The right to refuse treatment in Oregon: A two-year statewide experience

The right to refuse treatment seems well established for psychiatric patients. Individual states, however, have very different procedures for managing this right and for overriding the refusal. Oregon's administrative procedure for override depends on an evaluation by an independent examining psychiatrist. This article empirically examines the 432 refusals leading to override requests in three Oregon psychiatric institutions in 1983 and 1984. Treatment refusal was found to be a common occurrence in all age groups. Those who refused treatment were seriously ill, unemployed, single individuals with previous psychiatric hospitalizations. Most refused treatment because of denial of their illness or delusional thinking about medication. Most refusals were overridden following the independent psychiatrist's examination. Because of the significant cost of the override procedure to the patient and the mental health system, the authors propose a new procedure which combines parts of the current procedure with a requirement that, at the time of the civil commitment hearing, the judge makes a separate decision as to the patient's competency to make treatment decisions.     

The value of RCT evidence depends on the quality of statistical analysis

The authors examined statistical practices in 193 randomized controlled trials (RCTs) of psychological therapies published in prominent psychology and psychiatry journals during 1999-2003. Statistical significance tests were used in 99% of RCTs, 84% discussed clinical significance, but only 46% considered-even minimally-statistical power, 31% interpreted effect size and only 2% interpreted confidence intervals. In a second study, 42 respondents to an email survey of the authors of RCTs analyzed in the first study indicated they consider it very important to know the magnitude and clinical importance of the effect, in addition to whether a treatment effect exists. The present authors conclude that published RCTs focus on statistical significance tests ("Is there an effect or difference?"), and neglect other important questions: "How large is the effect?" and "Is the effect clinically important?" They advocate improved statistical reporting of RCTs especially by reporting and interpreting clinical significance, effect sizes and confidence intervals.     

Sex Role Ideology, Relationship Context, and Response to Sexual Coercion in College Females

This study examined the impacts of traditional sex role orientation and relationship context upon women’s responses to sexual coercion in a sample of 114 female undergraduates in the northwestern USA. We examined differences in the amount of time participants allowed a simulated sexually coercive situation to continue, comparing groups based upon the extent to which participants endorsed traditional feminine sex roles on the Sex Role Ideology Scale, as well as the context of the relationship in which such behaviors occurred, which was manipulated as an independent variable. Results indicated that individuals in the long-term relationship condition took significantly longer to terminate the vignette than did their peers. However, no significant effect of traditionality upon response latency was observed.     

The BPQ: a scale for the assessment of borderline personality based on DSM-IV criteria

The aim of the study was to develop a self-report measure that assesses borderline personality traits as defined by DSM-IV criteria, including separate subscales for each criterion. A sample of normal subjects from community colleges in the midwestern region of the United States was used to develop the scale. The psychometric properties of the scale were examined using an additional United States sample and student samples from England and Australia. The scale was compared with existing measures of borderline and schizotypal personality. Evidence for the internal consistency and convergent and divergent validity of the new scale is presented. The results of several analyses of variance comparing males and females in the three national groups are reported. A Principal Components Analysis of the subscales suggested either a single factor or two correlated factors. Oblique rotation yielded a structure that distinguished identity/interpersonal and impulsivity borderline personality traits. It is concluded that the new scale provides a useful tool for clinicians and researchers interested in screening for borderline personality traits in both general and clinical populations. Suggestions for further research are indicated.     

Recognizing the un-real McCoy: priming and the modularity of face recognition

Fodor (1983) has proposed that face perception is carried out by an informationally encapsulated module, whose operation is unaffected by context or expectancies. We tested the modularity hypothesis by examining whether discriminations between normal and distorted versions of famous faces can be primed, either by the name of an associated person (semantic context) or by a valid cue as to the identity of the target face (expectancy). A preliminary experiment showed that, in the absence of priming, discriminations between normal and distorted versions of a face were unaffected by whether the target faces were familiar or not, confirming that these judgments tap perceptual, not postperceptual (semantic), coding processes. In Experiment 1, accuracy was significantly higher when target face pairs were preceded by related name primes, as compared with unrelated ones. In Experiment 2, reaction times were significantly faster for targets preceded by a valid identity cue than for targets preceded by an invalid one. Neither effect could be explained as a speed—accuracy tradeoff. These results fail to support Fodor’s conjecture that face processing is encapsulated.     

Abused Conservative Christian Wives: Treatment Considerations for Practitioners

Through narrative, the authors explore the faith‐based challenges of a physically and emotionally abused Conservative Christian wife to illustrate her ideological assessment of agency in a violent marriage and her concerns about the religious consequences of escape. To offset religious teachings that obstruct the safety and self‐assertion of abused Conservative Christian wives, the authors offer practitioners practical, idiomatic recommendations through which clients can reassess the limitations of common religious schemas, including conceptions of wifely submission, marital permanence, infinite forgiveness, and pious suffering. The religious community's responses to abused wives, particularly those of the clergy, are also discussed.     

Special Treatment? Flexibilities in the Politics of Regenerative Medicine’s Gatekeeping Regimes in the UK

ABSTRACT

Emerging flexibilities are apparent in gatekeeping regimes applicable to regenerative medicine products, raising issues about the extent to which and forms in which such flexibilities might promote emerging products as a sector warranting special treatment, in the context of recent policy developments in the UK and wider European Union. Concepts of ‘gatekeeping’, ‘gatekeeping regimes’ and ‘gateways’ can point to the ways in which regulatory institutions, health technology assessment organisations, and national planners and purchasers of health services together define and control entry to the medical product marketplace and the adoption of products into the public health-care system. Flexibilities in existing regimes and new gateways are a way of maintaining ‘connection’ between gatekeeping regimes and technoscientific innovation in order to steer innovation pathways. The gateways concept has affinity with that of Callon’s ‘obligatory passage points’. A wide set of recent policy documents show that the measures promoted exhibit a range of alternative gateways that are being constructed around central, legal, restrictive gatekeeping regimes. However, it would be easy to overestimate the significance of these developments as relaxations that would favour innovative producers and their products on a large scale with wide public health impacts. The concepts of gatekeeping regimes and gateways enable understanding of hybrid developments of exceptions and exemptions to dominant regimes which bridge across the arenas of market regulation, health technology assessment and health-care system planning. These arenas are being drawn closer together as a means of politically managing stakeholders’ aims in the UK, EU and other innovating biomedical health systems globally.