Modeling psychiatric patients' treatment decision making

Decision-making processes of psychiatric inpatients were assessed at admission and prior to discharge, and compared to hospital staff members using a paired comparison paradigm in which subjects chose between hypothetical antipsychotic medications. Multidimensional analyses of binary choice matrices revealed that all subjects based decisions on the risks and benefits of medication, and weighted risks and benefits in roughly equal proportions. Hospital staff demonstrated greater internal consistency in their decisions than the inpatient sample at both time points. For newly admitted inpatients, severity of psychiatric symptoms and nonverbal intelligence were related to internal consistency of decision making, and behavioral indices of medication compliance predicted relative weighting of risks and benefits. For predischarge and comparison samples, verbal intelligence and treatment preferences predicted both outcome measures. Reliance on verbal reports of decision making may be misleading when assessing competence in acutely impaired psychiatric patients.     

Using similarity judgments to conduct a mugshot album search

Mugshot searches fail because the witness must be shown too many photos. Current methods to reduce the number rely too heavily on verbal reports of individual features. This research reports three tests of a new system that augments the presently used tools by having the witness choose photos that are subjectively similar to the target. Each photo thus chosen increases the ranking of every photo in the album that is similar to it, as determined by a similarity network in which the album photos are embedded. Because the ranking of the target itself is usually thus increased, it is soon displayed. The tests used familiar targets, an incidental one, and unfamiliar videoed ones. From 76% to 84% of the “witnesses” reached the target, having viewed 2.4 to 8.5 times fewer photos than they would have had they simply leafed through photos as is traditionally done.     

The Unintended Effects of Social Policy Measures

The unintended effects of social policy measures are frequently important, controversial, difficult to ascertain and even more difficult to quantify. Some selected aspects of four types of unintended effects are discussed in this article. First, effects due to redistribution of income as well as life chances and opportunities as determined by market forces and attitudes (sexism, ageism, racism) favor some at the expense of others. Even redistribution which increases gross domestic product (GDP) often disadvantages certain groups. Second, contingency-related benefits tend to favor population groups differently. Third, free and subsidized health services, in certain conditions, increase both the supply and demand for services—the moral hazard problem. Fourth, contingency benefits in cash and kind tend to increase the incidence of such contingencies and, if income-related, tend to result in poverty and unemployment traps. Cross-national comparative studies may be a useful device in ascertaining effects or the absence of effects.     

Just punishments: Guideline sentences and normative consensus

The federal sentencing guidelines prescribe ranges of sentences to be given to persons convicted of felonies in the federal criminal courts. The U.S. Sentencing Commission wrote the guidelines attempting to make sentences conform to community views of appropriate punishments, along with several other criteria. Employing data from a 1994 national sample of adult Americans, designed as a factorial survey, the degree of correspondence is shown between guidelines sentences and those desired by the American public. Although at the individual level only a modest degree of concordance was found, the central tendencies of public opinion (median sentences) were found to correspond quite closely to the guidelines sentences. The major points of disagreement centered around drug trafficking crimes: the guidelines prescribed very long sentences for those crimes and distinguished sharply among trafficking in heroin, powder cocaine, and crack, whereas median sentences desired by the public were much lower and did not distinguish sharply among trafficking in those drugs. We interpret the findings as indicating that the guidelines sentences conform reasonably closely to American normative consensus concerning the sentencing of federal felons.The research reported in this article was commissioned by the U.S. Sentencing Commission. The views expressed in this article are not necessarily endorsed by the Commission. Full expositions of the findings from the national survey used are given by Rossi and Berk (1995, 1997).