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.     

Influence of Family,Agency, and Caseworker Dynamics on Caregivers' Satisfaction With Their Child Protective Services Experience

Numerous child protective services (CPS) agencies have adopted differential responses as a system reform hypothesized to facilitate family engagement. This research tests a conceptual framework developed to examine dynamics between caregiver, agency, and caseworker factors that are assumed to impact caregiver engagement. Data from a randomized control study and structural equation modeling methods were used to explore the influence of these factors on caregiver satisfaction with their CPS experience. The results indicate that receipt of alternative response, caregivers' ratings of their caseworker's interaction style, and caregivers' positive emotional response influenced satisfaction with their intervention experience, while negative emotional responses did not.     

Measuring the Growth of the Nonprofit Sector: A Longitudinal Analysis

Scholars have examined the effects of various environmental factors on the nonprofit sector to elucidate the role of nonprofits in modern society. However, researchers report a paucity of information on nonprofit growth using longitudinal data, especially outside the United States. This article analyzes 40 years of political, economic, and sociodemographic data in South Korea to test theories of nonprofit growth and to determine whether the concepts and theories developed for Western societies can be successfully applied in South Korea. The results show that demand‐ and supply‐side economic theories account for variations in nonprofit growth, but the existing socioeconomic explanations fail to recognize the political influences on nonprofit development. Nonprofit organizations have emerged from social and economic necessity but have also been nurtured within a political framework.     

Affordability After Subsidies: Understanding the Trajectories of Former Assisted Housing in Florida

Each year, thousands of units are lost from the assisted rental housing inventory through deterioration and default, subsidy expiration, and market-rate conversion. While a good deal of research and data collection has focused on identifying at-risk developments, less is known about what happens to former assisted developments after they exit income and rent restrictions. This article uses a survey of former assisted properties in Florida to identify their postsubsidy trajectories—that is, as to whether developments continue as rental housing, are converted to condominiums, or leave the housing stock through vacancy and demolition; and for those that continue as rental housing, whether they continue to offer affordable rents. Using logistic regression models, the article examines the property, housing market, and neighborhood characteristics that determine these trajectories. The results show that smaller properties, those that have been out of subsidy programs longer, and those in stronger neighborhood housing markets are more likely to be converted to condominiums. Among developments that continue as rental housing, those that previously had more stringent rent restrictions, those in strong rental submarkets, and those with better transit access tend to become unaffordable compared with previous rent limits.     

Democratization and Political Change as Threats to Collective Sentiments: Testing Durkheim in Russia

Durkheim argued that acute political crises result in increased homicide rates because they pose a threat to sentiments about the collective. Though crucial to Durkheim's work on homicide, this idea remains untested. The authors took advantage of the natural experiment of the collapse of the Soviet Union to examine this hypothesis. Using data from Russian regions (N = 78) and controlling for measures of anomie and other covariates, the authors estimated the association between political change and change in homicide rates between 1991 and 2000. Results indicated that regions exhibiting less support for the Communist Party in 2000 (and thus greater change in political ideals because the Party had previously exercised complete control) were regions with greater increases in homicide rates. Thus, while democratization may be a positive development relative to the Communist juggernaut of the past, it appears that the swift political change in Russia is partially responsible for the higher rates of violence there following the collapse of the Soviet Union.