Encouraging pursuit of court-ordered treatment in a state hospital.

The authors discuss a performance improvement project designed to encourage staff psychiatrists at a large state hospital to more assertively pursue the option of court-ordered treatment for severely mentally ill inpatients who refuse medication for more than a week. A campaign was undertaken in 1997 to educate psychiatrists about the importance of using psychotropic medications early in a patient's hospital stay. A monthly report is now circulated to all personnel identifying units on which patients have refused medication for more than a week and psychiatrists who have filed court petitions. The number of petitions filed annually has doubled, from 97 in the year before the project to 192 four years later.

Psychological aspects of sexual functioning among cleric and noncleric alleged sex offenders.

Cleric sexual misconduct with minors is a problem receiving increased attention from the media, victims groups, and church authorities. Mental health professionals are increasingly being asked to assist church and civil authorities to help better understand the problem of cleric sexual misconduct with minors. In the current study we compared self-reported sexual functioning among cleric alleged child molesters, noncleric alleged child molesters, and normal control subjects. We hypothesized clerics would differ from nonclerics and normals in reported sexual functioning. Our sample included 30 Roman Catholic clerics and 39 nonclerics who were alleged to have engaged in sexual misconduct with minors, and 38 normal control subjects, all of whom took the Derogatis Sexual Functioning Inventory (DSFI) as part of their forensic psychiatric evaluation. Our results indicated clerics were more likely to report fewer victims, older victims, and victims of male gender than noncleric alleged child molesters. Clerics differed from nonclerics and normal control subjects on several dimensions of self-reported sexual functioning. Lower offense rate histories among clerics suggest that, as a group, clerics may be less seriously psychologically disordered than noncleric child molesters. Low DSFI scores among Roman Catholic clerics may be accounted for in part by their unique training and socialization process. Future studies should attempt to study the influence of social desirability on DSFI scores. Normative data from nonoffending celibate clergy are needed.

Denial and social desirability in clinical evaluations of alleged sex offenders.

Clinicians are increasingly being requested to evaluate alleged sex offenders. Denial of sex offenses and minimization of psychopathology is common in such patients. We studied the relationship between denial of deviant sexual behavior and minimization/exaggeration of problems (i.e., response bias) during clinical evaluations in 59 alleged sex offenders. The data indicated that patients who denied allegations of deviant sexual behavior showed significantly more minimization of problems than did admitters (p < .001), and patients who admitted allegations showed more exaggeration of problems than did deniers (p < .05). Response bias was significantly associated with a number of personality characteristics. In particular, alleged offenders who denied deviant sexual behavior were more likely to be defensive about undesirable personality characteristics and to minimize problems than were those who admitted to deviant sexual behavior. When defensive, alleged sex offenders were likely to minimize anxiety and personality disorders. The data support the forensic utility of psychological testing in the assessment of alleged sex offenders.

Clinical evaluation of an automated cleaning device for dialyzers.

This paper describes the clinical evaluation of dialyzer efficiency after cleaning and sterilization using an automated dialyzer cleaner. In vivo clearance measurements of small molecules and an in vitro measurement of BSP showed no diminution after 5 uses, and ultrafiltration rate did not decrease with an increase in dialyzer use. Scanning and transmission electron microscopy of the membrane showed an increase in accumulation of cellular debris and fibrin with increasing use. Our experience using the automated dialyzer clearner for more than one year leads us to conclude that it is an effective way to clean dialyzers and that no patient ill-health occurs as a result of re-using dialyzers cleaned by this technique.

An automated cleaning device for dialyzers: machine design and technology.

The expansion of dialysis services and the introduction of disposable dialyzers have led to an increase in cost of hemodialysis. Many centers have attempted to reduce the cost of dialysis by using dialyzers on multiple occasions after cleaning and sterilization. Manual techniques for cleaning dialyzers are tedious, using valuable technician time and possibly leading to an increase in exposure to Hepatitis B surface antigen. These disadvantages can be avoided by the use of the automated device in this paper. We have also evaluated the dependability of the machine and the reduction in dialysis costs realized from its use.