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PubMed1975

Is dangerousness an issue for physicians in emergency commitment?

The laws of many of the states require a physician to determine that a mentally ill individual presents a danger to others before the disturbed person can be civilly committed for involuntary treatment. The author contends that the prediction of dangerousness is not and should not be within the competence of medicine, but that physicians are competent to judge whether or not the severity of mental illness impairs a patient's competence to make an informed decision regarding treatment. The basic issue in emergency commitment is the patient's welfare, not his potential dangerousness. Dr. Alan A. Stone comments on Dr. Peszke's presentation.

Commitment of Persons with Psychiatric Disorders↗
PubMed1976

The murdered child and his killers.

The authors studied 112 cases of child homicide in New York City in 1968-1969 to identify contributing social and psychiatric factors and to determine the fate of the surviving siblings and the degree of involvement of the city's social agencies with the families. There was a pattern of long-term familial child maltreatment extending to the siblings and continuing after the murders. The victims were usually illegitimate preschoolers; the assailants, usually the mothers or their paramours, had backgrounds of assaultiveness and social deviance and killed in impulsive rage. Reports of sexual abuse of victims or of suicide or psychosis among assailants were rare. The authors present case illustrations and offer guidelines for improved prevention by psychiatrists and social workers.

Child Abuse↗
PubMed1994

Restraint and seclusion: a review of the literature.

OBJECTIVE: The author reviewed the literature published since 1972 concerning restraint and seclusion. METHOD: The review began with a computerized literature search. Further sources were located through citations from articles identified in the original search. RESULTS: The author synthesized the contents of the articles reviewed using the categories of indications and contraindications; rates of seclusion and restraint as well as demographic, clinical, and environmental factors that affect these rates; effects on patients and staff; implementation; and training. CONCLUSIONS: The literature on restraint and seclusion supports the following. 1) Seclusion and restraint are basically efficacious in preventing injury and reducing agitation. 2) It is nearly impossible to operate a program for severely symptomatic individuals without some form of seclusion or physical or mechanical restraint. 3) Restraint and seclusion have deleterious physical and psychological effects on patients and staff, and the psychiatric consumer/survivor movement has emphasized these effects. 4) Demographic and clinical factors have limited influence on rates of restraint and seclusion. 5) Local nonclinical factors, such as cultural biases, staff role perceptions, and the attitude of the hospital administration, have a greater influence on rates of restraint and seclusion. 6) Training in prediction and prevention of violence, in self-defense, and in implementation of restraint and/or seclusion is valuable in reducing rates and untoward effects. 7) Studies comparing well-defined training programs have potential usefulness.

Attitude of Health Personnel↗
PubMed2001

Gender-related differences in the characteristics of problem gamblers using a gambling helpline.

OBJECTIVE: The characteristics of male and female gamblers utilizing a gambling helpline were examined to identify gender-related differences. METHOD: The authors performed logistic regression analyses on data obtained in 1998-1999 from callers to a gambling helpline serving southern New England. RESULTS: Of the 562 phone calls used in the analyses, 349 (62.1%) were from male callers and 213 (37.9%) from female callers. Gender-related differences were observed in reported patterns of gambling, gambling-related problems, borrowing and indebtedness, legal problems, suicidality, and treatment for mental health and gambling problems. Male gamblers were more likely than female gamblers to report problems with strategic or "face-to-face" forms of gambling, e.g., blackjack or poker. Female gamblers were more likely to report problems with nonstrategic, less interpersonally interactive forms of gambling, e.g., slot machines or bingo. Female gamblers were more likely to report receiving nongambling-related mental health treatment. Male gamblers were more likely to report a drug problem or an arrest related to gambling. High rates of debt and psychiatric symptoms related to gambling, including anxiety and depression, were observed in both groups. CONCLUSIONS: Individuals with gambling disorders have gender-related differences in underlying motivations to gamble and in problems generated by excessive gambling. Different strategies may be necessary to maximize treatment efficacy for men and for women with gambling problems.

Adult↗
PubMed2003

Personality diagnoses in adolescence: DSM-IV axis II diagnoses and an empirically derived alternative.

OBJECTIVE: The study of personality pathology in adolescence is in its infancy. This article examined the applicability and limits of DSM-IV axis II personality disorder diagnoses in adolescents, assessed the validity of a method for assessing adolescent personality pathology, and began to develop an empirically grounded classification. METHOD: A total of 296 randomly selected clinicians described a patient age 14-18 in treatment for maladaptive personality patterns using axis II ratings scales and the Shedler-Westen Assessment Procedure-200 for Adolescents (SWAP-200-A), a Q-sort instrument for assessing adolescent personality pathology. After examining the nature and frequency of axis II disorders in the sample, the authors used Q-factor analysis to identify naturally occurring groupings of patients on the basis of shared personality features. RESULTS: Axis II diagnoses in adolescents resembled those in adults, although application of DSM-IV criteria appeared to overdiagnose antisocial and avoidant personality disorder in adolescents. Q analysis with the SWAP-200-A isolated five personality disorders (antisocial-psychopathic, emotionally dysregulated, avoidant-constricted, narcissistic, and histrionic) and one personality style. Patients' dimensional scores on each diagnostic prototype showed predictable associations with ratings of current axis II disorders, measures of adaptive functioning, and symptoms assessed with the Child Behavior Checklist. CONCLUSIONS: With some exceptions, personality pathology in adolescence resembles that in adults and is diagnosable in adolescents ages 14-18. Categories and criteria developed for adults may not be the optimal way of diagnosing adolescents. Data from samples of adolescents may prove useful in developing an empirically and clinically grounded classification of personality pathology in adolescents.

Adolescent↗
PubMed1975

History strikes again: two 20th-century reform ventures.

There are striking parallels between the rise and decline of the health center movement of the early decades of this century and the community mental health center movement of the sixties. Four ideas that dominated the early health center movement--district location, preventive care, community participation, and bureaucratic organization--were also important in the development of community mental health centers. Both movements initially were expressions of the reform spirit of the times and later were undermined by the shift to conservative domestic politics.

Community Health Services↗
PubMed1977

Creating a mental health consultation package for community agencies.

The author designed a consultation package for a community mental health center consultant to present to the relevant agencies and organizations in the community. The consultation package is designed to create a series of regularly scheduled voluntary group meetings that center on the discussion of a case or a particular topic. The package also includes a written agreement, an evaluation procedure, and a six- to eight-month free trial period. The steps for establishing a new consultative relationship and developing a consultation network are also outlined. By using those steps and the package, the author and his colleagues have successfully established consultation services with schools, with the welfare, probation, and police departments, and with organizations of physicians, nurses, and clergy.

Attitude of Health Personnel↗
PubMed1980

Is the least restrictive environment always the best? Sociological and semantic implications.

Considerable semantic confusion surrounds the use of the concept "least restrictive environment." Imprecise use of this and other terms in planning services for chronic mental patients has been associated with errors in logic and faculty generalization . Recent events related to out-of-hospital placement of chronic mental patients in a number of communities provide evidence of the potential dangers inherent in using these concepts imprecisely. It is unwarranted to assume that the degree of restrictiveness is determined primarily by the locus of care or to think of "least restrictive environments" as falling along a continuum. A more complex conceptual approach is needed, one that takes into account some of the numerous environmental, patient, and staff variables associated with restrictiveness.

Deinstitutionalization↗
PubMed1985

Family violence: principles of intervention and prevention.

The dispersal of clinical and research information on family violence among many subspecialties has obscured the multidimensional nature of the problem and the need for clinicians in all settings to develop a coherent approach to family violence. Through an interpretive review, the author discusses specific mental health contacts that necessitate the exploration of family violence. Failure to do so may lead to underdiagnosis of dissociative disorders and overdiagnosis of depressive disorders in victims. The author also discusses three types of interventions--verbalization, violence-prevention strategies, and advocacy and support--that are useful with victims, abusers, and other family members as well as with "battered professionals" who handle these cases, and describes a comprehensive intervention program.

Aged↗
PubMed1985

Patterns and major determinants of homicide in the United States.

Criminal homicide has increased steadily during the past two decades to account today for more than 1 percent of deaths in the United States. After providing background information on the rates and patterns of homicide in the U.S., the author uses the literature to present a twofold discussion of factors affecting the incidence of homicide: those that act as a deterrence to crime, such as punishment, and environmental and biological factors that can interact in a complex way to produce violence and murder. Examples of these latter factors include firearms, drug and alcohol abuse, genetics, race, psychiatric disorders, metabolic states, the economy, geographic region, the media, and political instability.

Alcohol Drinking↗