Analgesia and other causes of amnesia that mimic post-traumatic amnesia (PTA): A cohort study

Objective. This study explores the possibility that a post-traumatic amnesia (PTA) like phenomenon is caused by the administration of drugs in hospital following injury and that this may be observed in patients who have not suffered a traumatic brain injury (TBI). This work also explored the possibility for an additional contribution to this phenomenon of demographic and psychological variables. Method. Sixty-three orthopaedic patients with no evidence of brain injury were recruited to a two-phase study. Medication records, demographic, and psychological data were obtained at the phase 1. At follow-up interviews (phase 2), psychological data (mood and post-traumatic stress disorder, PTSD) were again obtained and retrospective assessment of PTA using the Rivermead PTA protocol was carried out in 47 patients. Results. Thirty-eight per cent (N=18) of the total sample (N=47) reported a PTA-like phenomenon despite not having suffered TBI. A logistic regression model including the receipt of opioids, surgery, and anxiety-related variables, was significant in predicting this phenomenon (χ²=22.054, df=4, p≤.01) and accounted for up to 57.5% of variation in the data. Age, either alone or in interaction with opioid use, depression, and PTSD symptoms were not significant predictors. PTA-like phenomenon did not occur without at least one predictive factor. Conclusion. Receiving opioids, undergoing surgery, and suffering clinical levels of anxiety at an early stage following injury, can lead patients who have not suffered a TBI to report a PTA-like phenomenon at follow-up. This suggests that retrospective PTA assessment on actual brain injury patients may also be influenced by these factors.     

Gender Differences in Moral Influences on Adolescents’ Eyewitness Identification

Abstract

In this study, 232 (89 11- to 12-year-olds, 71 13- to 14-year-olds; 72 15- to 16-year-olds) students recruited from grades 6th–11th in an urban public high school participated in a study of eyewitness identification. The focus of this study was on the effects of age, gender and moral orientation on decisional bias and, as a secondary outcome, on accuracy (using signal detection analysis).The primary purpose of this and previous studies in this series is to uncover implicit moral decision-making in decisional bias. In this study the perpetrator, the bystanders and the foil were all females. Prior to completing the eyewitness identification task, participants were given instructions that emphasized either (a) fairness and crime prevention, or (b) neither. These instructions had no discernible effect on accuracy but, as in past studies, younger participants (below the age of 13) had lower decisional criteria, resulting in a higher rate of false alarms/positives. Further, those who judged the transgression as worse had a lower decisional criterion, indicating more false alarms. Females were more accurate than the males in identifying the female perpetrator and scored significantly higher on how bad they would feel if they were the victim than did the males.     

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.