The clinician–patient working alliance: is it a significant predictor of psychiatric medication adherence in a sample of recently released parolees?

Persistent psychiatric symptoms can serve as a major barrier to the successful reintegration of parolees with mental illness. Thus, it is important to identify factors that might impact their mental health recovery, such as low adherence to their treatment regimen. The strength of the clinician/patient working alliance has been found to be significantly associated with psychiatric medication adherence in prior research, but this relationship has not been assessed in a parolee population. Logistic regression analysis was used to determine if patient-rated working alliance was a significant predictor of low psychiatric medication adherence while taking into account alcohol/illegal drug use, age, and ethnicity in a sample of recently released parolees with mental illness (N = 49). Patient-rated working alliance, age, and ethnicity were not significant predictors of low adherence. Alcohol/illegal drug use during the follow-up period was associated with a significantly increased likelihood of meeting the criteria for low medication adherence (OR = 8.36; 95% CI = 1.60, 43.66). While working alliance was not found to be a significant predictor of medication adherence in this study, further research is needed to examine how substance misuse impacts the clinician–patient working alliance in this population.     

Atypical Accommodations for Employees with Psychiatric Disabilities

People with psychiatric disabilities often need atypical accommodations to participate in today's workforce. Some of these accommodations, including structural and social changes in the workplace, can address biases against people with psychiatric disabilities, while others ameliorate deficits that may affect performance or interaction with others. Many courts have denied requests for such accommodations based on employers' assumptions about performance or the direct threats purportedly posed by people with psychiatric disabilities. By challenging these assumptions, which can be influenced by stigma and stereotypes, and by enforcing an employer's duty to interact regarding potential accommodations, employees with psychiatric disabilities could benefit from structural and social accommodations. Courts should consider social science research in determining which nontraditional accommodations may be reasonable and whether the employer can establish that they impose any undue hardship. Such consideration will expand opportunities for people with psychiatric disabilities in the workplace without unduly interfering with employers' interests.     

Secondary Confessions as Post-identification Feedback: How Jailhouse Informant Testimony Can Alter Eyewitnesses’ Identification Decisions

Prior research has shown that primary confession evidence can alter eyewitnesses’ identifications and self-reported confidence. The present study investigated whether secondary confession evidence from a jailhouse informant could have the same effect. Participants (N?=?368) watched a video of an armed robbery and made an identification decision from a photo lineup. Except for those in the no-feedback conditions, all participants then read that certain lineup members either confessed to the crime, denied involvement, or were implicated by a jailhouse informant. Jailhouse informant testimony implicating the identified lineup member led participants to have significantly higher confidence in their identification. In contrast, jailhouse informant testimony that implicated a lineup member other than the identified led participants to have significantly lower confidence in their initial identification, and 80% of these witnesses changed their identification. These results indicate that jailhouse informant testimony can influence eyewitnesses’ confidence and their identification decisions.     

Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.     

Utility of the minnesota multiphasic personality inventory personality disorder scales with adolescent psychiatric inpatients

Personality disorders play an important role in the treatment of many adult psychiatric disorders. Current research has begun to examine the role of personality disorders in adolescent psychopathology. Unfortunately, there is limited research available to document the reliability and validity of personality disorder assessment measures for use with adolescent psychiatric patients. The Minnesota Multiphasic Personality Inventory (MMPI) Personality Disorder Scales have shown adequate psychometric properties with adult samples, but have not been tested using adolescents. The present study was designed to examine the utility of the MMPI Personality Disorder Scales with 217 adolescent psychiatric inpatients. A multivariate analysis of variance revealed males scored significantly higher than females on the schizoid, narcissistic, and antisocial scales, a pattern that has been found in adult psychiatric patients. Also, the MMPI Personality Disorder Scales correlated in patterns consistent with research on adult samples. In addition, the MMPI Personality Disorder Scales were meaningfully correlated with the Tridimensional Personality Questionnaire. However, factor analysis revealed a different factor structure than that found with adults. The similarities between adolescent and adult data suggest that the assessment of personality disorders in adolescents may provide useful clinical information on the development of personality disorders.This article was presented at the American Psychological Association Convention, Toronto, Ontario, Canada, August 1993. The research was funded in part by a grant from the Charles Reiley Armington Foundation for Values in Children.Received M.A. from Case Western Reserve University. Her major research interests are in the areas of depression and personality disorders.Received Ph.D. in clinical psychology from the Ohio State University in 1986. Completed his predoctoral internship and postdoctoral fellowship at the Brown University Program in Medicine, Providence, Rhode Island. Actively involved in research on risk factors for suicide in adolescents and adults. Has published empirical studies, theoretical papers, and treatment guidelines related to suicide and its risk factors.Received his Ph.D. in Clinical Psychology from Case Western Reserve University, Cleveland, Ohio. His major research interests include depression, suicide, adolescence, and family systems issues.     

Essential medicolegal death investigation services: standardization of a survey instrument based on the Essential Public Health Services

The National Academy of Sciences recommends that states assess the performance of medicolegal death investigation agencies. To aid in performance assessment, we adapted an instrument based on the CDC's 10 Essential Public Health Services by translating the terminology to that of essential medicolegal death investigation services. This produced a survey that could be used to standardize reporting practices and services of agencies. To validate the instrument, a stratified random sample of 12 death investigation chiefs in 12 states was interviewed. This sample represented both medical examiner and coroner jurisdictions within the varying medicolegal structures. A cognitive testing process elicited how well participants could respond to and interpret the survey questions. The response was favorable in that the respondents agreed that given specific revisions toward question clarification, the instrument would be a useful and relevant tool for assessing system performance.     

Between Constitutional Mo(nu)ments: Memorialising Past,Present and Future at the District Six Museum and Constitution Hill

This article explores the powers and potentialities of imaginations of political community at the site of the museum in contemporary South Africa. Taking the District Six Museum (Cape Town) and Constitution Hill (Johannesburg) as the empirical backdrop, I explore the ways in which memorialising practices at these sites bolster or deflate the exaltation of the post-1996 constitutional moment. This argument aligns closely with contemporary discussions by South African constitutional theorists about the role of monumentalism and counter-monumentalism. Indeed, I argue that memorialising techniques employed at the District Six Museum offer a practice of memory-making that resists the fixed and limited boundaries proffered by the new South African constitutional discourse exalted at Constitution Hill. However, my critique does not include a call for a reform of the latter. Instead, I argue that the continuation of monumental memory practices at Constitution Hill, in juxtaposition to counter-monumental practices at District Six, serves a key role in revealing the limits of fixed notions of law and subjectivity in imagining past and future political communities. Drawing on Antonio Negri’s concept of constituent power, I argue that the juxtaposition of monumental and counter-monumental memorial practices exposes the illusion of the division between transcendent Power (potestas) and immanent power (potentia). Finally, I turn to Emilios Christodoulidis’ conception of ‘strategies of rupture’ to consider ways in which this contradiction might be made to ‘persist’ through the site of the museum. Indeed, if the goal is to illuminate the illusion of transcendent power, the juxtaposition of memorialising practices between the two sites (a museological form of ‘tapping of contradiction’) may serve as a platform for the truth of constituent power to be realised.     

The effect of post-identification feedback, delay, and suspicion on accurate eyewitnesses

We examined whether post-identification feedback and suspicion affect accurate eyewitnesses. Participants viewed a video event and then made a lineup decision from a target-present photo lineup. Regardless of accuracy, the experimenter either, informed participants that they made a correct lineup decision or gave no information regarding their lineup decision. Immediately following the lineup decision or after a 1-week delay, a second experimenter gave some of the participants who received confirming feedback reason to be suspicious of the confirming feedback. Following immediately after the confirming feedback, accurate witnesses did not demonstrate certainty inflation. However, after a delay accurate witnesses did demonstrate certainty inflation typically associated with confirming feedback. The suspicion manipulation only affected participants' certainty when the confirming feedback created certainty inflation. The results lend support to the accessibility interpretation of the post-identification feedback effect and the erasure interpretation of the suspicion effect.