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At least 91 records · Page 5Linked to original sources
PubMed2005

Voluntary vs. involuntary hospital admission in acute mania of bipolar disorder: results from the Swiss sample of the EMBLEM study.

BACKGROUND: Patients with acute mania in bipolar disorder require pharmacological treatment to reduce symptoms. In addition, it is recognised that admission status is a clinically relevant aspect of bipolar disorder. There is, however, a lack of published data assessing the association of admission status with clinical or functional outcomes. The European-Mania-in-Bipolar-Longitudinal-Evaluation-of-Medication (EMBLEM) study has been designed to describe outcomes associated with medication therapies. Baseline data from this study are now available and we used these data to examine the characteristics of patients with acute mania in the Swiss EMBLEM cohort who were admitted involuntary and voluntary, respectively, and their functional and clinical status. METHODS: Ninety-five patients with an acutely manic or mixed episode of bipolar disorder were included in the Swiss cohort of the study. Patients' history, psychosocial functioning, clinical measures of mania and depression, pharmacological and compliance variables were assessed. Statistical methods comprised univariate analyses of variance and logistic regression analyses to elucidate associations between variables of interest. RESULTS: Patients with involuntary hospital admission (n = 55) were more aggressive and had less insight. They had a more frequent history of substance abuse and were less likely to take anticonvulsants or lithium. Furthermore, these patients showed lower compliance, which also guided physicians' decision on pharmacotherapy. LIMITATION: The EMBLEM study had an observational and non-interventional design; therefore it was not possible to compare treatment groups by means of stringent between-group analyses. However, a main target of this study was to gather clinically relevant information on outcomes of acute mania associated with currently available medication therapies. CONCLUSIONS: Involuntary admission status was significantly associated with clinical status, especially aggression and also compliance. Admission status in bipolar patients plays a clinically important role.

Acute Disease↗
PubMed1990

Madness at the crossroads: John Home's letters from the Royal Edinburgh Asylum, 1886-87.

A detailed and critical discussion of John Home, a certified inmate of the Royal Edinburgh Asylum during 1886-87, is presented from a historical perspective which is sensitive to the respective positions of the practitioner and the patient. Particular attention is paid to the letters Home wrote during his confinement and their significance for understanding asylum life during this period. Some interpretative difficulties surrounding the use of medical records, patient letters and other related evidence are also examined.

Bipolar Disorder↗
PubMed1975

Survey of incapacity associated with mental handicap at Rampton and Moss Side Special Hospitals: a comparison with the 1970 National Survey.

The results of a survey carried out at Rampton and Moss Side Special Hospitals into physical and behavioural incapacity associated with mental handicap are described and compared with the findings of the 1970 National Survey. The Special Hospital patients were found to be less mentally handicapped than similar patients in subnormality hospitals in the National Health Service. The prevalence of physical incapacity associated with mental handicap was also lower in the Special Hospitals but the Special Hospital patients were assessed as more behaviourally disordered. In both surveys the incapacities present were concentrated in the severely mentally handicapped patients. In the Special Hospitals survey the women, when compared with the men, were found to be more behaviourally disordered and to suffer from a greater degree of multiple severe incapacity. All the differences found between the two surveys are consistent with the statutory criteria for admission to a Special Hospital.

Activities of Daily Living↗
PubMed1999

The "mad" vs. the "bad" revisited: managing predatory behavior.

Ever since the Englightenment, western democracies have maintained separate institutions for the "mad" and for the "bad." For the mad they provided protection and treatment, and for the bad, deterrence and punishment. During the past decade, however, increasing social conservatism and the apparent failure of the criminal justice system have resulted in a series of changes in social policy. In order to protect the public adequately from repeatedly violent predators, legislation has been introduced in several states that remands those predators to mental institutions on completion of their prison terms. Challenges to this legislation, based on ex post facto, double jeopardy, and civil rights considerations were effectively dismissed by the U.S. Supreme Court in Kansas v Hendricks in June, 1997. An effect, however unintended, of upholding these laws and of policy changes leading up to them, is that they have effectively blurred the separation between mad and bad. This paper details the following: 1) the events that have led to these changes in policy and law; 2) the preparations being made in New York State's mental health system to prepare for managing such predators when and if such laws are enacted; 3) the dangers and drawbacks these changes have brought in states where they have already been legislatively mandated; and 4) suggestions for alternatives that would reaffirm the separation between mad and bad.

Adult↗
PubMed1999

Psychopathy as a risk factor for violence.

As a result of Kansas v Hendricks, many sex offenders in the U.S. are likely to be civilly committed to mental institutions for indefinite periods, and many others with histories of violent offenses may also be so committed. It therefore becomes critical for mental health professionals to understand the risk factors for re-offending that put the public in jeopardy. The most reliable of these factors is psychopathy, which will here be defined, along with its differentiation from the more commonly diagnosed antisocial personality disorder. The assessment of psychopathy, its relationship to crime--especially, to violent crime, its (non-) responsiveness to the usual treatment, and an outline of a potentially more effective one, are presented. Finally, and particularly in view of its widely accepted validity, the potential for abuse of the PCL-R and :SV are noted.

Antisocial Personality Disorder↗
PubMed1997

Violent offender research and implications for the criminal justice system.

Some offenders are at very high risk to reoffend. Research conducted at the author's institution and elsewhere shows that psychopathic offenders are especially likely to be violent, that future violence can be predicted with considerable accuracy among men who have committed at least 1 violent offense, and that treatment programs to reduce dangerousness do not always have the intended effects (i.e., they may actually increase the dangerousness of some individuals). Implications for the criminal justice system pertain to release following insanity acquittal, offender sentencing and parole, preventive detention, offender treatment, and program evaluation.

Antisocial Personality Disorder↗