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At least 127 records · Page 7Linked to original sources
PubMed2003

Reviving Ulysses contracts.

Ulysses contracts have faced paternalism objections since they first were proposed. Since the contracts are designed to override a present request from a legally competent patient in favor of a past request made by that patient, enforcement of these contracts was argued to be unjustifiable strong paternalism. Recent legal developments and new theories of practical reasoning suggest that the discussion of Ulysses contracts should be revived. This paper argues that with a proper understanding of the future-directed planning embodied in Ulysses contracts, the charge of strong paternalism can be answered, and the enforcement of some Ulysses contracts may be justified under the rubric of weak paternalism.

Advance Directive Adherence↗
PubMed1991

The Garry David case.

A prisoner with an antisocial personality disorder had almost completed his sentence for attempted murder and there was considerable public concern over his imminent release. The article discusses the many attempts made by the Victorian Government during the past six months to detain him. A recommendation was made to change the Mental Health Act 1986 by including personality disorders as a form of "mental illness". The outcome of such advice has enormous implications for the practice of psychiatry in Victoria.

Antisocial Personality Disorder↗
PubMed1999

Insight in severe mental illness: implications for treatment decisions.

This article reviews recent research related to impaired insight in schizophrenia and its consequences for cognitive, behavioral, legal, and treatment compliance issues affecting this population. It discusses efforts to find the neurobiological basis for lack of insight and the various structures or circuits of the brain that have been implicated. In the search for a more reliable and valid measure of insight for treatment decisions, the development of various assessment instruments is summarized. Impaired insight is shown to be related to a poorer course of the illness and noncompliance with necessary treatment. The implications of these findings for treatment decisions, legal interventions, and ongoing treatment monitoring are discussed.

Adult↗
PubMed2001

Measuring risk in a high security forensic setting through the behavioural status index.

This paper reports data analysis for the Behavioural Status Index risk sub-scale. Data were collected, using a repeated measures method by primary nurses, from a sample of 503 individual patients in two high security mental health hospitals. Results are reported for descriptive statistics, and factor analysis; and differences between the independent groups of Mental Health Act 1983 classification, ward dependency and gender. Data trends are indicative of clinically interesting relationships. A distinct factorial structure emerged suggesting groupings of attentional, violent, destructive, iconic-compensatory and escapist behaviours. Results are reported to be underpinning current European studies.

Adult↗
PubMed2002

Loud and clear.

Explore the source record for details and available documents.

Antisocial Personality Disorder↗
PubMed2006

Predictive signs and indicators of aggressiveness and violence: a comparison between a group of adolescents attending an external penal area, a group of prisoners and a group of patients with borderline personality disorder.

AIM: Aggressive and violent behaviours in juveniles and young adults have become increasingly widespread. Most such behaviours have 2 common roots: lack of actual motivation and brutality. The most reliable indicators and predictive signs have been linked to structural personality features (e.g. defensive strategies, impulse control). With this cross-sectional study we wanted to determine specific indicators and predictive signs of violent and aggressive behaviours in these population segments. METHODS: We compared the structural personality features of 3 groups: one with 26 male adolescents with conduct disorder (F91.8), one with 29 male patients with borderline personality disorder (F60.31) and one with 34 male prisoners with antisocial personality disorder (F60.2). The test battery included: the ''Structured clinical interview for DSM-IV axis II disorders'' (for the recruitment of adult groups); the ''Indicators of aggressive conduct'' and the ''Profile of mood states'' (for the recruitment of the adolescent group); the ''Defense mechanisms inventory'' (DMI). RESULTS: The predominant defensive strategies and starting emotional backgrounds differed significantly among the groups. A profile of low emotional response was found to support aggressiveness, while a profile of aggressiveness and violence was associated with clinically significant impulsivity. CONCLUSIONS: Several indicators and clinical predictors of aggressiveness and violence, as well as high-risk-profiles, may be determined using these instruments.

Adolescent↗
PubMed1988

Emerging problems for staff associated with the release of potentially dangerous forensic patients.

Mental health professionals have been concerned recently about their liability for the actions of patients in their outpatient practices. The history of suits against clinicians for negligent release of inpatients extends back several decades since before the Tarasoff decision. The authors suggest that the same consumerism/victims' rights trends that resulted in Tarasoff and its progeny are likely to rebound again on forensic clinicians and that such pressures are likely to add to other political and social pressures that already complicate the treatment of forensic inpatients. They present three cases to illustrate the dilemmas involved in the release of forensic patients and argue that clinicians must bear significant responsibility for their current plight because of overstated claims of capacities to predict and treat aggressive behavior.

Adult↗
PubMed1988

Relationships between legal and clinical factors among forensic hospital patients.

Recognizing that established relationships enhance understanding and therefore improve clinical intuition and inference, the authors examined clinical and legal characteristics of a legally and clinically heterogeneous population of maximum security forensic hospital patients (n = 380). Several findings serve to substantiate outcomes of previous studies of subgroups of offenders. Some new relationships among legal and clinical variables are established. The relationship between admission legal status and Axis I diagnosis is dependent upon the Axis II diagnosis. Those admitted for competency evaluations have the lowest percentage of psychotic diagnoses and the highest IQ. Kidnapers have the highest percentage of psychotic diagnoses and there is a relationship between previous incarceration and drug treatment refusal. The authors discuss clinical implications, generalizability, and the needs for further investigation.

Adult↗
PubMed1987

The management of psychopathic offenders.

The concept of psychopathic disorders has persisted in mental health legislation despite doubts as to its validity as a diagnosis and its treatability. There is a need for careful selection of those psychopathic offenders most likely to respond to medical treatment in hospital and to admit them under the appropriate section of the Mental Health Act.

Antisocial Personality Disorder↗
PubMed1987

Lest treatment abet suicide.

Epidemiologic data have identified risk factors, such as major depressive illness and sedative/alcohol addiction, that can help the clinician detect potentially suicidal persons. Evidence of subtle differences in the pattern of suicidality in bipolar and unipolar depressive illnesses has emerged. Suicide occurs early in unipolar episodes and intensifies along with increasing agitation and worsening melancholic symptoms. In bipolar depressive episodes, suicidality becomes an issue late in the course of a single episode, and illness severity and lethality are progressively aggravated by each affective relapse. Safe, effective treatment for suicide patients is the responsibility of the individual clinician and depends on neuropsychiatric variables, proper therapy, and direct and honest communication between patient and clinician. Adamant avoidance of division of primary clinical responsibility among cooperating specialists and clinician obstinancy when dealing with third parties can help prevent suicides. Early identification of psychosis, sedativism and subtle organicity are imperative. Pharmacotherapy usually equates to the fastest acting, most effective antidepressant drug, but some patients require electroconvulsive therapy to reduce suicidality. Involvement is the essence of psychotherapy in suicide management.

Adult↗