Mental Competency

Human adults attribute traits to faces readily and with high consensus. In two experiments investigating the development of face-trait inference, adults and children ages 3-12 attributed trustworthiness, dominance and competence to pairs of faces. In Experiment 1, children as young as 3-4 years made face-trait attributions converging with those of adults and 5-6 year olds were at adult levels of consistency. In Experiment 2, children aged 3 and above consistently attributed the basic "mean/nice" evaluation to faces varying not only in trustworthiness but in dominance and competence. This research suggests that the predisposition to judge others using scant facial information that appears in adult-like forms early in childhood does not require prolonged social experience.

Human adults attribute character traits to faces readily and with high consensus. In two experiments investigating the development of face-to-trait inference, adults and children ages 3 through 10 attributed trustworthiness, dominance, and competence to pairs of faces. In Experiment 1, the attributions of 3- to 4-year-olds converged with those of adults, and 5- to 6-year-olds’ attributions were at adult levels of consistency. Children ages 3 and above consistently attributed the basic mean/nice evaluation not only to faces varying in trustworthiness (Experiment 1) but also to faces varying in dominance and competence (Experiment 2). This research suggests that the predisposition to judge others using scant facial information appears in adultlike forms early in childhood and does not require prolonged social experience.

Enteral feeding (or ‘tube feeding’) is a very common inpatient intervention to maintain nutritional status where the oral route is inadequate, unsafe or inaccessible. A proportion of patients will need to continue tube feeding in the community after their admission and will require a gastrostomy tube. Although gastrostomy insertion is relatively straightforward, it is not without complications in an often frail and vulnerable group of patients and a multidisciplinary approach is necessary to ensure that the procedure is appropriate. Some patients are better managed with careful assisted hand feeding or nasogastric tubes. Particular care needs to be taken in deciding whether patients with dementia should have a gastrostomy in view of data suggesting that this group of patients have a particularly poor prognosis after the procedure. Decisions regarding the provision of enteral nutrition at the end of life or where patients are not competent to make an informed judgement are particular...

Background-Surrogates frequently are unable to predict which treatment their charges would want and also can experience significant distress as a result of making treatment decisions. A new method, the patient preference predictor (PPP), has been proposed as a possible way to supplement the process of shared decision-making to address these two concerns. The PPP predicts which treatment the patient would want based on which treatment similar patients want in similar circumstances. The present article describes the results of the first evaluation to assess whether patients support the use of a PPP. Methods-Self-administered survey of patients at a tertiary care centre. Results-Overall, 1169 respondents completed the survey (response rate=59.8%). In the event that the respondent became unable to make decisions due to a car accident, 78.9% would want the PPP to be incorporated into the process of making treatment decisions for them. In contrast, 15.2% of respondents would not want the PPP to be used for them. Respondents who endorsed the PPP cited the possibility that its use could increase the chances that they receive the treatments they prefer and/or reduce the burdens on their surrogate decision-maker. Conclusions-The majority of respondents endorsed the possibility of incorporating a PPP into the process of shared decision-making based on its potential to increase surrogates' predictive accuracy and/or reduce surrogate distress. These data provide strong patient support for further research to assess whether, in practice, the use of a PPP can increase the chances that incapacitated patients receive the treatments they prefer and reduce the burden of making decisions on their surrogates.

Surrogates frequently are unable to predict which treatment their charges would want and also can experience significant distress as a result of making treatment decisions. A new method, the patient preference predictor (PPP), has been proposed as a possible way to supplement the process of shared decision-making to address these two concerns. The PPP predicts which treatment the patient would want based on which treatment similar patients want in similar circumstances. The present article describes the results of the first evaluation to assess whether patients support the use of a PPP. Self-administered survey of patients at a tertiary care centre. Overall, 1169 respondents completed the survey (response rate=59.8%). In the event that the respondent became unable to make decisions due to a car accident, 78.9% would want the PPP to be incorporated into the process of making treatment decisions for them. In contrast, 15.2% of respondents would not want the PPP to be used for them. Re...

Driving simulation has become popular in the context of assessment of driving ability, as it provides a safe and economical method of assessing driving behaviors in comparable, controlled and repeatable driving conditions. The objective of the present paper is to provide a critical examination of issues that should be considered in the design of simulator experiments investigating driving performance in drivers with cognitive impairments. These refer mainly to methodological issues with a potential impact on the generalizability of research findings. The paper offers a focused review of studies investigating driving performance as assessed on simulators, targeting cognitive impairments which are age-related or caused by neurodegenerative disorders, including mild cognitive impairment (MCI), Alzheimer's disease (AD), Parkinson's disease (PD) and stroke. This focused review presents summaries of selected studies reporting assessments of the special populations of drivers noted above, including information on the research questions, the characteristics of the subjects, the type of simulators used (level of fidelity), the driving scenarios and tasks used, simulator outcomes, dependent measures, and the main findings, as well as further research suggestions. The paper references selected findings highlighting what they reveal about several key methodological issues: gauging task demands in relation to actual driving; how differences in cognitive ability affect performance, and how this varies for different driving tasks; issues related to scenario design, such as simulator limitations, scenario authoring and simulated driving tasks; the need to develop operational definitions and comparability; limitations that affect the generalizability of simulator studies; the simulator adaptation syndrome; the bias in performance assessment that can result when drivers have not adequately adapted to the simulator; and driving simulator validation. The issues covered would help readers recognize the many confounding variables and sources of measurement error that can flaw research of this type, and their implications for future investigations.

Legal research in Sweden has traditionally focused on a systematization of the legal rules and their practical application, while the task of studying the effects of the application of the laws has been handed over to other branches of the social sciences. In contrast, new legal theories focusing on proactive and therapeutic dimensions in law have gained increasing attention in the international arena. These approaches may be better suited for evaluating legislation governing compulsory psychiatric care. Theoretical discussions and studies of causal mechanisms underlying criminal behaviour, as well as the implementation and value of instruments for predicting behaviour, are relevant to contemporary criminological research. Criminal behaviour varies across different groups of perpetrators, and the causes can be sought in the interplay between the individual and social factors. Multi-disciplinary efforts, integrating research from forensic psychiatry, psychology, sociology, and criminology, would be beneficial in leading to a better understanding of the causes underlying criminal behaviour.

In modern medicine professional relationship between the clinician and the patient is patient-centered. Patients become actively involved in the treatment decision making process and are encouraged to express their health-related preferences. Some patients may, however, refuse a favorable risk/benefit ratio treatment. This manuscript presents three cases of refusal of treatment by mentally competent surgical patients and discusses differences in their management. Conclusion: To achieve the best medical outcome for patients who possess the Actual Understanding test of mental competence clinicians use the deliberate model of medical professional relationship. For patients demonstrating the Understanding test of mental competence and wishing to utilize their health-related preferences physicians are obliged to deploy the interpretive model of doctor-patient relationship. In mentally competent patients with an illness-induced acute psychological regression the interpretive model of doctor-patient relationship as an initial strategy and cognitive behavior therapy can be useful in modifying treatment rejecting behavior and improving medical outcome.

Objective: To investigate the understanding and expectations of defendants referred to Valkenberg Hospital for 30-day observation. Design: Defendants referred for 30 days of psychiatric assessment were surveyed by means of a semi-structured interview within 3 days of admission. Participants: One hundred consecutive referrals from the Western, Northern and Eastern Cape were considered; 88 were eventually entered into the study. Results: All defendants were generally ignorant of the reasons for referral, but had a good understanding of court procedure and wrongfulness. Mentally ill subjects differed only in their not being able to distinguish between a guilty/not guilty plea. Most did not have legal representation, did not personally request the assessment and denied guilt of the alleged offence. Conclusions: Mental illness affects triability but not necessarily criminal responsibility. Disturbingly, most defendants were without legal representation and were unaware of the purpose, implications and possible outcomes of psychiatric observation. It is imperative that the legislation governing these aspects be reviewed.

Aggressive challenging behaviour is frequently reported in adults with intellectual disability and it is often treated with antipsychotic drugs. However, no adequate evidence base for this practice exists. We compared flexible doses of haloperidol (a typical, first-generation antipsychotic drug), risperidone (an atypical, second-generation antipsychotic), and placebo, in the treatment of this behaviour. 86 non-psychotic patients presenting with aggressive challenging behaviour from ten centres in England and Wales, and one in Queensland, Australia, were randomly assigned to haloperidol (n=28), risperidone (n=29), or placebo (n=29). Clinical assessments of aggression, aberrant behaviour, quality of life, adverse drug effects, and carer uplift (positive feelings about the care of the disabled person) and burden, together with total costs, were recorded at 4, 12, and 26 weeks. The primary outcome was change in aggression after 4 weeks' treatment, which was recorded with the modifie...

The aim of the study was to provide a standardization of self-reported competences and emotional/behavioural problems in Spanish adolescents, using the Achenbach's Youth Self-Report (YSR), and to compare our results to those from other countries. The YSR was completed by 2822 adolescents aged 11-18 years, recruited from secondary schools in two regions of Spain. There were significant differences in Total behaviour problems and in most problem scales in boys and girls, scoring boys higher on externalizing syndromes, whereas girls score higher on internalizing syndromes . Males' mean scores were higher than females' scores for social competence. Age effects also showed significant differences with respect to internalizing problems, thought problems, social problems and depression. Cut-off points based on the 90th and 98th percentile developed from this sample are presented for the competences and the problem scales. To test the overall range of variations across cultures,...

Leaders of research infrastructures (RIs) in Europe who are scientists require competencies in management. RItrain has addressed this issue by identifying skills required, locating relevant courses and finding gaps, whilst establishing a Master of Management programme. We describe how one contributing microbiology RI determined the most relevant skills.

Prospective studies of intergenerational continuity in parenting quality remain scarce, with little attention given to the potential role of social competence as a mediator of continuity. This study examined social competence as a mediator in the pathway from 1st generation (G1) to 2nd generation (G2) parenting quality. A normative sample of children and their parents were assessed in childhood, and again 10 and 20 years later. Parenting quality of G1 parents was assessed at each time point with multiple informants, as was G2 social competence. G2 parenting was assessed at the 20-year follow-up for those who were parents. The mediational role of social competence in G1 to G2 parenting quality was tested via nested path analytic models, accounting for continuity and cross-domain relations. Social competence mediated the intergenerational relation of parenting quality; results were invariant across gender and ethnic minority status and were unchanged after controlling for age, IQ, socioeconomic status, rule-abiding conduct, and personality (i.e., constraint). The authors discuss results regarding developmental theories of close relationships and the potential for cascading benefits within and across generations from interventions to improve G1 parenting or G2 social competence.

In Canada, Review Boards are mandated to evaluate individuals found Not Criminally Responsible on Account of Mental Disorder (NCRMD) on an annual basis and render 1 of 3 dispositions: (a) custody, (b) conditional discharge, or (c) absolute discharge. To promote social reintegration, conditional discharge can be ordered with the condition to live in supportive housing. However, NCRMD accused face great barriers to housing access as a result of the stigma associated with the forensic label. The goal of this study was to evaluate the role of housing in the clinical and criminal trajectories of forensic patients as they reintegrate into the community. Data for this study were extracted from a national study of individuals found NCRMD in Canada (Crocker, Nicholls, Seto, Côté, et al., in press). The present study focuses on a random sample of NCRMD accused in the province of Québec, who were under a conditional discharge disposition during the study period (n = 837). Controlling for sociodemographic, clinical, and criminal variables, survival analysis showed that individuals placed in independent housing following a conditional discharge from the Review Board were 2.5 times more likely to commit a new offense, nearly 3 times more likely to commit an offense against a person, and 1.4 times more likely to be readmitted for psychiatric treatment compared with individuals residing in supportive housing. These results point to the influence housing can have on the trajectories of forensic patients, above and beyond a range of clinical, criminological, and sociodemographic factors.

In the Sydney 2000 Paralympic Games it was found that some people competing in the intellectual disabilities class in basketball did not have intellectual disabilities. This was a major, purposeful, transgression of the rules and as a result people with intellectual disabilities were disallowed from competing in future Paralympic events. This paper will describe the research and procedures which have been put in place to provide the evidence to support the re-inclusion of athletes with intellectual disabilities back into the Paralympic Games. This will include a description of the processes in place to establish initial eligibility criteria that athletes meet the definition of having an intellectual disability and also the classification procedures that then establish that the disability has an impact upon the sport. Three sports have been agreed for re-inclusion in London 2012, table tennis, athletics and swimming and the research producing the classification system for each will b...

In 1984, Louisiana joined the trend towards legislative recognition of a right to refuse medical treatment.' The need for legislative action in this area is generally acknowledged: courts have frequently requested legislative guidance to resolve issues presented by withdrawal or denial of questionable medical treatment. 2 The public shares an interest in the Copyright 1986, by Louisiana Law Review.

Background and Aims: Inflammatory bowel disease [IBD] is characterized by recurrent disease flares. The impact of psychosocial wellbeing on the occurrence of flares is unclear. In this prospective study, we aimed to evaluate the association between patient-reported psychosocial wellbeing and disease flares using continuous monitoring. Methods: Consecutive IBD patients were recruited from the myIBDcoach telemedicine study cohort. Over 12 months, participants reported on disease activity together with anxiety, depression, fatigue, perceived stress and life events every 1-3 months. Flares were defined using a combination of clinical disease activity and additional measurements. Generalized estimating equation models were used to assess associations between psychosocial wellbeing and flares over time. The influences of both the presence of psychosocial symptoms in general as well as novel psychosocial symptoms were analysed. Results: In total, 417 patients were included. Forty-nine patients [11.8%] experienced a flare during the study period. The occurrence of life events in the preceding 3 months was positively associated with flares (odds ratio [OR] = 1.81; 95% confidence interval [CI] = 1.04-3.17), while the presence of anxiety, depression, fatigue and perceived stress in general was not. However, novel perceived stress [OR = 2.92; 95% CI = 1.44-5.90] was associated with flares. Conclusions: The occurrence of life events and novel perceived stress are associated with disease flares in the next 3 months, while the presence of perceived stress in general is not. These findings underline the importance of continuous personalized monitoring of IBD patients and may contribute to the prevention of disease flares.

Background
The concept of autonomy in bioethics is subject to significant debate, with scholars describing it in contradictory terms-ranging from "fundamental" and "universal" to "blurry" and "flawed". Despite its central role in safeguarding patients' rights, informed choice, and personal integrity, the paradoxical nature of autonomy has led to conceptual fragmentation and academic disagreement.

Objectives
This study aims to reconcile autonomy with other core ethical principles—beneficence, non-maleficence, and justice—by considering it as a non-absolute principle that can be justifiably infringed upon in certain ethical circumstances. Additionally, it explores how emerging interdisciplinary approaches may refine or consolidate autonomy in bioethical discourse.

Objectives:To evaluate the performance of a one-minute screening test measured against a validated 10-minute screening test for mild cognitive impairment (MCI) in detecting CI in patients aged ≥ 65 years with two or more vascular risk factors (VRF).Methods:Patients (n=1523) aged 65 years or older without documented CI symptoms or dementia with two or more VRF participated in this study set in Canadian primary care practice. Baseline data was collected, followed by the 1-minute animal fluency (AF) test and the 10-minute Montreal Cognitive Assessment (MoCA). Physicians (n=122) completed case reports during patient interviews and reported their diagnostic impression. AF test sensitivity, specificity, and accuracy in predicting a positive MoCA was assessed.Results:Study sample mean age was 79.7 years, 55% were female, 97.6% were Caucasian and 75% had ≤ 12 years of education. The AF test and MoCA detected CI in 52 and 56 percent of the study population, respectively. The AF test demonstr...

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient's decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence of this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients' informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm.

pattern than controls. Whereas, in the link 1 the results obtained were similar to the showed by Hooker et al. (2000). The fact that the link 2 was preserved in schizophrenic suggests that could be efficacy the counterfactual therapy designed to increase or dramatize CFT oriented toward everyday social interactions. Regular practice with such CFT might produce improvement in social functioning.

Introduction: In today's world, having principle and targeted management is one of the progress and development factors of any organization. Effective use of time for each manager is the most important base for managing current affairs and controlling daily activities. The present study aimed to investigate and analyze the relationship between factors affecting time management among the senior, middle and first-line managers of the hospitals in Kermanshah in 2015. Methods: This was a cross-sectional and descriptive-analytical study conducted in 2015 in ten hospitals of Kermanshah. The study population consisted of all senior, middle and first-line managers of the studied hospitals (N=240) which were selected using census method. The required data were collected using a researcher-made pair-wise comparison questionnaire. The collected data were analyzed using the DEMATEL technique through Matlab8.1.0.604 software. The results showed that, from the studied managers' viewpoints, the variables of goal setting and prioritization of objectives and activities were certainly affecting variables and located in the cause group. Also, the variables of planning, delegation, communication management, and meetings management were affected variables and located in the effect group. Furthermore, in the hierarchy of affecting and affected variables influencing time management, goal setting and meetings management with the coordinates (1.23, 1.23) and (1.06, -1.05) were identified as the highest and lowest priorities and were considered as the most affecting and most affected variables, respectively. The results of the present study showed that among the studied variables influencing time management, goal setting was the highest priority and most affecting variable, and meetings management was the lowest priority and the most affected variable. It is recommended to increase the hospital managers' knowledge about time management and the need for accurate goal setting through providing management and time management courses, and requiring them to develop a time management plan in order to improve their time management.

The paper discusses the impact which recent advances in gene technology may have for people with intellectual disabilities. It highlights a conflict between the apparent benefits of advances in genetics for the population in general and the negative effects on persons with intellectual disabilities in particular. This conflict is illustrated in the paper through the use of examples, including the implications of a person's lack of capacity to consent to investigations and treatment; the issue of individual responsibility for antisocial behaviour when this is considered to have a genetic component; and the issue of life and death decisions about treatment in the face of a progressive, genetically determined, disorder. The authors adopt a human rights perspective to discuss these examples because it provides a richness to articulate and justify moral concerns in this area which is lacking in much of the current debate as this is dominated by the primacy of autonomy.

This article reports on a survey of forensic psychiatrists and psychologists who read two case study vignettes and assessed whether each criminal defendant was competent to stand trial, using three differently worded standards of competency: one that focused on whether the defendant's thinking was rational, a second that focused on whether the defendant's behavior was rational, and a third that did not use the word "rational." The objective was to discover whether forensic examiners would distinguish among the standards (i.e., find the defendant competent under one standard but not under another) or whether they would find the defendant competent under all standards or incompetent under all standards. In responding to both vignettes, more than three-fourths of all respondents either found the defendant competent under all three standards or incompetent under all three standards. In addition, in answering one vignette, the respondents were divided almost equally in ...

This paper presents an analysis of the applicability of a principalist approach for a global, or cross-cultural, bioethics. We focus especially on the principle of individual autonomy, a core value in ethical discourse. We echo some long-standing criticisms of other anthropologists, sociologists, and many medical ethicists, that the individualistic approach to autonomy is a Euro-American value and cannot be ethically applied in all settings. As a remedy, we have suggested an adaptation of Kleinman's Explanatory Model approach to questions of decision-making. We argue that the analysis and resolution of ethical dilemmas might also benefit from forms of pedagogy that integrate anthropological and other social science perspectives, and the incorporation of ethnographic techniques in ethical practice. We begin our discussion with a case. Mr. R is an Asian man with seriously compromised lung function. He has been hospitalized for several months and is currently on a ventilator. The ICU medical team wants to remove him from life support but the family, consisting of his wife and two daughters, has so far declined. An ethics consult is arranged to mediate between the ICU personnel and the family. The family has been in the U.S. for about six years and the wife does not speak English. An interpreter is present. A physician begins by asking the wife, through the interpreter, "Do you think your husband would want to be like this? Do you think he is happy?" He then shows an X-Ray of the patient's lungs to demonstrate the gravity of Mr. R's condition. A bilingual friend arrives. The physicians present options: place the patient on a ward with a DNR order and the understanding that he will not be moved back to the ICU; or send him home with a ventilator (although the family has already said that everyone works extensive hours and no one will be available to stay with him). Because he is not a citizen, there are no nursing homes available (in this state) for transferring a ventilator dependent patient. The family friend translates for his wife: "She is his wife, she cannot say whether he is happy. As his wife, she does not know what he would want. It is not possible for her to decide. Also, she believes that, as a Catholic, she cannot choose to withdraw him from life support. She wants him to stay in the ICU on the machine." At this point in the consult, the medical team is visibly angry, stating in English that his condition is irreversible and they need his room for someone who might live. It's an economic issue. They also comment that the family is wrong in their understanding of church policy on withdrawing life support. What can ethnographic or cultural analysis add to our understanding of this or other such cases? There are a variety of issues in this case that easily lend themselves to anthropological exposition. Mutual exploration of the following themes by ethicists and anthropologists might generate rich material to shape the resolution of this dilemma: • Patriarchal family and customary gender roles, • Individual vs family (collective) focus of decisions, • Negotiating religious interpretations, • Discussing death-how appropriate is open discussion, • Truth-telling as acceptable or not, • Issues of distributive justice-(how do and how should we respond to the reality that if this patient lived in New York or Illinois, he could, as a non-citizen, be moved to a nursing home on life support, as his family wishes?). Our fundamental objective in this discussion is to interrogate the problematic biomedical/Euro-American bias toward the individual and over-reliance on a Euro-American bioethics approach.

Psychiatrists in the UK have recently lamented the need for a code of ethics for psychiatry. There is a clear difference between a code of ethics and a code of practice (such as the non-statutory one of the UK Mental Health Act of 1983) or indeed a code of conduct. Sarkar and Adshead (2003) argue for the need to protect the patient in a world which is becoming more and more contractarian and utilitarian. Indeed the public often views psychiatrists as having to protect it from psychiatric patients and because of this the latter are put at a higher risk for detention. Codes of conduct and practice are therefore not sufficient for psychiatrists I as patients put trust in these professionals to "protect their interests when they are not well enough to protect themselves".peer-reviewe

In this article, we examine one of the most contentious and divisive issues in mental health law: the right of the involuntary patient to refuse treatment. The recognition of this right can be traced to American case law starting in mid-1970s. The passing of the Canadian Charter of Rights and Freedoms in 1982 precipitated somewhat similar developments in Canada. Many provincial Mental Health Acts have been changed to reflect this newly acknowledged right. In addition, there have been two recent court decisions in Canada, Thwaites v. Health Sciences Center and Fleming v. Reid, which reflect the impact of the Canadian Charter on this issue. The right to refuse treatment has implications for the field of psychiatry.

Dr. Gill's rehab inpatient, Joel, is a decorated former Navy Seal. By age 35, he had served around the globe for a decade. His military career ended two years later, when he suffered a spinal cord injury from two gunshot wounds to his neck. The injuries left him an incomplete quadriplegic-Joel can eat and swallow and move his arms somewhat, but he cannot use his hands; he has nerve pain and spasticity in his extremities. Three months ago, following his initial surgery and monthlong hospitalization, Joel was sent to Dr. Gill's unit. During these months, Dr. Gill has kept a close watch on Joel's depression and adaptation to his medical condition. In general, Joel's depression is in line with what any formerly able-bodied-indeed athletic-person would experience in a like situation. Joel has rejected antidepressant medication, however, and has been determined competent to do so. He is not married and did not have a romantic relationship at the time of his injury. On the occasions when some of his friends from the Seals or from college have visited, Dr. Gill has watched Joel enjoy their company and even laugh.

After adjudication by the courts that an individual is not criminally responsible for the offense committed, forensic psychiatrists/psychologists are tasked with evaluating an acquittees' ongoing risk of violence. These findings determine whether an acquittee is retained in a forensic hospital or transferred to a civil psychiatric setting or into the community. Better understanding of risk factors that affect decisions to retain or release acquittees from secure forensic facilities would increase clarity in decision-making, assist evaluators in identifying who may be successful outside of secure settings, and potentially assist in the development and implementation of targeted treatments to address risk factors before and after transfer. The current study evaluated which risk factors of the Historical-Clinical-Risk Management 20, Version 3 differentiated acquittees whom clinicians opined to have a dangerous mental disorder and required retention from those whom clinicians opined...

After adjudication by the courts that an individual is not criminally responsible for the offense committed, forensic psychiatrists/psychologists are tasked with evaluating an acquittees' ongoing risk of violence. These findings determine whether an acquittee is retained in a forensic hospital or transferred to a civil psychiatric setting or into the community. Better understanding of risk factors that affect decisions to retain or release acquittees from secure forensic facilities would increase clarity in decision-making, assist evaluators in identifying who may be successful outside of secure settings, and potentially assist in the development and implementation of targeted treatments to address risk factors before and after transfer. The current study evaluated which risk factors of the Historical-Clinical-Risk Management 20, Version 3 differentiated acquittees whom clinicians opined to have a dangerous mental disorder and required retention from those whom clinicians opined to be ready for transfer to a less secure setting. Results indicated that the Clinical and Risk Management scales predicted opinions regarding readiness for transfer, even after accounting for acts of violence in the hospital. These findings suggest clinicians are attuned to relevant and current risk factors in evaluations, rather than disproportionately focused on historical factors. Implications for practice and future research are discussed.

This longitudinal study examined internalizing behavior problems (anxiety/depression) in early adolescence in relation to adversity in early childhood and child verbal competence. We hypothesized that verbal competence would act as a protective factor in the face of early adversity, that is, high verbal IQ would predict relatively lower internalizing problems in early adolescence primarily for those children who experienced the greatest adversity. The sample was based on 191 Costa Rican children and their mothers, who were recruited in infancy from an urban community and assessed again at 5 and 11-14 years. Families were generally lower-middle to working class. A total of 165 children (94 boys) participated in the early adolescent follow-up (mean age = 12.3 years). Internalizing problems were based on maternal report (Spanish Child Behavior Checklist). Our cumulative risk index (CRI)˙of adversity in early childhood consisted of home environment quality (HOME score), socioeconomic status, maternal depressed mood (CESD), and maternal IQ. Controlling for the effects of age, gender, internalizing problems at 5 years, and verbal IQ at 5 years, there was a significant interaction between early adversity and verbal IQ at age 11-14 years in predicting internalizing problems in early adolescence. Youth with high verbal IQ had comparable levels of internalizing problems regardless of high or low adversity in early childhood. In contrast, youth with low verbal IQ received higher internalizing problem ratings if they experienced high adversity early in life. The results raise the possibility that interventions to improve verbal competence might help lower the risk of internalizing problems in the face of early adversity.

This study looks at the vocabulary used in Pakistani English fiction that has been Urduized. This study, which uses data from the one million-word Pakistani English Fiction corpus (PEF), examines the impact that the Urduized words used in Pakistani English have on their language. Numerous modifications at th 1 e level of lexicon have been made in Pakistani English as a result of Urdu's influence through code substitution. Through with the use of dynamic vocabulary rooted in Pakistani culture, the data analysis demonstrates how Pakistani English clearly reflects the influence of its home culture.The distinctive characteristic of Pakistani English is the frequent lexical usage of Urduized words in fiction. This reinforces the idea that Pakistani English is an autonomous collection that has transcended the procedure of locating and represents autonomous lingual standard of its own.

Background Consent to treatment is a cornerstone of medical ethics and law. Nevertheless, very little empirical evidence is available to inform clinicians and policymakers regarding the capacities of forensic patients with schizophrenia spectrum disorders (SSDs) to make decisions about their treatment, with the risk of clinical and legal inertia, silent coercion, stigmatization, or ill-conceived reforms. Study Design In this multinational study, we assessed and compared with treatment-related decisional capacities in forensic and non-forensic patients with SSD. 160 forensic and 139 non-forensic patients were used in Austria, Germany, Italy, Poland, and England. Their capacity to consent to treatment was assessed by means of the MacArthur Competence Assessment Tool for Treatment (MacCAT-T). Multiple generalized linear regression models were used to identify the socio-demographic and clinical variables associated with MacCAT-T scores. Study Results In total, 55 forensic (34.4%) and 58...

The aim of the research was to determine the quantitative structure of winning systems of the world's leading women players in table tennis in the years 1970-2021. The study used the Wu Huanqin game analysis method. It consists of observing the game, counting the scoring actions within the three stages or situations of a rally: serve/attack', 'return/attack', and 'stalemate phase'. In total 165 women's matches were analysed. The type and size of the ball (celluloid vs. plastic and 38 mm vs. 40 mm diameter) were factors according to which three research periods had been distinguished. With the changes of the ball used an increase in the use of subsequent actions in the so-called stalemate phase can be seen. This is probably related to slowing down the game and reducing the use of spin rotation when playing a large, plastic ball. The number of points scored directly with the serve decreases in particular periods. However, the use of side-forehand-serves and forehand-hook-serves increases over time. Service returns are dominated by backhand returns. This may be related to the greater possibilities of using disguised and diverse techniques to receive the serve (e.g. push, so called "banana" flick or "strawberry" flick, topspin). An interesting observation also was the large number of scorings with repetitive techniques in stalemate phase (e.g. repetition of topspin forehand or block backhand).

Nearly all general practitioners meet representatives of drug companies.' The drug industry spent an estimated £5000 per general practitioner promoting its products in the United Kingdom in 1985.2 Drug representatives are a crucial element in the promotion of products, and expenditure on representatives accounts for over 500/o of promotional budgets.' Information is available on the frequency and duration of meetings between general practitioners and drug companies' representatives.' I describe my meetings with representatives during one year, including the samples, gifts, and literature given to me. The study was based at my singlehanded general practice in a rural town, population 1000, in the south east of Ireland. The practice was not dispensing. For 50 of the 52 weeks between 29 August 1990 and 28 August 1991 I and two receptionists recorded details of the visits by representatives of drug companies to my surgery. We recorded each representative's name and gender, the name of the company represented, the time spent with me, the name and number of products promoted, and any samples, gifts, or literature provided. The representatives were unaware that the study was taking place. For each visit I adopted a passive role, allowing the representative to dictate its content and duration. I did not request any samples but accepted all samples and gifts that were offered. The value of the samples was calculated from the prices quoted for September 1991 in the Monthly Index of Medical Specialities. I received a total of 109 visits, a mean of 2-2 per week, from 49 representatives of 41 drug companies, a mean number of 2-7 visits per company. The visits lasted for a mean of 6-17 (range 2-16) minutes, and the sex of the representatives made no significant difference to the length of the visits (t= 1 63; df= 107; p=0-106). In each visit a mean of 3 3 (1-6) products were promoted. Data sheets were offered in 11 of the visits whereas advertising brochures were offered in 51. Two representatives offered copies of articles from peer reviewed journals. I received a gift in 64 visits: these usually displayed an advertisement for the product being promoted, and consisted of stationery, pens, diaries, calendars, or trinkets (mugs, tapes, towels, clothes brush, desk tidy, air freshener, ice scraper, and flower seeds). I was given samples of drugs in 103 of the visits and received 174 samples altogether. The table lists these samples according to the classification used in the British National Formularv. Free drug samwlples received by, a general practitioner in one year. Drugs

Background: This study was designed to explore the neuropsychological basis of competence to consent to treatment in first-episode schizophrenia by evaluating its differential and joint links with cognitive versus metacognitive performance. Methods: Twenty-one first-episode patients were assessed with the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) and a metacognitive version of the Wisconsin Card Sorting Test (WCST). In addition to the standard administration of the WCST, subjects were also asked to rate their level of confidence in the correctness of each sort (prior to getting the feedback) and to choose whether they wanted each sort to be "counted" toward their overall performance score on the test. Each "ventured" sort received a bonus of 10 cents if correct but an equal penalty if wrong. Results: Compromised capacity to consent was more strongly related to deficits at the metacognitive level than to cognitive deficits per se. Moreover, prediction of competence to consent significantly improved when adding the new, free-choice metacognitive measures to the conventional WCST measures but not the other way around. Conclusions: These preliminary results suggest that metacognition plays a fundamental role in capacity to consent, which might be at least equally important for decision-making competence as cognitive deficits per se.

To explore the doctrine of informed consent and the development of capacity in adolescents with psychiatric problems to help clinicians better reflect on the relevant ethical issues. We discuss the relevant literature and explore the role of psychiatric impairment in adolescents' ability to consent. In common law, there is no minimum age at which individuals are able to consent to medical treatment and no age below which they are unable to consent. Adolescents' right to self-determination is based on their ability to understand and appreciate the information relevant to the medical decision and on their ability to consent voluntarily and freely. There is a consensus in the literature that, around age 14 years, adolescents have the cognitive ability to understand information necessary for consent. However, there are limited empirical data regarding adolescents' ability to appreciate the information and to make a voluntary decision. Clinicians need to involve adolescents i...

This article examines the legal implications linked to recent scientific research on human consciousness. The article contends that groundbreaking revelations about consciousness expose the frailties of the criminal law's traditional dual dichotomies of conscious versus unconscious thought processes and voluntary versus involuntary acts. These binary doctrines have no valid scientific foundation and clash with other key criminal law defenses, primarily insanity. As a result, courts may adjudicate like individuals very differently based upon their (often unclear) understanding of these doctrines and the science that underlies them. This article proposes a compromise approach by recommending that the criminal law's concept of voluntariness consist of three parts: (i) voluntary acts, (ii) involuntary acts, and (iii) semi-voluntary acts. The semi-voluntary acts category, which is new, incorporates modern ideas of consciousness and also advances the law. Using some actual criminal cases, this article applies this new three-part grouping and demonstrates how it enhances a more just outcome for defendants, victims, and society.

Background and Purpose—Little is known about informed consent for tissue plasminogen activator (tPA). Our objectives were to determine how frequently informed consent is obtained when tPA is given to stroke patients in clinical practice and whether the person providing consent (patient or surrogate) was the appropriate decision-maker.Methods—This retrospective cohort included acute stroke patients given tPA in 10 Connecticut hospitals (1996–1998). Consent was defined as any documentation of discussion about risks and benefits of tPA. Patients had adequate decision-making capacity if they were alert, oriented, and without aphasia or neglect (patient was appropriate decision-maker). Patients with any of these deficits were considered to have diminished capacity (surrogate was appropriate decision-maker).Results—Among 63 patients who received tPA, 53 (84%) had informed consent documented; 16/53 (30%) gave their own consent. Among patients with adequate decision-making capacity, 5/8 (63...

claims that the argument from marginal cases is 'the central argument' behind the claim that nonhuman animals have rights. But she thinks, along with Cora Diamond, that the argument is 'obtuse'. Two different meanings could be intended here: that the argument from marginal cases is too blunt or dull to dissect the reasons why it makes sense to say that nonhuman animals have rights or that the argument from marginal cases is insensitive regarding nonrational human beings (the marginal cases of humanity). The purpose of the present article is to argue that, despite Anderson's and Diamond's nuanced and perceptive treatments of the argument from marginal cases, this argument is not obtuse in either sense of the term.

In this paper we develop a hermeneutic approach to the concept of competence. Patient competence, according to a hermeneutic approach, is not primarily a matter of being able to reason, but of being able to interpret the world and respond to it. Capacity should then not be seen as theoretical, but as practical. From the perspective of practical rationality, competence and capacity are two sides of the same coin. If a person has the capacity to understand the world and give meaning to the situation, he or she is able to make decisions, and is thus competent. People can fail in the area of practical rationality. They can feel ill at ease, uncomfortable or not at home in the situation. Under such conditions, they appear as incompetent, and urge caregivers to respond in such a way that their competence can be raised. The issue is not how to measure their incompetence, but how to help them to become more competent, that is to get a practical grip on their situation and to be able to live out their lives in such a way that they develop their identity in relations with others. From a hermeneutic point of view, assessing a patient's capacity implies focusing on the patient's way of meaning making and regarding her behavior from the perspective of practical rationality. The focus should not be on the assessment as a matter of fact, but on improving capacity. This requires allowing the patient to experience the world meaningfully and affording her, in the context of a supportive and trustful institutional environment, the possibility of developing a personal narrative where her choices are expressed verbally or non-verbally.

The notion that physicians can simply "lock people up" has contributed to much of the stigma associated with psychiatry, and this is not mitigated by pointing out-as the authors do-that physicians are acting as extensions of the state. As Dr. Robert Simon points out in his book, Psychiatry and Law for Clinicians, "…mental health professionals must understand that it is not they who make commitment decisions about patients. Commitment is a judicial decision that is made by the court or by a mental health commission. The clinician files a petition or medical certification that initiates the process of involuntary hospitalization." (Simon, 1998, p. 127, italics mine). This is not a trivial or semantic distinction. True: Most states provide for brief, emergency hospitalizations (e.g., 48-72 hours) before a judicial hearing is held, at which time it is a judge-not a psychiatrist-who determines whether sufficient grounds exist for continuing the hospitalization. But the initial petition for involuntary civil commitment, in many states, may be initiated by "…police officers, next of kin, psychiatrists, other physicians, psychologists, social workers, or With regards,

The notion that physicians can simply "lock people up" has contributed to much of the stigma associated with psychiatry, and this is not mitigated by pointing out-as the authors do-that physicians are acting as extensions of the state. As Dr. Robert Simon points out in his book, Psychiatry and Law for Clinicians, "…mental health professionals must understand that it is not they who make commitment decisions about patients. Commitment is a judicial decision that is made by the court or by a mental health commission. The clinician files a petition or medical certification that initiates the process of involuntary hospitalization." (Simon, 1998, p. 127, italics mine). This is not a trivial or semantic distinction. True: Most states provide for brief, emergency hospitalizations (e.g., 48-72 hours) before a judicial hearing is held, at which time it is a judge-not a psychiatrist-who determines whether sufficient grounds exist for continuing the hospitalization. But the initial petition for involuntary civil commitment, in many states, may be initiated by "…police officers, next of kin, psychiatrists, other physicians, psychologists, social workers, or With regards,

The British Parliament stated that health services would be covered by the Disability Discrimination Act 1995 (the act). However, when people with disabilities are at their most vulnerable, for example when in hospital or subject to medical procedures, the antidiscrimination law fails them. A review of cases indicates that when people with disabilities are subject to medical treatment, the legislative protections are allowed to vanish. Instead, medical decisions are justified on obscure notions such as "best interests", often with irreversible or even terminal results. This article examines the relevant provisions and limitations of the act, the features of notable non-treatment decisions, and the act's potential to guide future decision making. It argues that antidiscrimination legislation should be assertively applied to protect vulnerable people.