ABSTRACT
OBJECTIVE: The authors evaluated the relationship between violent behavior and decision making about hospitalization from the psychiatric emergency room. METHOD: The medical charts of 321 patients evaluated in an urban psychiatric emergency room during a 4-week period were reviewed retrospectively. Violent behavior was defined as physical attacks on persons or fear-inducing behavior before or during the evaluation in the emergency room; and its value in predicting hospitalization decisions was assessed with logistic regression analyses that also included 12 demographic, clinical, and contextual variables. RESULTS: A model predicting hospitalization decisions was developed and cross-validated. Although violent patients were more likely to be hospitalized than nonviolent patients, clinical variables such as diagnosis and overall severity of psychiatric impairment were more important than violent behavior in predicting hospitalization decisions. CONCLUSIONS: Despite legal pressures to focus on overt behaviors such as violence as a basis for liability prevention and civil commitment, clinicians in this study did not allocate inpatient resources to preventively detain persons unlikely to benefit from treatment. Rather, they hospitalized the most severely disturbed patients, with diagnoses such as schizophrenic and manic disorders for which a widely accepted therapeutic armamentarium exists. The results are consistent with clinical recommendations that in the evaluation of the violent patient, attention needs to be given to the underlying disorder, since violent behavior itself can result from diverse causes only some of which require inpatient psychiatric treatment.
Subject(s)
Emergency Services, Psychiatric , Hospitalization , Mental Disorders/psychology , Mentally Ill Persons , Patient Selection , Violence , Decision Making , Humans , Mental Disorders/therapy , Referral and ConsultationABSTRACT
Children with shunted, uncomplicated, communicating hydrocephalus were tested to determine (1) the persistence of neuropsychological impairment and (2) the relationship between neuropsychological functioning, ocular motility, and acuity abnormalities. Eighteen hydrocephalic and 18 individually age- and sex-matched controls were given a neuropsychological battery, repeated after an interval of 1 year. Hydrocephalic children were also tested at the beginning of the second year for strabismus, amblyopia and visual acuity. Their medical records were reviewed for history of ocular motility and/or acuity abnormalities. Hydrocephalic children with normal range IQ were found to have lower verbal IQ, memory, and fine motor skills compared to controls. A history of ocular motility and acuity abnormalities was associated with impaired visuospatial and verbal problem-solving skills.
Subject(s)
Cerebrospinal Fluid Shunts , Eye Movements , Hydrocephalus/surgery , Neurocognitive Disorders/diagnosis , Neuropsychological Tests , Visual Acuity , Achievement , Child , Child, Preschool , Female , Follow-Up Studies , Functional Laterality , Humans , Intelligence , Male , Mental Recall , Postoperative Complications/diagnosis , Problem Solving , Psychomotor Performance , ReadingABSTRACT
Cognitive and personality disturbances following severe closed head injury in young adults are associated with poor rehabilitation outcome. Yet systematic programmes for dealing with these disturbances have generally not appeared. The present report briefly describes the Neuropsychological Rehabilitation Program (NRP) at Presbyterian Hospital in Oklahoma City and the initial outcome data on eighteen closed head injury patients and seventeen untreated controls. Greater improvement in neuropsychological functioning occurred in the NRP patient group on selected variables, but generally the effects were modest. Emotional distress, however, substantially decreased in treated patients. Fifty percent of the NRP patients maintained productivity 75% of the time or more following rehabilitation, compared to 36% of the controls. Treatment successes showed less personality disturbances than treatment failures and better learning and memory scores post-treatment.
Subject(s)
Craniocerebral Trauma/rehabilitation , Adolescent , Adult , Craniocerebral Trauma/psychology , Employment , Female , Follow-Up Studies , Humans , Male , Personality Tests , Rehabilitation, Vocational , Wechsler ScalesABSTRACT
A neuropsychological battery was given to a CT-defined group of children shunted for uncomplicated hydrocephalus with estimated normal range IQs. When no other brain anomalies were present, verbal IQ estimates were inferior to age and sex matched controls, but still in the normal range. In the presence of average academic performance and normal range IQ, impairment of neuropsychological functioning in verbal and nonverbal memory, fine motor speed, and visuospatial problem solving was observed. Successful neurosurgical management of hydrocephalus is not necessarily equated with achieving normal neuropsychological functioning.
Subject(s)
Cerebrospinal Fluid Shunts , Hydrocephalus/surgery , Learning Disabilities/psychology , Child , Child, Preschool , Concept Formation , Dyslexia/psychology , Female , Humans , Intelligence , Male , Mental Recall , Motor Skills , Postoperative Complications/psychology , Psychological TestsABSTRACT
Hydrocephalic, letter reversal and normal children were tested with a tactile matching-to-sample task, a tachistoscopic matching-to-sample task, and a dichotic listening paradigm. For hydrocephalics, intrahemispheric as well as interhemispheric errors occurred; the partial callosal hypothesis was not supported. Letter reversal children demonstrated an interhemispheric deficit only in tactile performance.
Subject(s)
Hydrocephalus/psychology , Learning Disabilities/psychology , Child , Child, Preschool , Corpus Callosum/physiopathology , Discrimination Learning/physiology , Dominance, Cerebral/physiology , Dyslexia/psychology , Female , Humans , Male , Pattern Recognition, Visual/physiology , Speech Perception/physiology , Touch/physiologyABSTRACT
Single night sleep recordings in closed head injury patients 6 to 59 months after injury revealed less stage 1 and a greater number of awakenings compared to age matched controls. Neither the time spent in REM sleep nor the Wechsler Memory Quotient were related to complaints of decreased or absent dreaming following injury. The proportion of REM and number of awakenings, however, showed a moderate relationship to certain behavioural problems.
