Inpatient Standards of Care and the Suicidal Patient. Part I: General Clinical Formulations and Legal Considerations

The most common legal action involving psychiatric care is the failure to reasonably protect patients from harming themselves. In this regard it is critical to understand that courts have tended to impose much stricter standards on inpatient than on outpatient care; that at the present time, most malpractice actions involve clinical activities related to inpatient care (negligent admission, treatment, supervision, discharge, etc.). This article reviews the current climate in the legal and clinical formulation of standards of care for hospitalized adult suicidal patients. It suggests general guidelines for effective assessment, management, and treatment procedures that balance the need for high-quality care by a reasonable and prudent practitioner with the requirements of court-determined and statutory standards. The authors specifically discuss court cases that show common failure situations in inpatient care, discharge planning, and follow-up (e.g., problems in pharmacotherapy, the decision to hospitalize, the assessment of imminence and lethality, etc.). The paper also emphasizes the crucial element of clinical judgment in developing any inpatient standard of care.     

THE FEMALE ROLE AND MENSTRUAL DISTRESS

Numerous studies of either sex role behavior (masculinity/femininity) or women's role attitudes (contemporary/traditional) as related to menstrual distress have amassed inconsistent and contradictory results. It was proposed that these two role variables may hold an interactive relationship with menstrual distress, and their study in isolation may have provoked less reliable results. An interaction was found with masculine women preferring a contemporary role and feminine women committed to traditional role values reporting greater menstrual and premenstrual distress. Feminine Contemporary and masculine traditional women revealed less distress ássociated with the menstrual cycle.