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This study examined predictors of initial elopement from residential care settings (RCS) in a large sample of youth receiving residential treatment in Hawai‘i (n = 1,261) and analyzed mandated reports from a subsample of elopement events (n = 300) to classify behavioral motivations of eloped youth. Given youth were nested within facilities (k = 16), a multi-level logistic regression was conducted. After controlling for other factors, youth in unlocked facilities diagnosed with disruptive behavior disorders were most likely to elope. Three major elopement motivational categories emerged: peer influence, escape from negative stimuli inside the RCS, and approach toward reinforcing stimuli outside the RCS. Each of these categories was associated with at least one youth characteristic (e.g., gender, diagnosis). Common motivational sub-categories included escape from anger- or frustration-inducing events, desire to use substances, and unspecified peer involvement. Programmatic implications are discussed. [ABSTRACT FROM PUBLISHER]

The investigation of the relationship between the sizes of the mental health population and the prison population, outlined in Penrose's Law, has received renewed interest in recent decades. The problems that arise in the course of the deinstitutionalization have repeatedly drawn attention to this issue. This article presents methodological challenges to the examination of Penrose's Law and retrospectively reviews historical data from empirical studies. A critical element of surveys is the sampling method; longitudinal studies seem appropriate here. The relationship between the numbers of psychiatric beds and the size of the prison population is inverse in most cases. However, a serious failure is that almost all of the data were collected in countries historically belonging to a Christian or Jewish cultural community. Only very limited conclusions can be drawn from these sparse and non-comprehensive data: a reduction in the number of psychiatric beds seems to be accompanied by increases in the numbers of involuntary admissions and forensic treatments and an accumulation of mentally ill persons in prisons. A kind of transinstitutionalization is currently ongoing. A pragmatic balance between academic epidemiological numbers and cultural narratives should be found in order to confirm or refute the validity of Penrose's Law. Unless comprehensive research is undertaken, it is impossible to draw any real conclusion. [ABSTRACT FROM AUTHOR]

The article examines the laws related to voting rights of persons with mental disabilities in Australia. Topics discussed include need of law governing political franchise without discrimination against persons with mental disabilities; domestic and international trends in adult guardianship and the political rights of persons with mental disabilities; and Japanese legal framework for guardianship, capacity, and voting.

Objectives - Many individuals with Alzheimer's disease (AD) experience behavioral and neuropsychiatric symptoms, which may cause caregiver distress and lead to the institutionalization of the patient. This analysis characterized behavioral symptoms and caregiver distress in trials of galantamine and their response to treatment. Materials and methods - Data were pooled from four randomized, placebo-controlled clinical trials of galantamine in patients with mild to moderate AD (three studies) or AD plus cerebrovascular disease (one study) ( n = 2177). Behavior and associated caregiver distress were assessed in each study using the Neuropsychiatric Inventory (NPI) and NPI distress (NPI-D), respectively. Results - After 5/6 months, but not after 3 months, NPI score was significantly improved with galantamine vs placebo ( P = 0.013). The benefit was particularly pronounced in patients categorized as having advanced moderate AD. At 5/6 months, there was a numerical benefit of galantamine over placebo in terms of caregiver distress; the difference was statistically significant in patients with moderate or advanced moderate AD. Conclusions - Galantamine reduces behavioral symptoms in patients with mild to moderate AD, leading to reduced caregiver burden. The reductions were greatest in patients with moderate or advanced moderate disease. [ABSTRACT FROM AUTHOR]

In the 1950s, the term ‘deprivation’ entered American psychiatric discourse. This article examines how the concept of deprivation permeated the field of mental retardation, and became an accepted theory of etiology. It focuses on sensory deprivation and cultural deprivation, and analyzes the interventions developed, based on these theories. It argues that the controversial theory of cultural deprivation derived its scientific legitimization from the theory of sensory deprivation, and was a highly politicized concept that took part in the nature—nurture debate. [ABSTRACT FROM PUBLISHER]

Abstract: In high care settings for persons with intellectual disability (ID) aggressive incidents often occur. Still little is known about factors that are associated with an increased risk for aggressive behavior in clients who are admitted to an inpatient treatment facility. In four inpatient facilities, 108 adults with mild and borderline ID and behavior problems were categorised into three aggressive incidents groups (no, mild, severe) according to their actual aggressive behavior observed for six months. The three groups were compared with regard to background and admission characteristics, psychiatric co-morbidity and emotional and behavioral problems. Results show that antisocial behaviors, behaviors indicative of a lack of impulse control, psychotic behaviors, mood related behaviors, and auto-aggressive behavior increased the likelihood of severe aggression. The three groups did not differ with regard to client and admission characteristics or psychiatric co-morbidity. Behaviors that are predictive of severe inpatient aggression in settings for adults with mild to borderline ID and behavior problems closely resemble those that are distinguished in risk assessment instruments for forensic non-disabled individuals. [Copyright &y& Elsevier]

Recent changes in psychiatric hospital care involving a reduction in the number of beds and time spent in hospital motivated the study of conditions of inpatient care on such wards. An ethnographic study of a locked, acute psychiatric ward in a department of psychiatry was performed with the aim of describing the health-care environment in such a ward. The ward admitted patients on both a voluntarily and involuntarily basis. Data were collected by means of 3.5 months of participant observations. The results showed a health-care environment that was overshadowed by control. Staff were in control but they also lacked control; they attempted to master the situation in line with organizational demands and they sometimes failed. At the same time, the staff tried to share the responsibility of caring for patients and next of kin. Patients were controlled by staff; they were the underdogs and dependent on staff for their care and the freedom to leave the ward. Patients tried to make themselves heard and reacted to the control by developing counter-strategies. What this study adds to earlier research is patients' pressure on staff and sometimes quite an open struggle for more control, which may be an expression for an unacceptable imbalance in power between patients and staff. [ABSTRACT FROM AUTHOR]

A focus group study was conducted to develop an understanding of the experiences of mothers who are trying to balance employment with caring for an adolescent with developmental disabilities. Mothers reported facing considerable difficulties balancing work and caregiving responsibilities because support services rapidly declined when their child reached adolescence. Service cuts were related to the fact that adolescents are expected to be able to care for themselves, despite the fact that for many adolescents with disabilities, this is not possible. The mothers also reported that the preponderance of the responsibility for arranging care for their children was theirs and was not shouldered by their partners. Policy implications are discussed. [ABSTRACT FROM AUTHOR]

Intensive 11-day behavioural training of an institutionalised woman with profound intellectual disability was used to teach proper eating by reducing her eating errors. The methods used included an increased number of learning opportunities, graduated guidance, the use of social reinforcement, and mild punishment through simple correction of eating errors. The treatment was faded into a maintenance phase. After the intensive training phase, the participant ceased to eat with her fingers from a plate, and her eating changed to a more tidy habit. She was also released from having her hand tied during the meals. The results were maintained during an informal follow-up 4 years later. [ABSTRACT FROM AUTHOR]

Examines the patterns in mortality among persons with mental retardation in a residential facility in Pomona, California. Prevalence of epilepsy in younger patients; Details on the mortality of subjects with Down syndrome; List of risk factors of morbidity and mortality; Brain damage mortality of clients with prenatal and perinatal causes.

Investigates from the physicians' perspective, the issues in the provision of medical care to individuals with mental retardation. Survey of a randomly selected sample of community physicians who practice a range of specialties; Responsibility for providing medical care to mental retardates; Obstacles to the provision of medical care; Measures to facilitate the clinical management of patients.

Risperidone has proven efficacy with reduced likelihood of causing extrapyramidal symptoms in the treatment of schizophrenia. Initial work suggests its utility in the management of aggression and self injury in patients with mental retardation. The use of risperidone in eight adult patients with moderate to profound mental retardation is described. Risperidone in these individuals was associated with significant reduction in aggression and self injurious behavior. Side effects were primarily those of sedation and restlessness. These cases illustrate the possible utility of risperidone in the treatment of aggression and self injury in adult patients with moderate to profound mental retardation. [ABSTRACT FROM AUTHOR]

BACKGROUND. There is a national trend to deinstitutionalize mentally retarded adults, placing them in community residential settings. As a result, community-based primary care physicians will assume responsibility for their medical care. Primary care physicians may have uncertainties regarding the medical care of this population. The purpose of this case series is to describe the medical care of a group of adults with mental retardation during their first year of community residence following deinstitutlonalization, and to provide practical advice to family physicians who care for these adults. METHODS. Medical diagnoses and medications at the time of deinstitutionalization of a series of 21 adults were abstracted from institutional records and transfer forms. Follow-up data were obtained from office medical records. RESULTS. In the first year following deinstitutionalization, each patient averaged 6.6 office visits to a family physician. Newly identified major health impairments were: chronic persistent hepatitis due to hepatitis B, acid peptic disease, gastroesophageal reflux disease, dysphagia, primary degenerative dementia, absence seizures, bronchiectasis, and idiopathic iridocyclitis. Significant changes in pharmacotherapy included consolidation of multidrug anticonvulsant regimens and discontinuance of psychotropics and laxatives. Health maintenance practices included hepatitis B immunizations, cholesterol determinations, smoking cessation counseling, and calcium supplementation. CONCLUSIONS. Newly deinstitutionalized patients require careful diagnostic and therapeutic reassessment. Family physicians assuming their care need to look for conditions common in this population, including dysphagia, seizure disorders, chronic hepatitis B, and sensory impairments. Previously neglected health maintenance practices need to be instituted. Pharmacotherapies, particularly anticonvulsants, psychotropics, and laxatives, may be amenable to dosage reduction or discontinuance. [ABSTRACT FROM AUTHOR]

Examines the community living preferences of institutionalized adults with mental retardation. Use of photographs that depicted a variety of residential characteristics; Pretraining community probes; Remedial training.

Forty-four inmates transferred to a state mental hospital from a maximum- security prison and its adjacent trusty unit were compared with a randomly selected group of thirty-seven inmates from, the same prison. Transferred inmates were found over-represented in terms of assignment to restrictive housing units, sentences of life or some form of life imprisonment, prior hospitalization in a state menial hospital, and conviction for murder. The two groups were not statistically different in terms of age, race, conduct, or prior incarcerations. Implications for planning psychological services in prisons are discussed. [ABSTRACT FROM AUTHOR]

Proponents of behavior therapies advocate expanded use of this approach based on its pragmatics and clinical successes. Critics, however, point not only to abuse in implementation, but charge that the behavioral approach is inherently unethical, especially when used with institutionalized mental patients. This article will review these arguments as well as provide an updated exploration of relevant court decisions impacting behavioral treatment in mental institutions. Suggested courses of action are then provided. [ABSTRACT FROM AUTHOR]

The article presents a guide in doing a psychological procedure in mental retardation diagnosis. A psychologist must distinguish the patient's case between mental retardation and mental deficiency. The author stressed that the examiner should structure a situation in which the retarded child can give an optimal test performance. Examination will do best in an empty room containing no distracting features. Knowing the maximum level of the child's capability is proven effective for differential diagnosis.

Examines the prevalence of institutionalism among individuals with psychiatric disability. Conduction of studies to measure the number of people who desire to remain hospitalized or who exhibit some measure of hospital attraction; Criterion description of patients that treatment teams consider institutionalized; Key elements of institutionalism.

The article focuses on the uncivilized provision of treatment for mentally ill inmates in Canada. It mentions several recommendations for improving theconditions which includes measures to reduce overcrowding, to increase capacity to treat prisoners with mental health problems and abolish the use of solitary confinement. It also states that physicians are either reluctant to provide services to patients or pay a price for services which shows a detrimental impact on the patients.

Objectives: To find out the frequency of medical conditions presented by a population of institutionalized chronic schizophrenic patients. Methods: The target population is a total of 220 schizophrenic patients, 48 men and 172 women, diagnosed following the ICD-10 criteria, institutionalized at least during 5 years in a 76,8% of the patients. The average age was of 64,64 years. Specific survey applied by the group of investigators aiming to collect socio-demographical data and the medical conditions, using the following psychometric scales: Cumulative Index of Illnesses (CII), Global Assessment Scale (GAS), and Clinical Global Impression (CGI). Statistical analysis was performed with SPSS v 15.0, including descriptive statistics and correlation analysis. Results: Diabetes was found in 15% of cases, obesity in 31,7%, overweight in 39%, high blood pressure in 24,5%, high cholesterol serum levels in 21%, high triglyceride serum levels in 8,7%. A 26% of the patients were smokers. The average number of categories at the CII scale was 4,84 and the average total score was 11,96. Conclusions: Our patients predominantly are of an advanced age, female sex, and long-term inpatients. The presence of comorbid physical illness is high. The relatively low number of smokers could be explained by the demographic characteristics of our sample. [Copyright &y& Elsevier]