Compulsory treatment with clozapine: a retrospective long-term cohort study

BACKGROUND: Clozapine is the gold standard in treatment of treatment-resistant psychotic patients. We know little about the effects of compulsory treatment in patients unwilling to accept the necessary treatment. AIMS: To assess the effectiveness, tolerability and safety of compulsory treatment with clozapine (CTC). METHOD: A cohort of 17 consecutive patients given compulsory treatment with clozapine were rated retrospectively by their treating psychiatrists on the basis of their case notes. RESULTS: CGI-S decreased significantly over time until last observation after a mean of more than 15 months. No patient deteriorated as measured by CGI-I. At last observation as many as ten of the 11 patients still on clozapine were classified as much to very much improved. The degree of custodial restriction at last observation showed improvement in 11 patients and no change in six. No serious adverse events were observed. CONCLUSION: A trial of compulsory treatment with clozapine showed this treatment to be feasible, effective, safe and well tolerated.     

The Relationship between Homelessness and Behavior Problems among Youth in North Texas: a Brief Report

This study sought to examine the relationship between homelessness and behavior problems among a community-based sample of youth in North Texas. Data were obtained from a cross-sectional, probability sample of households and a targeted sample of homeless families in Dallas, Texas, with children older than 5 years old (N?=?5232). Parents were asked to report five behavior problems on behalf of their children including arrest or trouble with police, academic problems, behavior problems at school, suspension, and suicide attempts. Logistic and negative binomial regression procedures were used to examine the relationship between homelessness and behavior problems. Youth exposed to homelessness were 36% (OR?=?1.63; 95% CI 1.00–1.85) more likely to exhibit any kind of behavior problems than youth who had never experienced homelessness. Homeless youth had 5.51 times the odds of arrest (95% CI 2.60–11.68), 1.74 times the odds of academic problems (95% CI 1.24–2.43), and more than 3 times the odds of suicide attempts (95% CI 1.46, 7.61) than youth who had never been homeless. Homelessness was associated with higher rates of problem behavior, including arrests, academic problems, and suicide attempts. Because homeless youth are commonly enrolled in school and present at health care clinics and emergency departments, clinics and schools may aid in the identification of homeless youth, as well as referral to care. In this way, clinicians may help reduce the burden of behavioral problems that disproportionately affect homeless youth.     

Legislator Turnout and the Calculus of Voting: The Determinants of Abstention in the U.S. Congress

The belief that turnout and abstention depend on theinteraction of the benefits and costs of voting is oneof the longest held in public choice. The interplaybetween benefits and costs has typically been studiedwithin the context of voter turnout in elections, butthese results are confounded by the fact thatparticipation in such elections is a low-cost, low-benefit activity. Analysis of voting in legislatures,where the potential returns and costs to participantsare greater, is more promising. This paper examines participation on roll calls in theU.S. House of Representatives during the recent 104thCongress (1995–1996). We analyze all contested rollcalls during this two-year period, using a negativebinomial count model that accounts for legislatorheterogeneity, to determine what factors associatedwith such votes induce turnout. Our results suggestthat, while turnout is predictable, its primaryexplanation does not lie with our standard calculationof expected benefits. We find that the ideologicalpolarization of the roll call alternatives is not avery important factor for turnout and, even morestrikingly and contrary to what past analysis hasimplied, the likelihood of any given legislator beingpivotal is completely irrelevant. Rather, what is mostimportant is that a non-trivial number of members ofCongress decide not to vote when contextual factorsforce them to choose between electioneering andlegislating. Consequently, while our results are notsufficient to induce a full-fledged ``paradox ofcongressional voting'' analogous to that of massvoting, they do indicate that participation inCongress depends most heavily on factors beyond adesire to affect the outcome.     

Building capacity in indigenous governance: Comparing the Australian and American experiences

This paper compares key aspects of governance structures for Indigenous populations in the United States and Australia. The paper focuses on policy coordination and administration, in particular the nodes of decision-making in the two countries in relation to government contracting and accountability. The U.S. approach to funding Indigenous organizations stems from the 1975 Indian Self-Determination and Education Act and its subsequent expansions. Through the development of contracting into permanent compacting via block grants, this approach builds established nodes of Indigenous government and facilitates whole-of-government coherence at the level of the American Indian tribe. The U.S. approach seems correlated with better performance and may lighten bureaucratic loads over the long term. The Australian model, on the other hand, seeks to create whole-of-government coherence through top-down financial accountability in a way that hampers the development of Indigenous political capacity. The paper traces the development of these practices through time and illustrates how they contribute to the fragmentation rather than growth of Indigenous political capacities. It suggests ways the Australian model could be improved even in the absence of fundamental reform by drawing on the contracting-to-compacting framework of longstanding U.S. practices.     

Violent Victimization and Perpetration During Adolescence: Developmental Stage Dependent Ecological Models

Using a variant of the ecological-transactional model and developmental theories of delinquency on a nationally representative sample of adolescents, the current study explored the ecological predictors of violent victimization, perpetration, and both for three different developmental stages during adolescence. We examined the relative influence of individual and family characteristics, peers, and neighborhood characteristics on the odds of experiencing violent victimization and perpetration over time with two waves of the National Longitudinal Study of Adolescent Health for those adolescents who reported no exposure to violence at Wave 1 (N = 8,267; 50% female; 59% Caucasian; 17% African-American; 14% Hispanic). We found that more proximal factors differentiated between different experiences with violence at Wave 2. Also, negative peers significantly differentiated between violent victimization and perpetration, and this influence was strongest in early adolescence. In exploratory analyses, we found that middle adolescents were particularly vulnerable to their disadvantaged neighborhoods for a high-risk group. This analysis is one of the few that considers multiple ecological contexts simultaneously and provides support for developmental differences within adolescence on the influence that peers and neighborhoods have in predicting violent victimization and perpetration.     

Experimentation at the interface of science and policy: a multi-case analysis of how policy experiments influence political decision-makers

For decades now, scholars have grappled with questions about how knowledge producers can enhance the influence of their knowledge on users and improve policy making. However, little attention has been paid to how policy experiments, a flexible and ex ante method of policy appraisal, obtain influence over political decision-making. To address this gap, an exploratory framework has been developed that facilitates systematic analysis of multiple experiments, allowing hypotheses to be tested regarding how an experiment’s institutional design can influence the views of political decision-makers. Cash’s categories of effectiveness are used to describe an experiment’s conceptual influence; being how credible, salient, and legitimate decision-makers perceive an experiment to be. The hypotheses are tested using 14 experiment cases found relevant to climate adaptation in the Netherlands, with complete survey responses from over 70 respondents. The results show that although, in general, the experiments had medium to high influence on decision-makers, institutional design does have a noticeable impact. Organisers should make choices carefully when designing an experiment, particularly in order to maintain relevance during an experiment’s implementation and to build community acceptance. Suggestions for future research include a comparison of experiment effects with the effects of non-experimental forms of appraisal, such as piloting or ex ante impact assessment.     

Indigenous peoples vs peasant unions: land conflicts and rural movements in plurinational Bolivia

Agrarian reforms do not constitute linear processes: rather, they are based on the interconnection between the crystallization of land governance in formal tenure rules and the way societies organize around a set of identities and power mechanisms. This paper focuses on how the misinterpretation of this two-way relationship, in setting up a new normative framework, can generate unintended consequences in terms of conflict. The recent wave of land conflicts in Bolivia shows how changes in the allocation of strategic resources inspired by the so-called ‘politics of recognition’ triggered processes of political ethnicization and organizational fragmentation, eventually contributing to fuelling new tensions between indigenous groups and peasant unions.