ABSTRACT
In 1976, the Tarasoff case established a new legal duty to protect third parties from a psychiatric patient's foreseeable violence. After the Tarasoff case, courts expanded the scope and role of a clinician's duty to protect, sometimes in novel ways. Later interpretations of Tarasoff began to limit significantly the situations in which a duty to protect would attach. Recent Tarasoff-type cases in which courts have rejected the clinician's duty to warn suggest that Tarasoff is declining in significance. The advent of state statutes that codify the establishment and discharge of Tarasoff duty have contributed to a further limitation of the duty to protect. Lastly, when faced with the management of dangerous patients, we advocate for a thorough, well documented assessment of risk of violence as the best means for addressing concern about potential legal liability.
Subject(s)
Duty to Warn/legislation & jurisprudence , Violence , California , Humans , Psychiatry , United StatesSubject(s)
Antisocial Personality Disorder , Commitment of Mentally Ill/legislation & jurisprudence , Criminal Law/legislation & jurisprudence , Violence/legislation & jurisprudence , Antisocial Personality Disorder/diagnosis , Antisocial Personality Disorder/history , Antisocial Personality Disorder/therapy , Commitment of Mentally Ill/history , Criminal Law/history , Ethics, Medical , History, 20th Century , Humans , Research , United KingdomABSTRACT
We have previously reported that the FAC1 protein is contained in hippocampal structures that resemble Hirano bodies. Hirano bodies are cytoplasmic inclusions containing actin filaments that are numerous in the hippocampus of many Alzheimer's disease patients. FAC1 is a developmentally regulated protein that is localized to the cytoplasm of neurons during development and is predominately a nuclear protein in adult brain. In hippocampal sections from non-demented adults. Alzheimer's disease, and dementia with Lewy bodies patients. Hirano bodies were immunolabelled with antibodies to the FAC1 protein. Confocal laser microscopy demonstrated the presence of actin in FAC1 labelled Hirano bodies, and ultrastructural analysis confirmed the presence of a lattice structure within FAC1 labelled Hirano bodies. Numerous FAC1 immunoreactive swollen dendrites were also present in the hippocampus of Alzheimer's disease and dementia with Lewy bodies patients. Within any one case the total number of FAC1 positive swollen dendrites correlated with the total number of Hirano bodies, suggesting an association between the two structures. Thus, FAC1 protein is contained in Hirano bodies and swollen dendrites in the hippocampus of patients with Alzheimer's disease and dementia with Lewy bodies.
Subject(s)
Alzheimer Disease/pathology , Hippocampus/pathology , Inclusion Bodies/chemistry , Nerve Tissue Proteins/analysis , Transcription Factors , Aged , Aged, 80 and over , Antigens, Nuclear , Dendrites/pathology , Dendrites/ultrastructure , Female , Humans , Inclusion Bodies/pathology , Inclusion Bodies/ultrastructure , Male , Microscopy, Electron , Middle Aged , Neurons/pathology , Neurons/ultrastructureABSTRACT
The incidence of nasal polyps in patients with CF in various studies varies from 6.7% to 48%. Fiberoptic rhinoscopy, a safe and minimally invasive diagnostic procedure, has the major advantage over routine physical examination of the nares because of the ability to examine the nose beyond the nasal vestibule. In examinations of both nostrils of 34 patients with CF age 4-30 years, nasal polyps were detected by rhinoscopic examination, but missed by physical examination in 17 (25%) of the nostrils. In 7% (5/64) of the nostrils in this series, rhinoscopy ruled out polyps that were reportedly identified on physician examination. This study confirms that even a careful physical examination of the nose is often inadequate to uncover significant nasal pathology such as nasal polyps.
