Aggressive behavior in the psychiatric clinic

Self and other directed violence of male psychiatric patients have been registered. The diagnostic analysis revealed an unequivocal correlation to delusional diseases and cerebroorganic hamper. Few patients caused a high percentage of all registered aggressions. Due to limited possibilities of drug treatment, changes of organization of communication and of the socio-organisational framework are aspired for the future.     

Impossible obligations and the non-identity problem

In a common example of the non-identity problem (NIP), a person (call her Wilma) deliberately conceives a child (call her Pebbles) who she knows will have incurable blindness but a life well worth living. Although Wilma’s decision seems wrong, it is difficult to say why. This paper develops and defends a version of the “indirect strategy” for solving the NIP. This strategy rests on the idea that it is wrong to deliberately make it impossible to fulfill an obligation; consequently, it is wrong for Wilma to create Pebbles because doing so makes it impossible to fulfill her obligation to protect her child from harms like blindness. A challenge for the indirect strategy is the well-known “rights waiver problem”: Since Pebbles’s very existence depends on Wilma’s having made herself unable to fulfill an obligation to Pebbles, Pebbles is likely to waive that obligation. I address this problem by recasting the indirect strategy in terms of a non-grievance evil. I argue that deliberately making it impossible to fulfill a moral obligation manifests a defective attitude toward morality—an attitude which sees moral obligations as things to be dodged whenever they are inconvenient. Next, I argue that acting on this attitude is a wrong-making feature that is independent of any wrong that might be done to Pebbles. I conclude that Wilma’s decision remains wrong even if Pebbles waives any objection to it.

     

The absent body in psychiatric diagnosis,treatment, and research

Synthese - Discussions of psychiatric nosology focus on a few popular examples of disorders, and on the validity of diagnostic criteria. Looking at Anorexia Nervosa, an example rarely mentioned in...     

Microcomputerized clinical and research laboratories in psychiatric inpatient,settings

Microcomputers have become increasingly useful in clinical settings, performing functions ranging from test administration to composition of narrative reports. They may in the near future be involved in therapeutic procedures. Clinicians and researchers have begun to wonder whether a microcomputer can take over a wide range of functions in clinical psychiatric settings, becoming a versatile and cost-effective tool. This paper describes the development of a comprehensive system for research and clinical data management on a psychiatric inpatient unit. The core of the system is an Apple II-Plus microcomputer equipped with PASCAL, standard peripherals, and an inexpensive custom interface. The system has met the current data management needs of the unit, and its expandability allows planning of assessment-and treatment-related research.     

Foreign citizens as patients at a psychiatric clinic

On 98 hospitalizations of foreign patients admitted to psychopathic wards of the mental hospital of Karl-Marx-Stadt from 1983 to 1987 is reported. Basing upon whose course of the disease and under consideration of special literature of medicine, selected questions concerning boundary-exceeding psychiatry are discussed. The proceeding practical importance of questions regarding intercultural psychiatric problems is mentioned.     

Group rounds in a day-night therapeutic clinic for psychiatric patients

The role of the group in the day-time clinic is presented, based on a more 10 years experience with this species of round, with the respects to a biopsychosocial concept of illness, to some reactions of patients, to rehabilitation, to compliance and to mediation of information; on the importance pour the psychotherapy os psychotic patients is oriented.     

Missed post-hospitalisation clinic appointment in a psychiatric hospital in Southeast Nigeria

ABSTRACT

Patients who have been attended to at psychiatric institutions sometimes fail to keep their scheduled appointments. This study was designed to assess the extent and determinants of missed first clinic appointments among recently discharged patients with schizophrenia. A total of 311 inpatients with a diagnosis of schizophrenia were participated in the study. The diagnosis of schizophrenia was confirmed using Munich version of the Composite International Diagnostic Interview. Socio-demographic and clinical data were collected using the socio-demographic questionnaire while analysis was done using SPSS (version 16). The rate of missed first outpatient appointment was found to be 25.7%. Missed appointment was associated with male gender, state of origin outside the study site, long distance from hospital to place of abode, longer appointment duration and illness severity at discharge. The findings in this study support the need for the introduction of community psychiatric services to improve patient access to services in Nigeria.     

Role of the unquantified electroencephalography in psychiatric research

This paper outlines potential research applications of the unquantified (paper or digital) electroencephalography (EEG) in psychiatry. Three main areas are highlighted: first, the need for thorough familiarity with the unquantified EEG is emphasized, including the ability to confidently recognize all normal and abnormal activities that could influence further analysis of the record as well as artifacts that can contaminate the tracings; second, the fact that definitive studies relating EEG abnormalities to psychiatric symptomatology and clinical response are lacking; and third, the potential for EEG to be utilized as a tool to decrease the risk of invasive research studies is discussed.     

Violence risk assessment and women: predictive accuracy of the HCR-20 in a civil psychiatric sample

Research to date has not adequately demonstrated whether the HCR-20 Violence Risk Assessment Scheme (HCR-20; Webster, Douglas, Eaves, & Hart, 1997), a structured violence risk assessment measure with a robust literature supporting its validity in male samples, is a valid indicator of violence risk in women. This study utilized data from the MacArthur Study of Mental Disorder and Violence to retrospectively score an abbreviated version of HCR-20 in 827 civil psychiatric patients. HCR-20 scores and predictive accuracy of community violence were compared for men and women. Results suggested that the HCR-20 is slightly, but not significantly, better for evaluating future risk for violence in men than in women, although the magnitude of the gender differences was small and was largely limited to historical factors. The results do not indicate that the HCR-20 needs to be tailored for use in women or that it should not be used in women, but they do highlight that the HCR-20 should be used cautiously and with full awareness of its potential limitations in women.     

The place of words and numbers in psychiatric research

In recent decades, there has been widespread debate in the human and social sciences regarding the compatibility and the relative merits of quantitative and qualitative approaches in research. In psychiatry, depending on disciplines and traditions, objects of study can be represented either in words or using two types of mathematization. In the latter case, the use of mathematics in psychiatry is most often only local, as opposed to global as in the case of classical mechanics. Relationships between these objects of study can in turn be explored in three different ways: 1/ by a hermeneutic process, 2/ using statistics, the most frequent method in psychiatric research today, 3/ using equations, i.e. using mathematical relationships that are formal and deterministic. The 3 ways of representing entities (with language, locally with mathematics or globally with mathematics) and the 3 ways of expressing the relationships between entities (using hermeneutics, statistics or equations) can be combined in a cross-tabulation, and nearly all nine combinations can be described using examples. A typology of this nature may be useful in assessing which epistemological perspectives are currently dominant in a constantly evolving field such as psychiatry, and which other perspectives still need to be developed. It also contributes to undermining the overly simplistic and counterproductive beliefs that accompany the assumption of a Manichean “quantitative/qualitative” dichotomy. Systematic examination of this set of typologies could be useful in indicating new directions for future research beyond the quantitative/qualitative divide.     

The Relationship Between Self-Control,Witnessing Domestic Violence,and Subsequent Violence

The notion that violence begets violence is well accepted. Less clear are the precise factors that link together child violence and adult violence in an individual's life course. This study examines the role that self-control has in linking together exposure to violence in a child's life and subsequent violence in that individual's life. A telephone survey with 375 residents in Southeastern Virginia was conducted. Attention is given to whether those who saw their parents fight are more likely to (1) have a low self-control and (2) report having experienced violence either as an offender or a victim. Results suggest that witnessing violence is not related to self-control, and those who witnessed violence were less likely to have subsequent experiences with partner abuse. Further, we found that low self-control has a link with partner abuse. Implications for theory, policy, and future research are provided.     

The structure of informed consent in psychiatric research

The manner in which the informed consent process is structured was explored by means of intensive interviews with 17 experienced psychiatric researchers. Despite differing views on informed consent, investigators displayed a commonality of practice. Most investigators were themselves not usually involved in obtaining consents, relegating the process to lower-level assistants. They did not closely monitor the process and generally were unaware of problems that may have arisen. Most protocols called for repeat contact with patients so that a relationship would develop and information could be provided before obtaining a formal consent. The actual signing of a consent form often reflected a decision that had been made much earlier in the process. These findings have significance for both sides in the dispute over informed consent in research. Those who favor tighter controls over psychiatric research will have to consider the implications of monitoring, without destroying, a prolonged and complicated process. Those who argue for a reliance on investigators' integrity must deal with the apparent lack of involvement most investigators have in the consent process.     

Descriptive profile of sex and psychiatric diagnosis among rural and peri-urban clinic attenders in South Africa

Of 1,232 patients receiving psychiatric medication in outlying areas of South Africa more than half had diagnoses of schizophrenia. Significantly more men than women had substance-induced psychosis, while significantly more women had depressive and anxiety disorders.