was prepared using a short convergent synthesis, including an enzymatic resolution step.

Administration, Oral↗
PubMed1994

The prosecution of violent psychiatric inpatients: one respectable intervention.

Is arrest and prosecution an acceptable response to assault committed by a psychiatric inpatient? The first reported case of such a response was in 1978, and the second not until seven years later. Soon after, an inconclusive debate over the propriety of prosecuting patients, with additional illustrative examples, took place in the psychiatric literature. The present author adds three more case reports in this communication, as well as outlines what actually occurs in his state. Three very recent publications have clarified the conflicts and ethical issues in this still-delicate discussion. It is concluded that predatory patient behavior should, in selected circumstances, correctly lead to the imposition of criminal sanctions, whether initiated by victims or clinicians.

Adult↗
PubMed1990

Imaging evaluation of children after falls from a height: review of 45 cases.

The injury pattern in the child who falls from a height is markedly different from that in the adult, so a different imaging protocol is needed. To help establish such a protocol, the authors reviewed the charts and imaging records of 45 children and infants 12 years of age and younger who had fallen one to six stories. Extremity fractures were the most common injury, occurring in 20 patients. Head injuries (including skull fractures) occurred in 19 patients. Abdominal injuries were present in only one patient. Pneumothoraces were seen in four patients and lung contusions in two patients. Fractures of the pelvis, spine, and os calcis were uncommon. The height of the fall did not enable prediction of either the severity or type of injury. The authors recommend radiography of the cervical spine and chest alone in the initial evaluation of the injured child and greater willingness to obtain computed tomographic (CT) scans of the head in children than in adults. Radiographs of the pelvis, thoracolumbar spine, and lower extremities, as well as CT scans of the head and abdomen, should be obtained on a case-by-case basis, and not according to protocol, as is often the situation in adults.

Abdominal Injuries↗
PubMed1988

Litigating a right to treatment: Woe is me.

The right to treatment was first proposed by Birnbaum in 1960. While its constitutional basis may still be in doubt, it has found significant acceptance in state legislation and in lower court decisions. Defining, implementing, and quantifying this right remain elusive. For well over a decade, the case of Walter Woe has been litigated in the federal courts of New York. It represents a continuing effort to obtain a level of care for patients involuntarily hospitalized in the public sector equal to that provided for those admitted voluntarily to general and private hospitals. A precommitment right to refuse inadequate treatment is a novel extension of the right to treatment, with potentially significant implications, and is part of the continuing legal battle.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

The presence of counsel at forensic psychiatric examinations.

In virtually all situations involving forensic psychiatric assessments, the patient is represented by counsel. But does this fact entitle the lawyer to be present at the clinical evaluation? In a series of New York cases spanning a generation, judges have allowed presence of counsel at the psychiatric examination. The most common reason given for such a conclusion is to assure better cross-examination of the expert witness. Psychiatric evaluations mandated by law necessitate several guidelines different from those of the usual doctor/patient relationship. While we may have to accept the presence of attorneys in our consulting rooms, they should be observers only. To allow active intervention would distort the clinical process.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

From impartial expert to adversary in the wake of Ake.

In deciding Ake v. Oklahoma, the Supreme Court held that, when defendants demonstrate that their sanity is likely to be a significant factor at trial, the State must assure them access to a competent psychiatrist who will not only examine them but also render other assistance to the defense. There have been 28 known subsequent decisions in which appellate courts have ruled on the validity of Ake-based claims; in only four did the defendant prevail. The case nonetheless raises issues relative to the proper role of the psychiatric expert. The Supreme Court's decisions, although not introducing a new ethical topic, appear to be favoring a more adversarial posture, at least within certain parameters. I suggest that impartiality, independence, and advocacy need not be mutually exclusive concepts and that some of our traditional beliefs about what part we should play in criminal law may have to be modified and expanded.

Expert Testimony↗
PubMed1986

Unforeseeable liability for patients' violent acts.

Psychiatrists have been held liable for violent acts committed by their patients when more than an error in professional judgment could be demonstrated. The authors describe several recent court cases in which judges have ignored or distorted acceptable clinical practices, conceivably creating a new liability standard whereby a tragic outcome is considered the result of failure to apply appropriate judgment. Following discussion of the cases are recommendations for managing the risks attendant to psychiatric decision making today, such as gathering as much of the patient's history as possible, obtaining previous records, documenting clinical reasoning, and consulting colleagues. Reforms for the legal process are also suggested.

Adult↗
PubMed1986

Incompetent misdemeanants--pseudocivil commitment.

Prior to Jackson v. Indiana, psychiatric hospitalization of those found to be incompetent to stand trial often led to an inordinately long confinement, a particularly invidious consequence if the patient had been accused only of a misdemeanor. After a highly publicized murder perpetrated by a patient originally in this category, New York State instituted a rather cumbersome set of procedures designed to assure several layers of review, including involvement of the legal system, prior to increasing privileges or discharging someone committed pursuant to a criminal court order. The effect of this new law on patient care is examined by looking at the hospital course of 52 incompetent misdemeanants at one state facility. They are demographically and clinically quite similar to a control group of persons civilly committed, except for an increased length of inpatient stay. When compared with those sent to the county penitentiary after conviction, the study population differs on several important parameters. Looking like a patient, the incompetent misdemeanant is, however, treated more as a criminal with no indication that public safety is thereby increased or that individual therapeutic objectives are enhanced.

Adult↗
PubMed1986

Pathological gambling and criminal responsibility.

There exists significant interdisciplinary support for eliminating the volitional component of the insanity defense. Somewhat in contrast to this trend is the presentation of pathological gambling as a potentially exculpatory condition in criminal trials. The authors discuss three federal appellate court decisions on this attempted inappropriate usage of psychiatric diagnostic nomenclature. All have upheld convictions, and thereby rejected contentions that such an impulse disorder can form the basis for a valid plea of lack of criminal responsibility. It is suggested that the public interest will be served by statutorily making disturbances of behavioral control insufficient to raise a defense of insanity.

Crime↗
PubMed1984

Double jeopardy: suicide and malpractice.

Psychiatric malpractice is not a common occurrence. However, the suicide of a patient under treatment is an event that may lead to legal action. The author details the basic facts and ideas necessary to an understanding of this phenomenon. The plaintiff must ultimately prove that there was a dereliction of professional duty that led directly to the death. Several cases from the legal literature are presented to illustrate how judges evaluate this type of claim. Recommendations designed to minimize the risk of being found negligent are offered, and include detailing the specifics of suicide precautions, careful documentation of decisions to grant patients increased freedom, consultation from supervisors or colleagues, and outreach to survivors. Suicide is not always preventable, but following appropriate standards of care is likely to convince the court that no liability need be attached to the patient's demise.

Adult↗