Medication noncompliance in schizophrenia: codification and update

Risk of relapse and recidivism makes the failure to take antipsychotic medication as prescribed a significant issue in forensic psychiatry. This question may arise in such contexts as the setting of bail, plea bargaining, the insanity defense, and sentencing. We have reviewed the literature on medication noncompliance in schizophrenia and present here the results, organized by topics relevant for the work of forensic mental health experts. Reported rates of noncompliance vary widely, reflecting major differences in the populations studied and the methods used as well as the complexities involved in defining noncompliant behavior. A noncompliance rate of 50 percent has been attributed globally to chronic patients, both medical and psychiatric. The tendency of significant factors to interact precludes a simple typology of noncompliance. However, environmental security and supportiveness correlate positively with adherence; whereas anxiety, paranoia, grandiosity, depression, and side effects correlate negatively. Clinicians' assessments of whether medication is being taken have proven to be unreliable. Although monitoring by chemical measurement, particularly a radioreceptor assay for urine samples, can be useful, depot injection ensures that prescribed medication is being taken. Less invasive means of promoting compliance are described; psychodynamic and ethical issues to be considered in the monitoring and promotion of compliance over extended time periods are presented. We also probe the link between medication noncompliance and behavioral relapse. The time between default and relapse is most often measured in weeks. Whether due to medication withdrawal or not, the relapse pattern of each individual tends to repeat, allowing its recognition before recidivism occurs. Restarting medication at this stage, especially with a dosage increase, is usually effective. In sum, the forensic mental health expert can now readily use a large and diverse literature to assist with a variety of significant issues.     

Political Party Trends in 1985: The continuing But Constrained Advance of the National Party

In 1985 the national party organizations continued to expandtheir spheres of activity into state and local politics. Bothparties made preparations for extensive involvement in the 1986state legislative elections. The Republican National Committeeinitiated programs to aid county party organizations, to induceDemocratic state legislators to join the GOP, and to encourageDemocratic voters to switch their party registration. The nationalDemocratic party continued to assert authority over state partiesas it engaged in the quadrennial practice of rules reform. Incontrast to the past, the 1985 reform process resulted in nosignificant rules changes and in little intra-party skirmishing.Both parties, however, were forced to recognize the limits ofnational party influence in state and local politics.     

Conceptions of National Security and American Entry into World War II

During World War II, official definitions of the requirements of United States national security were extended beyond the defense of the western hemisphere to include preventing any single power dominating Eurasia. This article challenges the commonly expressed view that this change was due to a belief that a strategy of continental defense would no longer suffice to protect the physical safety of the United States. The focus is on the period between Munich and Pearl Harbor when U.S policy moved away from the principle of non-involvement embodied in the neutrality legislation of 1935-37. The role in this process of the argument that America's own safety was dependent upon the European balance of power, particularly because of the dangers posed by the development of aviation and the possible suborning of Latin America, is critically examined. It is argued that the broader conception of America's security requirements reflected both a consciousness of the unique power of the United States to determine the outcome of the war and an implicit belief that the values and interests for which the nation should be prepared to fight extended beyond physical security.     

Legitimacy of Authority and Protest Actions in Response to Collective Disadvantages

Social Justice Research - A wealth of evidence has demonstrated that individuals’ participation in collective actions largely derives from perceived group disadvantages. In the present...     

“Sex change” in skeletal remains: Assessing how heat-induced changes interfere with sex estimation

The true impact of heat-induced changes in human bone regarding their sex estimation has not been comprehensively documented having a potentially negative impact on forensic anthropology. The objective of this paper was to evaluate how heat exposure affects sex estimation based on both morphological and metric features. The study focused in both low-to-medium intensity burns and high intensity burns. Selected sexually dimorphic features were analysed in 51 experimentally burnt skeletons from the 21st Century Identified Skeletal Collection. Bones were burnt to maximum temperatures between 450 °C and 1050 °C achieved after 75 to 257 min. Morphological methods tested in this study comprised the recommendations for hipbone features from Buikstra and Ubelaker (1994) and from Bruzek (2002). On the other hand, metric references tested here were the ones from Wasterlain (2000), Curate et al. (2016) and Gonçalves et al. (2013) focused on the humerus, femur, calcaneus and talus. Agreement was tested with Gwet’s AC1 test and was further assessed by calculating the relative amount of perfect agreements. Results demonstrated that heat-induced changes affected not only the scoring of morphological features burnt at high temperatures but also the scoring of features burnt at lower intensities. On the other hand, metric features were only considerably affected in high intensity burns, no major changes being documented for low-to-medium intensity burns. For low-to-medium intensity burns, the Bruzek and Curate et al. methods revealed a better agreement between the pre- and post-burning scores. For high intensity burns, better agreement was obtained by using the Bruzek (2002) and Gonçalves et al. (2013) methods. As expected, heat-induced warping, fracture and metric change had a major impact on the pre- and post-observations’ agreement. Contrary to what has been systematically assumed over the years, this impact is also quite substantial in bones burnt at low-to-medium burn intensities so caution is advised during the analysis of this kind of burnt skeletal material.     

Tell us how you Really Feel: Validating an Inmate Social Climate Survey

Correctional facilities have a discernible social climate, or collection of contextual properties that derive in part from the perceptions of inmates. These properties include the physical, organizational, social, and emotional characteristics of correctional institutions. Social climate directly influences the attitudes and behavior of inmates, their well-being, and prison management. The present study describes the results of an applied research project conducted in association with a government agency that audits Ohio’s prisons and youth facilities through site inspection visits and survey data. The agency’s questionnaires, as well as the procedures used to sample inmates and administer the instruments, were evaluated to determine the degree to which they accurately reflected the perceptions of inmates and the social climate of the correctional institutions. We identified several problems related to survey construction and administration. The results suggest that the surveys are at least to some degree not measuring several important dimensions of the correctional environment and the experiences of inmates as intended.