Mark J. Mills

Inpatient Evaluation of Aggression in Psychiatric Patients

The authors rated violent and violence-related behavior of patients on a psychiatric intensive care unit, and found that despite the restricted environment such behavior was manifested to a considerable degree. The amount of violent behavior was significantly correlated with admission Brief Psychiatric Rating Scale ratings on measures of thought disorder and schizophrenic thinking, but not with ratings of hostility.

Alcoholism and dental management

Alcohol is widely used and abused in the United States. Because alcohol affects all parts of the body, it is important for dentists as well as all other medical practitioners to be aware of the signs of alcoholism. Some dental problems occur more frequently in alcoholic patients, and often general dental care for these patients must be modified.

Family conflict, psychopathology, and dangerous behavior by schizophrenic inpatients

Data supporting the hypothesis that history of severe discipline and parental conflict in childhood is related to current violence were obtained in a study of 100 schizophrenic inpatients. In addition to a relation between inpatient violence and degree of schizophrenic symptoms, inpatient assaults and other dangerousness measures were positively and significantly correlated with severity of parental discipline, especially involving the father, and with degree of family conflict, particularly fights between parents and others outside the home.

Consent for dental therapy in severely ill patients

Delirium, dementia, or depression is frequently seen in association with severe medical illness. Usually transient, it is precipitated by the stress of systemic illness and the medications used to treat the underlying disease. Unrecognized, it may invalidate the informed consent required for the provision of emergency dental care services.

The context of involuntary commitment on the basis of danger to others: a study of the use of the California 14-day certificate.

This study examines the application of civil commitment criteria for prolonged (14-day) involuntary hospitalization of individuals judged to be dangerous to others by reason of mental illness. The California Civil Commitment Statute (Lanterman-Petris-Short, LPS) provides for such commitment, after a 72-hour period of observation. For a sample of 71 males on an acute inpatient unit, we examined the relationship between 14-day certification by reason of dangerousness to others (DO) under the LPS and measures of prehospitalization dangerousness, prior legal status, assaultive behavior in hospital, and mental status. The 31 per cent of subjects who were certified as DO were found to have been significantly more often held initially for 72-hour observation on the DO grounds than were patients who were certified for other reasons. However, subjects in the DO group were no different from the contrast groups on ratings of assaultiveness of preadmission behavior and of violent acts while in hospital. The implications of these results for the evaluation of civil commitment proceedings are discussed.

Dental management considerations for the patient with post-traumatic stress disorder

Vietnam veterans with post-traumatic stress disorder are frequently encountered in the dental office. They are often anxious, hostile, depressed, withdrawn, or resistant to treatment. Their psychological set and relatively high incidence of alcohol and drug-related problems frequently require modification of their dental therapy. An attractive and biologically sound restoration of the orofacial structures may improve long-term rehabilitation by enhancing self-esteem and social interactions.

PARENS PATRIAE CONSIDERATIONS IN THE COMMITMENT PROCESS

Seventy-one commitment-seeking decisions made by 36 clinicians in a state-funded mental health center were studied to determine the extent to which clinicians attend to legally mandated “dangerousness” criteria in seeking commitment. A previous finding that clinicians rely largely on the dangerousness criteria was replicated. In addition, clinicians were found to be sensitive to clinical indicators of the patients need for treatment, a question which is central to the parens patriae approach to involuntary hospitalization. Further, patients who were judged to be more seriously ill or more dangerous were more likely to retract their requests for discharge. This finding suggests that the patients request for release and the psychiatrists petition for commitment together constitute an interactive, transactional process in which the clinicians and the patients views of the patients need for hospitalization influence each other.

Treating Patients Who Threaten Violence

The problem of violence in contemporary American society is both complex and compelling.1 Interpersonal violence can occur in many forms, with death due to intentional injury being the most serious, though not the most common violent crime. In 1980 the United States homicide rate reached 10.6/100,000—the highest rate recorded this century. The lifetime risk for being a victim of homicide is 1/240 for whites and 1/47 for blacks. Further, the prevalence of nonfatal assault is about 100 times greater.2