The Psychiatric clinics of North America
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Psychiatr. Clin. North Am. · Mar 1999
Review Case ReportsThe right to refuse psychiatric treatment.
The right to refuse psychiatric treatment has become an important clinical and legal issue in the last twenty-five years. This article briefly reviews the clinical, administrative, and legal aspects of the right to refuse psychiatric treatment, especially medication. Emphasis is placed on the clinical issues including the reasons for treatment refusals, and the management of treatment refusal. Empirical data are provided to illustrate the rights driven and treatment driven models of involuntary psychotropic medication administration.
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No one missing piece can solve the puzzle of juvenile violence. Although numerous risk factors have been identified, the implementation of successful preventive and treatment programs remains the greatest challenge. ⋯ The consequence of failing to do so is summarized by King's prophetic statement, "The choice today is no longer between violence and nonviolence. It's either nonviolence or nonexistence."
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Older adults are an important segment of the population that has specific health care needs. Their unique biopsychosocial characteristics impact the presentation, evaluation, and management of psychiatric illnesses. ⋯ Research in this area is relatively new and much more information is still needed. Close attention should be paid to new knowledge as it emerges about this growing population.
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Subcortical dementias are a heterogeneous group of disorders that share primary pathology in subcortical structure and a characteristic pattern of neuropsychological impairment. This article describes the neurobiological and cognitive features of three prototypical subcortical dementias, Parkinson's disease, Huntington's disease, and progressive supranuclear palsy, concentrating of traits shared by disorders. Clinical features are also discussed, especially those which differentiate subcortical dementias from cortical dementias, such as Alzheimer's disease. The cortical-subcortical nomenclature has been criticized over the years, but it continues to provide an effective means of classifying dementia profiles in clinically and theoretically useful ways.
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Suicidal behavior in older people is more often lethal than in any other age group. Social isolation, losses and physical illness, a past history of suicide attempts, and psychiatric illness are risk factors with implications for prevention of late life suicide. Preliminary indications are that community outreach to elders at risk and educational programs for primary care providers on the identification and treatment of late life depression are effective at lowering suicide rates.