Nursing management of acute psychotic episodes.

Communicating with an individual experiencing an acute psychotic episode involves skills that can be learned and refined. People experience psychosis in a variety of ways. Assessment skills and increased awareness of self are clinical skills that can be learned to improve communication and intervention with persons experiencing acute psychosis. This article defines characteristics of acute psychotic episodes with assessment parameters, initial nursing interventions, and referral sources. The authors offer a model for managing acute psychosis. This staged approach provides options for interventions based on accurate identification of the stage of psychosis.

Base-rate estimates of criminal behavior by homeless mentally ill persons in New York City.

OBJECTIVES: The study aimed to estimate the prevalence of homelessness among mentally disordered offenders entering the criminal justice and forensic mental health systems, to compare base rates of arrest for violent and nonviolent criminal charges among homeless and domiciled persons with mental illness, and to examine patterns in the categories of victims chosen by these two groups. METHODS: The authors analyzed data from structured psychiatric interviews and criminal and psychiatric records of 77 homeless defendants and 107 domiciled defendants referred for psychiatric examination by the criminal and supreme courts in Manhattan over a six-month period. RESULTS: Mentally disordered defendants had 40 times the rate of homelessness found in the general population, and 21 times the rate in the population of mentally ill persons in the city. The overall rate of criminal offenses was 35 times higher in the homeless mentally ill population than in the domiciled mentally ill population. The rate of violent crimes was 40 times higher and the rate of nonviolent crimes 27 times higher in the homeless population. Homeless defendants were significantly more likely to have been charged with victimizing strangers. CONCLUSIONS: Homeless mentally ill persons appear to be grossly overrepresented among mentally disordered defendants entering the criminal justice and forensic mental health systems and to have a higher base rate of arrest for both violent and nonviolent crimes than domiciled mentally ill persons.

Obsessional harassment and erotomania in a criminal court population.

The criminal behaviors of harassment and menacing are difficult to control, and of increasing concern to the general public and local law enforcement officials. In 1992, the New York State Legislature modified the Penal Law, responding to public fears and concerns that stalking behavior may become violent. Some persons charged with these types of offenses are suffering from psychiatric disorders. Among these disorders are those classified as Delusional Disorders. According to both DSM-III-R (1987-1993) and DSM-IV (1994), there are five specific types of Delusional Disorder: erotomanic, grandiose, jealous, persecutory and somatic. This type of disorder tends to be chronic. Forty eight cases of persons charged with harassment and menacing in the New York County Criminal and Supreme Court and referred for evaluation to the Forensic Psychiatry Clinic between January 1987 and January 1994 are reviewed. When cases of erotomania and other affectionate/amorous complaints were compared with persecutory/angry forms of harassing behavior, there was a great deal of similarity. When all harassers were compared to the Clinic population as a whole, major differences in ethnicity, age, educational level and sex were noted. Findings are presented regarding incidence, other demographic data, recidivism, violence and clinical diagnosis. The researchers conclude that erotomania does exist, however, there are other psychiatric disorders which can also be diagnosed in individuals accused of harassing and menacing behavior. From the point of view of the victim and the criminal justice system, the similarities in behavior patterns are more important than the different diagnoses.

Homeless mentally disordered defendants: competency to stand trial and mental status findings.

This study examines relationships between homelessness and findings of incompetency to stand trial in a sample of mentally disordered offenders. All 263 defendants referred for competency evaluation over a six-month period by the Criminal and Supreme Courts in Manhattan were studied. Each defendant was evaluated by two forensic psychiatrists using a structured interview protocol. After removing "false-positive" referrals, 42 percent of the mentally disordered defendants referred to this setting were found to have been homeless at the time of their instant offense, making them more than 40 times more likely to be homeless than the general population and 21 times more likely to be homeless than the rest of the city's mentally ill population. Homeless mentally disordered defendants were significantly more likely to be found incompetent to stand trial than domiciled defendants (p < .007) but also presented with significantly higher levels of psychopathology. Examination of mental status findings revealed that homeless defendants were more likely to be psychotic, including a higher incidence of formal thought disorder and ideas of reference. The relationship between homelessness and incompetency seems to be mediated by psychotic symptoms, suggesting that these defendants are not being found incompetent because they are homeless, but that homeless defendants are more likely to be psychotic and to exhibit a greater degree of psychopathology. The clinical and public policy implications of these findings are discussed.

Teaching hospitalized patients with serious, persistent mental illness.

1. Although patient teaching is an important nursing function, minimal research was found related to education of patients with schizophrenia. Teaching psychiatric patients about illness, treatment, and rehabilitation has not received the same attention in psychiatric nursing as it has in other nursing specialties. 2. Eighty percent of the patients who participated in patient education classes would recommend the program to others. Treatment teams reported that some patients asked more questions about their treatment and became more active in ward groups following the classes. 3. The use of nurses as patient educators facilitates professional nursing practice and effectively ensures that patients' general physical health and psychiatric education needs are systematically addressed.

Geriatric offenders examined at a forensic psychiatry clinic.

This descriptive research paper reports on 52 geriatric defendants accused of criminal offenses and referred for forensic psychiatric evaluation. It addresses demographic and clinical variables in that population. The authors hope that the data will assist in planning for forensic and therapeutic services for geriatric persons in the criminal justice system.

The Mariel refugee and the New York Criminal Court.

In the spring of 1980, the Mariel Boat Lift brought refugees from Communist Cuba to the shores of Florida. Most refugees came seeking political freedom, but many were sent by the Cuban Government directly from its prisons and mental institutions. Literal rejects of their own society, they arrived in this country and spent many months interned in refugee camps. As they moved out into local communities, their behavioral problems began to come to the attention of local authorities. This paper describes the "Marielitos" seen in the Forensic Psychiatry Clinic for the Criminal and Supreme Courts of New York between mid-1980 and mid-1985. It explores how their reactions to their new environment may be affected by their past psychiatric and criminal histories, their language barrier, and the stress of the emigration experience.

Mental health and corrections: towards a working partnership.

This paper describes the development of mental health services to the courts and correction facilities in the City of New York. The origins, structure, and functions of the interagency New York City Task Force on Prison Mental Health Services are explained. The Task Force's role in the development, promulgation, and implementation of the Minimum Standards for Mental Health Services in New York City Correctional Facilities are outlined. These standards, enacted by the New York City Board of Correction, are described and discussed.

The judge's view of competency evaluations. II.

Twenty trial court judges were surveyed to determine what information they considered pertinent in psychiatric examinations for competence. These judges showed a clear understanding of what they were asking for in ordering the examinations but also showed a significant tendency to use the competency exam to advise them about other issues in addition (e.g., dangerousness or the need for treatment). As a group the judges appeared to be eager for psychiatric input. Typical judges could be described as pragmatic in their views of psychiatry in the courtroom, having a relatively low level of expectation but a high degree of satisfaction with the psychiatric opinions they receive.

Women and arson: a demographic study.

This study describes women accused of setting fires in the City of New York who were evaluated between 1980 and 1983 at the Forensic Psychiatry Clinic for the New York Criminal and Supreme Courts. Consideration is given to their age, ethnicity, history of prior mental illness, abuse of controlled substances, economic status, family background, education, and employment. Their methodology, planning, and targeting for their firesetting behavior, as well as reported motivations for engaging in arson, are also considered.