Forensic hospitals are responsible for both the custody and treatment of patients, including treatment that will minimize the risk of future violence to the community. This study examined factors that affected length of stay (LOS) in Maryland’s only maximum-security forensic hospital for mentally ill patients who were adjudicated not criminally responsible (NCR) for serious violent crimes. The current study focused on the combined effects of demo-graphic, legal, and clinical variables on LOS in NCR patients who had been approved for transfer to a less restrictive environment to determine what, if any, variables should be targeted for services during hospitalization. The results of the study indicated that, in addition to gender, history of employment prior to the offense was the strongest predictor of LOS. Three other variables contributed less significantly to the prediction model. These findings have pro-grammatic implications for forensic psychiatric facilities treating the seriously mentally ill.
A patient whose clinical presentation met criteria for schizophreniform disorder was ultimately found to have neurosarcoidosis, and the psychiatric symptoms responded to steroid treatment. The ongoing search for organic etiology was prompted by the presence of cognitive decline, perseveration and rare bizarre automatisms. This is virtually the first reported association between schizophreniform disorder and sarcoidosis. We reviewed the literature on neurologic involvement and psychiatric manifestations in sarcoidosis as well as the concurrence between organicity and schizophrenic psychosis. The importance of attending to all elements of the mental status examination in a patient with complex atypical findings is underscored.
In the past 10 years, there has been an impressive proliferation of information regarding the prediction of violence risk. Much of the information is devoted to describing the empirical basis of risk prediction and the various instruments available for the assessment of risk. Yet, there has been little discussion of how risk assessments can inform the therapeutic process. This article describes the application of risk assessment to clinical practice in a maximum-security forensic hospital. A brief discussion of the forensic systems issues is also included.
Drug-induced akathisia, especially antidepressant-induced akathisia, is a concern for mental health professionals of all disciplines, especially since the introduction of the so-called third-generation antidepressants such as fluoxetine. Failure to identify and treat this disorder can result in extraordinary suffering for the patient, which can in turn lead to preoccupation with the idea of suicide, specifically by jumping. The goal of this paper is to provide clinicians with an understanding of the protean presentations of this disorder along with a discussion of the current theories of etiology and pathophysiology as well as a strategy for identification and treatment.
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