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Haroon H, Wolfe N, Feizi S, Barboriak P. Assessing Two Decades of Insanity Acquittee Release from the North Carolina Forensic Program. J Am Acad Psychiatry Law 2023; 51:342-352. [PMID: 37399257 DOI: 10.29158/jaapl.230024-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/05/2023]
Abstract
Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.
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Affiliation(s)
- Haseeb Haroon
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023.
| | - Nicole Wolfe
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Sara Feizi
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
| | - Peter Barboriak
- Dr. Haroon is on the Adjunct Faculty at the Keck School of Medicine of University of Southern California, Los Angeles, CA. Dr. Wolfe is Forensic Psychiatrist, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC, and Forensic Psychiatry Fellowship Director, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Feizi is Adjunct Assistant Professor, Department of Psychiatry, University of North Carolina at Chapel Hill, Chapel Hill, NC. Dr. Barboriak was Director of Forensic Services, Division of State Operated Healthcare Facilities, North Carolina Department of Health and Human Services, Raleigh, NC; he died March 29, 2023
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Akbalık Kara M, Pınarbaşı AS, Çelik M. Peritoneal dialysis for term neonates in a neonatal intensive care unit. Pediatr Int 2022; 64:e15155. [PMID: 35616157 DOI: 10.1111/ped.15155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 01/01/2022] [Accepted: 01/28/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND This study aimed to evaluate the indications, complications, and outcomes of peritoneal dialysis (PD) in term neonates from a state hospital. METHODS The demographic, clinical, and laboratory data of 67 newborn term infants who underwent PD within the first 4 weeks of life between June 2014 and June 2019 were retrospectively analyzed. RESULTS Twenty-five patients (37.3%) were male, 42 (63.7%) were female. The mean gestational age was 38.3 ± 0.8 (range: 37-40) weeks and mean birthweight 3,100 ± 504.9 g (range: 1,800-5,000 g). The mean age of patients at the start of dialysis was 7.97 ± 8.34 days (range:1-44 days) and the mean duration for dialysis was 3 ± 5.42 days (range 1-40 days). The majority of patients who underwent PD had inborn error of metabolism (59.7%). The most common complication was dialysate leakage. Thirty-three neonates (49.2%) died during PD process because of underlying disease, 17 patients (25.4%) were referred to other centers, and 17 patients (25.4%) were discharged. There were seven acute kidney injury patients associated with hypernatremic dehydration. There were statistically significant differences between non-survivors and survivors in terms of dialysis duration, birthweight, weight at admission, requirements for mechanical ventilation, and inotrop agent, and also the renal angina index. CONCLUSIONS In our region, hypernatremic dehydration is still a one of the major cause for acute kidney injury (AKI) in newborns. In state hospitals, pediatric specialists must be present in neonatal intensive care units in order not to refer unstable patients to other centers and to provide high-quality patient care.
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Affiliation(s)
- Mehtap Akbalık Kara
- Department of Pediatric Nephrology, Gaziantep University Medical Faculty, Gaziantep, Turkey
| | - Ayşe Seda Pınarbaşı
- Department of Pediatric Nephrology, Diyarbakır Children's Hospital, Diyarbakır, Turkey
| | - Muhittin Çelik
- Department of Neonatology, Gaziantep University Medical Faculty, Gaziantep, Turkey
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Delgado D, Mitchell SM, Morgan RD, Scanlon F. Examining violence among Not Guilty by Reason of Insanity state hospital inpatients across multiple time points: the roles of criminogenic risk factors and psychiatric symptoms. CNS Spectr 2020; 25:714-22. [PMID: 31910932 DOI: 10.1017/S1092852919001809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Institutional violence in state hospitals is a public health problem that has been severely understudied. Given the personal (ie, staff and patients) and fiscal harms associated with institutional violence, more research into contributing factors for violence is needed. The overarching aim of this study then was to examine associations among psychiatric symptoms, criminal risk factors, and institutional violence. METHODS Participants were 200 male, female, and transgender forensic mental health inpatients adjudicated Not Guilty by Reason of Insanity and committed to the California Department of State Hospitals. Participants completed a psychiatric symptom measure, and measures of and associated with criminal risk. Institutional violence was recorded from file review and includes physical violence toward staff or patients for 6-months prior to and post patient participation in this study. RESULTS After adjusting for previous institutional violence, results indicated that psychiatric symptoms were not associated with follow-up institutional violence; however, criminal risk was associated with follow-up institutional violence. Unexpectedly, 2 aspects of criminal risk, antisocial cognitions and associates, were not associated with follow-up institutional violence after adjusting for previous institutional violence. Results also provided a tentative cutoff score on the Self-Appraisal Questionnaire for predicting follow-up institutional violence. CONCLUSIONS These results have important implications for treating and managing patients at risk for institutional violence, including the need to assess criminogenic risk and leverage treatments that target these risk factors as a best practice approach.
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Akıcı A, Mollahaliloğlu S, Dönertaş B, Özgülcü Ş, Alkan A, Filiz Başaran N. Patients' attitudes and knowledge about drug use: a survey in Turkish family healthcare centres and state hospitals. Turk J Med Sci 2017; 47:1472-1481. [PMID: 29151319 DOI: 10.3906/sag-1608-29] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background/aim: Irrational drug use is a common problem. This study aimed to evaluate patients' knowledge and habits concerning drug use, and compare them in terms of some sociodemographic characteristics. Materials and methods: A face-to-face questionnaire was given to outpatients from family healthcare centres (FHCs) and state hospitals (SHs) in 12 provinces in Turkey during May 2010. A total of 4470 patients (FHCs: 2209; SHs: 2261) responded to the questionnaire (response rate: 93.1%). Results: Getting prescriptions without a physical examination was common (second place in FHCs; third place in SHs); 51.0% stated that they wanted physicians to prescribe drugs that they had used before. More than half stated that antibiotics cured every illness. In addition, 55.9% reported that their relatives recommended drugs to them when they got ill; 37.1% reported that they recommended them to relatives as well. Of the survey respondents, 70.5% stated that they had stopped their medications before the recommended time. Patients' knowledge and attitudes about drug use showed significant differences in comparisons of sex, age, educational level, and social security. Conclusion: Patients' knowledge and attitudes about drugs were far from rational. To eliminate irrational use of drugs, public education about drug use is needed.
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Dardashti LJ, O'Day JA, Barsom MW, Schwartz EH, Proctor GJ. Illustrative cases to support the Cal-VAT guidelines. CNS Spectr 2015; 20:311-8. [PMID: 25817927 DOI: 10.1017/S1092852915000127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
There is increasing interest in developing more nuanced methods for managing aggression and violence in long-term psychiatric inpatient settings. However, the dearth of controlled studies has, at times, hampered presentation of viable options. Following the publication of guidelines developed in the California State Hospital forensic system, the authors present a group of 7 cases illustrating different approaches to violence management, including pharmacological, psychotherapeutic, and environmental interventions.
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