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Biomedical subjects

W C Myers

Publications and source records attributed to W C Myers.

At least 19 recordsLinked to original sources
PubMed2001

Improving performance at the local level: implementing a public health learning workforce intervention.

In an effort to continually improve performance of the essential public health services with community partners, the diverse public health workforce in a major metropolitan area engaged in an organizational learning process. Core public health organizational competencies, identified in a multi-year collaborative applied research initiative, provided the curricula content for the public health learning experience. All members (about 600) of the Columbus and Franklin County (Ohio) Health Departments participated in four one-half day small group, highly interactive modules conducted during a 2-year period. The purpose of this article is to describe the design and implementation of this workforce intervention, the lessons learned, and implications for developing organizational capacity and improved performance.

Competency-Based Education↗
PubMed2001

Autocastration as a presenting sign of incipient schizophrenia.

Previous case reports on autocastration have identified individuals who engaged in genital self-mutilation as being overtly psychotic, as having previously received a diagnosis of schizophrenia, or as having significant dysfunction of ego integrity, manifesting as guilt and low self-esteem. This paper describes a patient who had had no previous psychiatric symptoms or mental health treatment and for whom the act of autocastration was the first sign of incipient schizophrenia.

Adult↗
PubMed2000

Project back-on-track at 1 year: a delinquency treatment program for early-career juvenile offenders.

OBJECTIVE: This study assessed the effectiveness of Project Back-on-Track, an after-school diversion program that uses a multimodal approach for the treatment of early-career juvenile offenders. METHOD: Project Back-on-Track completers (30 of 41 enrollees; 73%), aged 9 to 17 years, 63% female, participated in a 4-week cycle of treatment consisting of group and family therapies, parent groups, educational sessions, community service projects, and empathy-building exercises. These youths attended the program 2 hours per day, 4 days a week, allowing for 32 hours of contact with the program per cycle; parents attended the program for 15 hours per cycle. Most youths were referred for violent offenses and met criteria for conduct disorder. RESULTS: Project Back-on-Track completers were significantly less likely than matched controls to have committed subsequent criminal offenses at 12 months. In addition, they had significantly fewer subsequent criminal charges at 9- and 12-month follow-up intervals than the control group. By decreasing the frequency of criminal recidivism, it is estimated that Project Back-on-Track resulted in savings to society of approximately $1,800 per youth enrolled after 1 year. CONCLUSION: At 1-year follow-up, findings suggest that treatment through Project Back-on-Track was effective in reducing criminal recidivism and costs in a population of early-career juvenile offenders.

Adolescent↗
PubMed2000

Anger experience, styles of anger expression, sadistic personality disorder, and psychopathy in juvenile sexual homicide offenders.

Sexual homicide by juveniles is a rare phenomenon, and information regarding the psychological and behavioral characteristics of this group is limited. No studies exist which have investigated anger experience and styles of anger expression, and the relationship between anger, sadistic personality disorder, and psychopathy, in this type of youthful offender. These areas were explored by evaluating 14 juvenile sexual homicide offenders through clinical assessment, the State-Trait Anger Expression Inventory (STAXI), the Schedule for Nonadaptive and Adaptive Personality (SNAP), the Revised Psychopathy Checklist (PCL-R), and review of correctional records. Descriptive information for the STAXI scales and internal consistency data are presented. Trait Anger was significantly higher than State Anger for the youth, but still comparable to adolescent norms. The difference between Anger-In and Anger-Out scale scores was not significant. Unexpectedly, Anger Control scale scores were significantly higher than Anger Out scale scores, clinically consistent with efforts by some of these boys to resist sadistic impulses. Those four (31%) participants who met criteria for sadistic personality had significantly higher Anger-Out scale scores than those without the disorder, and were also higher on Trait Anger to a marginally significant degree. Psychopathy was significantly negatively associated with Anger Control. This study is intended to contribute to the scant literature on juvenile sexual homicide, and lends some support to the validity and utility of sadistic personality disorder as a diagnosis in younger forensic populations. The findings did not support the contention that this form of violence is necessarily an outgrowth of excessive anger.

Adolescent↗
PubMed1998

Criminal and behavioral aspects of juvenile sexual homicide.

This preliminary research provides a descriptive, systematic study of juvenile sexual homicide. Fourteen incarcerated juveniles, identified through a department of corrections computer search, were assessed using a structured diagnostic interview, an author-designed clinical interview, and a review of correctional files and other available records. Five of the offenders' victims survived the homicidal attack, but their cases were nevertheless included in this study as the offenders' intent was clearly to kill their victim, and the victim's survival was merely by chance. All victims were female and all offenders were male. Their crimes typically occurred in the afternoon, and involved a low-risk victim of the same race who lived in the offender's neighborhood. The sexual component of the crime consisted of vaginal rape in over one-half of the cases. Weapons, typically a knife or bludgeon, were used in all but one case. Thirteen of these youths had a prior history of violence, and twelve had previous arrests. Chaotic, abusive backgrounds and poor adjustment in school were typical for these boys. A conduct disorder diagnosis was present in twelve of the youths, and violent sexual fantasies were experienced by one-half of the sample. The findings in this study suggest that juvenile sexual murderers comprise less than 1% of juvenile murderers, and are likely to be an emotionally and behaviorally disturbed population with serious familial, academic, and environmental vulnerabilities.

Adjustment Disorders↗
PubMed1998

Murder, minors, selective serotonin reuptake inhibitors, and the involuntary intoxication defense.

This article examines the clinical and legal aspects of the involuntary intoxication defense, primarily as it relates to violent acts perpetrated by minor and adult patients who have been prescribed selective serotonin reuptake inhibitors (SSRIs) and related psychoactive medications in a therapeutic context. The Model Penal Code recognizes the involuntary intoxication defense and its potential applicability to cases in which the defendant's criminal behavior is believed to be associated with prescription medication use. Two case reports of juvenile murderers who attributed their violent behavior to SSRI treatment are presented. Selected pertinent case law is reviewed. Currently there is a lack of convincing scientific evidence that clearly confirms or negates the postulated relationship between antidepressant agents and violent behavior. However, the use of the involuntary intoxication defense will likely continue to increase due to the growing number of novel psychotropic medications being developed and marketed along with advances in the scientific understanding of their actions and side effects.

Adolescent↗
PubMed1997

Adolescents' misperceptions of the dangerousness of acetaminophen in overdose.

Clinical observations suggest that adolescents commonly and naively use acetaminophen in suicide attempts even when they do not wish to die. It is estimated that 18,500-mg acetaminophen tablets can lead to hepatotoxicity, while death is usually associated with ingestion of 50 or more tablets. A sample comprising 569 adolescent students completed an author-designed survey assessing teenagers' knowledge of acetaminophen's therapeutic and harmful effects. The findings support our original data that adolescents have ready access to acetaminophen and use it in suicide attempts, but underestimate its potential for toxicity. Forty-two percent of this sample underestimated the dose to cause harm, believing it would require 20 or more tablets, and 50% underestimated the dose to cause death, stating 100 or more pills would be necessary. Adolescents appear to seriously underestimate the dangerousness of acetaminophen in overdose, and lack knowledge regarding side effects of overdose.

Acetaminophen↗
PubMed1997

Psychopathology and personality in juvenile sexual homicide offenders.

This project describes the psychopathology and personality findings in 14 juveniles who committed sexual homicide. These incarcerated youth were assessed using a structured interview, a personality assessment instrument, correctional files review, and an author-designed clinical interview. Nearly all of these youth met DSM-III-R conduct disorder criteria at the time of the crime. The presence of personality disorders and moderately high psychopathy scores at follow-up were common. Two-thirds of these youth reported the presence of violent sexual fantasies before their crimes. Weapons, most often knives, were used by these juvenile sexual murderers to kill known victims in a majority of the cases. They usually acted alone and selected a low risk victim. These findings suggest that juvenile sexual murderers are an emotionally and behaviorally disturbed population with identifiable psychopathology, personality disturbances, and criminal patterns.

Adolescent↗
PubMed1996

MMPI profiles of depressed adolescents with and without conduct disorder.

This study examined whether adolescents with depression would produce significantly different MMPI profiles from adolescents with depression and conduct disorder. Twenty-four adolescents who met DSM-III-R criteria for major depression or dysthymia were included in the study. Nine of these 24 subjects also met DSM-III-R criteria for Conduct Disorder. Results indicated that depressed only adolescents had significantly higher elevations on scales 2 and 0 while those with depression and conduct disorder had significantly higher elevations on scales F and 9. These findings suggest that the presence of conduct disorder in depressed adolescents may lead to a veiling of their affective symptoms, thus potentially causing clinicians to underdiagnose depression in such cases.

Adolescent↗
PubMed1996

MMPI differences among adolescent inpatients, rapists, sodomists, and sexual abusers.

This study examined Minnesota Multiphasic Personality Inventory (MMPI) responding among 61 adolescent sex offenders accused of Sexual Abuse (n = 22), Rape (n = 19), and Sodomy (n = 18) and 15 adolescents without a history of sexual offending admitted to an inpatient psychiatric unit. Results indicated significant differences between sex offenders and inpatients as well as among sex offender groups on both single-scale elevations and 2-point code types. Contrary to previous research, adolescents in the sex offender groups demonstrated significantly more psychopathology than those in the inpatient sample. Subjects in the Sodomy group achieved the highest clinical scale elevations and were more likely to have scales associated with significant psychopathology as one of their 2-point pairs. In general, increased psychopathology was associated with increased sexual deviancy. That is, subjects in the sexual offender groups evidenced more psychopathology than inpatients and the more deviant Sodomy and Rape groups evidenced more psychological disturbance on the MMPI than Sexual Abuser subjects. Results indicate that the MMPI can be useful in providing both quantitative and qualitative distinctions among adolescent sex offenders.

Adolescent↗
PubMed1995

Psychopathology, biopsychosocial factors, crime characteristics, and classification of 25 homicidal youths.

OBJECTIVE: This study investigates diagnostic, behavioral, offense, and classification characteristics of juvenile murderers. METHOD: Twenty-five homicidal children and adolescents were assessed using the Diagnostic Interview for Children and Adolescents, clinical interviews, record review, and all available collateral data. RESULTS: DSM-III-R psychopathology was found in 96% of these youths, and one half of them had experienced suicidal ideation at some point in their lives. Nevertheless, only 17% had ever received mental health treatment. Family and school dysfunction were present in virtually all subjects. Histories of abuse, prior violence, arrests, and promiscuous sexual behavior were typical. Motives were equally divided between crime-based and conflict-based causes. A weapon was used in 96% of cases. Significant differences were found between crime classification groups and victim age, physical abuse, IQ, and victim relationship. In addition, those who committed sexual homicide were significantly more likely to have engaged in overkill, used a knife, and been armed beforehand. Ten profile characteristics present in at least 70% of these juveniles were identified. All murders were readily classified according to the FBI Crime Classification Manual (CCM). CONCLUSIONS: These findings support juvenile murderers as being an inadequately treated, emotionally and behaviorally disturbed population with profound social problems. The CCM proved to be a useful instrument for the classification of this sample.

Adolescent↗
PubMed1995

Axis I and personality comorbidity in adolescents with conduct disorder.

This study was undertaken to investigate psychiatric comorbidity in male and female adolescents with conduct disorder diagnoses. Twenty-five hospitalized adolescents (11 females, 14 males) with conduct disorder were evaluated using structured diagnostic interviews for Axis I and personality disorders. The most common Axis I comorbid diagnoses were: depressive disorders (major depression and/or dysthymia), 64 percent; anxiety disorders (separation anxiety disorder, overanxious disorder, panic disorder, obsessive-compulsive disorder, phobias, and/or posttraumatic stress disorder), 52 percent; substance abuse, 48 percent; and attention-deficit hyperactivity disorder, 28 percent. Common Axis II disorders included passive-aggressive personality disorder, 56 percent, and borderline personality disorder, 32 percent. When compared with the male subjects, the females had significantly more total Axis I disorders and a trend toward more total personality disorders, anxiety disorders, depression, and borderline personality disorders. These findings support conduct disorder as a complex illness with extensive Axis I and II involvement as well as some gender differences in presentation.

Adolescent↗
PubMed1995

Adolescent psychopathy in relation to delinquent behaviors, conduct disorder, and personality disorders.

The purpose of this study was to explore the relationship between psychopathy as measured by The Revised Psychopathy Checklist (PCL-R) and delinquent behaviors, conduct disorder, and personality disorders in psychiatrically hospitalized adolescents. Thirty adolescent inpatients were assessed for psychopathy, delinquent behaviors, DSM-III-R Axis I disorders, and personality disorders using the Revised Psychopathy Checklist (PCL-R), the Diagnostic Interview for Children and Adolescents (DICA-R), and the Structured Interview for DSM-III-R Personality Disorders (SIDP-R). Significant relationships were noted between elevated PCL-R psychopathy scores and delinquent behaviors, conduct disorder, and narcissistic personality disorder. The validity of the PCL-R as a measure of psychopathy in adolescence was supported. Longitudinal studies are needed to clarify the clinical application of the PCL-R to adolescent populations.

Adolescent↗
PubMed1994

Disulfiram for alcohol use disorders in adolescents.

Alcohol abuse and dependence in adolescents is a serious health concern with significant morbidity and mortality. Disulfiram has been used to treat alcoholism in adults since 1948, but there are no known reports of disulfiram treatment in minors. Case reports are presented on the use of disulfiram in two adolescent males with alcohol dependence and strong family histories of alcoholism. Prolonged abstinence from alcohol occurred in the first case, whereas poor pharmacological compliance resulted in an early relapse in the second case. The judicious use of disulfiram in adolescents is recommended for consideration in those with alcohol use disorders. A protocol is proposed that recommends a thorough medical and psychiatric evaluation, documentation of a serious alcohol use disorder, careful assessment for comorbid diagnoses, family involvement when possible, and obtainment of informed consent that encompasses education about the nature and effects of disulfiram along with its potential interactions with other medications.

Adolescent↗
PubMed1994

Sexual homicide by adolescents.

Sexual homicide encompasses murders that are sexual in nature. The limited literature on sexual homicide by juveniles is reviewed in conjunction with pertinent studies from the adult literature. Three cases studies of sexual murder by adolescents are presented. These boys were evaluated clinically as well as by administration of a structured diagnostic interview (DSM-III-R version of the Diagnostic Interview for Children and Adolescents). Sexual homicide by adolescents, an infrequent and poorly understood form of violent behavior, is proposed as a valid and distinct form of juvenile murder with serious prognostic implications.

Adolescent↗
PubMed1994

Psychiatric hospitalization of children in Florida. Legal aspects.

The hospitalization of children in psychiatric hospitals and their associated rights or lack thereof remains an important issue. Much attention has been focused on children's rights in Florida, most recently with the cases of Gregory K. and Kimberly Mays. On a national level, Hillary Rodham Clinton has drawn attention to children's rights through her advocacy for children. The commitment of children to mental health facilities in Florida deserves examination. This is an important issue, not only to the psychiatrist who tests youths, but also to the family practitioner, internist, or any other referring physician who is involved in the case of the child and the family. It is imperative that the primary care physician as well as the psychiatrist know and understand the limitations and requirements for civil commitment of a child in a psychiatric setting.

Adolescent↗