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.     

Constructing patient–psychiatrist relations in psychiatric hospitals: the role of space and personal action

This essay investigates the role of space and personal action in the construction of patient–psychiatrist relations at psychiatric hospitals. In order to explore such a theme, the writings of R.D. Laing prove to be salutary. This is namely accredited to Laing's tenet that the staff and patients of a psychiatric hospital are institutionalised by both physical structures and personal action. A central approach taken in this essay is to explore Laing's theory through an inter-textual reading of Michel Foucault's Madness and Civilization (1967) and Erving Goffman's Asylums (1961).     

Rich doctors and poor patients: Market failure and health care systems in developing countries

This article argues that, in developing countries, health care systems (HCS) have been facing the problem of market failure, implying that the fair rules of market principles do not apply and patients often become losers. Explaining the theoretical issues involved, the article examines various causes of market failures in HCS, including: rent-seeking activities by doctors, asymmetric information between doctors and patients, between patients and insurance companies, and the oligopolistic behaviour of health care practitioners. The policy implications of the study suggest that, in many cases, government intervention is essential to eliminate market failures in the HCS in developing countries.     

Criminal Court-Ordered Psychiatric Evaluations:Does Gender Play a Role?

This study examines potential gender differences among defendants referred by criminal courts for psychiatric evaluations by analyzing demographic, clinical, and criminal history variables and evaluation findings. This study offers a large sample size of 718 females, as well as 3,627 males. Bivariate logistic regression and heterogeneity analyses were utilized to assess potential differences. Females were older; diagnosed more with mood, anxiety, and borderline personality disorders; less likely to have prior felony convictions; and more likely to be in the community than jail at the time of the evaluation. In addition, when controlling for other factors, females were more likely to be evaluated as having a mental disease or defect, to need hospitalization pending trial, and to be incompetent to stand trial.     

重点精神病人管控问题及其对策

近年来,全国各地陆续发生多起精神病人肇事肇祸事件,严重威胁到了人民群众生命财产安全和社会治安秩序,精神病人一时间成为人们恐惧的对象。当前我国对重点精神病人的管控工作仍然薄弱,管控机制、管控措施等依然存在诸多问题。总结重点精神病人肇事肇祸的特点,分析当前重点精神病人管控工作存在的问题,以公安机关在该项工作中的角色定位为出发点,借鉴国外先进的管理经验,从而提出完善法律制度保障、建立多部门联动机制、动态核查机制及加强民警培训等方面的可行性建议。     

中医医患关系的法律性质探讨

中医医患关系既有民事法律关系又有行政法律关系,中医医患关系的法律性质是纵横交错的法律关系。明确中医医患关系的法律性质,对中医医疗卫生法治建设具有重要的理论和实践意义。     

Unusual suicide with a chainsaw

Described here is a case of suicide with the use of a chainsaw. A female suffering from schizophrenia committed suicide by an ingenious use of a chainsaw that resulted in the transection of her cervical spine and spinal cord. The findings of the resulting investigation are described and the mechanism of suicides with the use of a chainsaw is reviewed. A dry bone study was realized to determine the bone sections, the correlation between anatomic lesions and characteristics of chainsaw. The damage of organs and soft tissues is compared according to the kinds of chainsaw used.     

PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.     

Forensic psychiatry in China

This article reviews the legal basis for the development of forensic psychiatry in China, the organization of clinical assessments, and training of forensic psychiatrists. Regulations for the management of patients in Ankang hospitals and the role of forensic psychiatrists within the Criminal Justice system are described. The primary role of forensic psychiatrists is to provide expert opinions on competence to stand trial and criminal responsibility in criminal cases. They are increasingly involved in civil court proceedings and tribunals at the request of a range of official agencies. The clinical cases assessed by Chinese forensic psychiatrists are very similar to those of their counterparts in Western countries, but the organizational and legal framework for these assessments reflects a very different system that has evolved independently.     

谈精神病患者被迫长期住院现象

精神病人长期住院现象在精神医疗实践中并不罕见。除因治疗之外,患者也会受到其他原因的制约而难以出院,其中包括人们对精神病患者自主权的忽视、受患者监护人及社会治安防控意识的影响等。毫无疑问,该现象的出现不仅是对患者人身自由权的侵害,对其自身发展十分不利;而且从社会角度上而言,也会造成大量医疗资源的浪费。文章对该现象出现的原因进行了分析,对其所具有的危害性作了阐述,并提出了解决该问题的具体建议,以期能使该社会顽疾得到逐步改善。