The Bulletin of the American Academy of Psychiatry and the Law, 1987
Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an imp... more Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an important right to refuse treatment case, are compared with models in other jurisdictions. In sum, few cases are reviewed; in almost all reviewed, the court overrides the patients' refusal. The case raises troubling implications about due process and quality of care.
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
A set of measures assessing abilities related to legal standards for competence in the adjudicati... more A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed.
Coercion during psychiatric admissions has been a topic of debate for many years. Although there ... more Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted. This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted. Health-care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to have the most longstanding impact. Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process.
The Patient Self-Determination Act (PSDA) has been in effect since December 1, 1991. The primary ... more The Patient Self-Determination Act (PSDA) has been in effect since December 1, 1991. The primary purpose of the PSDA is to promote patient awareness of advance directives. Many psychiatrists are unaware of the PSDA and its requirements or believe that the PSDA does not apply to psychiatric facilities and patients. In this article the requirements of the PSDA are reviewed. Potential applications of advance directives in psychiatric care are discussed and problem areas are identified. It is suggested that psychiatrists take an active role in the implementation of the PSDA.
The Bulletin of the American Academy of Psychiatry and the Law, 1995
The objectives of this study were (1) to investigate whether the relationship between functional ... more The objectives of this study were (1) to investigate whether the relationship between functional decisional capacity and the resulting quality of treatment posited by the informed consent theory is found in clinical practice; and (2) to describe the range of decisional impairments found in long-term psychiatric inpatients who comply with prescribed treatment. Eighty-eight long-term, compliant, psychiatric inpatients, in two public hospitals, who were prescribed antipsychotic medications were assessed. Following a formal assessment of decisional capacity, subjects were categorized according to level of impairment, using a hierarchical scheme. All subjects were evaluated for the presence of abnormal involuntary movements. The appropriateness of treatment with antipsychotic medications was determined using accepted clinical guidelines. Patients with more serious impairments of decisional capacity were more likely to receive inappropriate treatment with antipsychotic medication; and ser...
Results of liver function tests in 42 children and adolescents treated with desipramine for up to... more Results of liver function tests in 42 children and adolescents treated with desipramine for up to 24 months were unchanged. Although tricyclic-related hepatotoxicity cannot be ruled out with a small sample, it does not appear to be a dose- or time-related phenomenon in this age group.
... Citation. Database: PsycINFO. [Journal Article]. Coercion and commitment: Understanding invol... more ... Citation. Database: PsycINFO. [Journal Article]. Coercion and commitment: Understanding involuntary mental hospital admission. ... There appears to be only a modest correlation between subjectively experienced coercion and formal legal status (voluntary vs involuntary). ...
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
Volume 13, Number 2 Developments in Mental Health Law July - December 1993 that mental health law... more Volume 13, Number 2 Developments in Mental Health Law July - December 1993 that mental health law takes into account in determining whether coercive hospitalization is justified (National Center for State Courts, 1986). For example, patients' experience of alien-ation and ...
METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania ... more METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania community hospital were interviewed within 48 hours of admission about their experience of coming to the hospital. All subjects were 17 years or older. Diagnoses were diverse, and ...
The purpose of this study was to determine what predicts patients' perceptions of coercio... more The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.
Of 31 consecutive male patients referred for evaluation of marital violence, 19 (61.3%) had histo... more Of 31 consecutive male patients referred for evaluation of marital violence, 19 (61.3%) had histories of severe head injury. Although the relationship between child abuse and head injury did not reach an acceptable level of significance, it did indicate a trend toward a positive relationship. Alcohol abuse, reported by 48.4% of the sample, was significantly associated with head injury. Confirmation of biological etiologies in marital aggression would have implications for prevention and treatment.
The Bulletin of the American Academy of Psychiatry and the Law, 1987
Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an imp... more Preliminary findings on the effects of the Massachusetts ruling in Rogers v. Commissioner, an important right to refuse treatment case, are compared with models in other jurisdictions. In sum, few cases are reviewed; in almost all reviewed, the court overrides the patients' refusal. The case raises troubling implications about due process and quality of care.
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
A set of measures assessing abilities related to legal standards for competence in the adjudicati... more A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed.
Coercion during psychiatric admissions has been a topic of debate for many years. Although there ... more Coercion during psychiatric admissions has been a topic of debate for many years. Although there has been considerable research on patients' perceptions of coercion, there has been no work on who places pressures on patients to be admitted. This article integrates interview data from interviews with patients, admitting staff and family and friends to describe the pressures brought to bear on patients to be admitted. Health-care professionals appear to be the most important source of pressures on patients, and to have the most impact on patients' perceptions of coercion. However, there are differences in type of pressure, and the pressures used by family and friends appear to have the most longstanding impact. Legal and clinical efforts to reduce the level of coercive pressures on patients need to recognize the importance of mental-health professionals, including especially those who are not legally mandated to participate in the admission process.
The Patient Self-Determination Act (PSDA) has been in effect since December 1, 1991. The primary ... more The Patient Self-Determination Act (PSDA) has been in effect since December 1, 1991. The primary purpose of the PSDA is to promote patient awareness of advance directives. Many psychiatrists are unaware of the PSDA and its requirements or believe that the PSDA does not apply to psychiatric facilities and patients. In this article the requirements of the PSDA are reviewed. Potential applications of advance directives in psychiatric care are discussed and problem areas are identified. It is suggested that psychiatrists take an active role in the implementation of the PSDA.
The Bulletin of the American Academy of Psychiatry and the Law, 1995
The objectives of this study were (1) to investigate whether the relationship between functional ... more The objectives of this study were (1) to investigate whether the relationship between functional decisional capacity and the resulting quality of treatment posited by the informed consent theory is found in clinical practice; and (2) to describe the range of decisional impairments found in long-term psychiatric inpatients who comply with prescribed treatment. Eighty-eight long-term, compliant, psychiatric inpatients, in two public hospitals, who were prescribed antipsychotic medications were assessed. Following a formal assessment of decisional capacity, subjects were categorized according to level of impairment, using a hierarchical scheme. All subjects were evaluated for the presence of abnormal involuntary movements. The appropriateness of treatment with antipsychotic medications was determined using accepted clinical guidelines. Patients with more serious impairments of decisional capacity were more likely to receive inappropriate treatment with antipsychotic medication; and ser...
Results of liver function tests in 42 children and adolescents treated with desipramine for up to... more Results of liver function tests in 42 children and adolescents treated with desipramine for up to 24 months were unchanged. Although tricyclic-related hepatotoxicity cannot be ruled out with a small sample, it does not appear to be a dose- or time-related phenomenon in this age group.
... Citation. Database: PsycINFO. [Journal Article]. Coercion and commitment: Understanding invol... more ... Citation. Database: PsycINFO. [Journal Article]. Coercion and commitment: Understanding involuntary mental hospital admission. ... There appears to be only a modest correlation between subjectively experienced coercion and formal legal status (voluntary vs involuntary). ...
APA PsycNET Our Apologies! - The following features are not available with your current Browser c... more APA PsycNET Our Apologies! - The following features are not available with your current Browser configuration. - alerts user that their session is about to expire - display, print, save, export, and email selected records - get My ...
Volume 13, Number 2 Developments in Mental Health Law July - December 1993 that mental health law... more Volume 13, Number 2 Developments in Mental Health Law July - December 1993 that mental health law takes into account in determining whether coercive hospitalization is justified (National Center for State Courts, 1986). For example, patients' experience of alien-ation and ...
METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania ... more METHODS: A sample of 157 patients admitted to a rural Virginia state hospital and a Pennsylvania community hospital were interviewed within 48 hours of admission about their experience of coming to the hospital. All subjects were 17 years or older. Diagnoses were diverse, and ...
The purpose of this study was to determine what predicts patients' perceptions of coercio... more The purpose of this study was to determine what predicts patients' perceptions of coercion surrounding admission to a psychiatric hospital. For 171 cases, the authors integrated data from interviews with patients, admitting clinicians, and other individuals involved in the patients' psychiatric admissions with data from the medical records. Using a structured set of procedures, coders determined whether or not nine coercion-related behaviors occurred around the time of admission. Correlation and regression analyses were used to describe the predictors of patients' scores on the MacArthur Perceived Coercion Scale. The use of legal force, being given orders, threats, and "a show of force" were all strongly correlated with perceived coercion. A least squares regression accounted for 43.3% of the variance in perceived coercion. The evidence also suggested that force is typically only used in conjunction with less coercive pressures. Force and negative symbolic pressures, such as threats and giving orders about admission decisions, induce perceptions of coercion in persons with mental illness. Positive symbolic pressures, such as persuasion, do not induce perceptions of coercion. Such positive pressures should be tried in order to encourage admission before force or negative pressures are used.
Of 31 consecutive male patients referred for evaluation of marital violence, 19 (61.3%) had histo... more Of 31 consecutive male patients referred for evaluation of marital violence, 19 (61.3%) had histories of severe head injury. Although the relationship between child abuse and head injury did not reach an acceptable level of significance, it did indicate a trend toward a positive relationship. Alcohol abuse, reported by 48.4% of the sample, was significantly associated with head injury. Confirmation of biological etiologies in marital aggression would have implications for prevention and treatment.
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