Correctional facility exam q

[sujalneuro]

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Hello all,

This q is from K and S q bank...

A 43 year old prisoner is found to have MDD. The correctional psychiatrist wants to start him on antidepressant therapy because of the severity of his disease. He was very often in solitary confinement for violent behavior with correctional staff. The prisoner refuses to take any medications, stating he does not want to complicate his life any more by having to take the drugs every day. Correctional officer tells you it would be a security risk to have this prisoner out of his cell every day for treatment any ways. What is the most appropriate next step in his management?

A. Do not give him antidepressant as he has the right to refuse?
B. Do not give the prisoner antidepressant because it is a security risk.
C. Do not give the prisoner antidepressant because he is not in a medical emergency.
D. Give the prisoner antidepressant as he does not have the right to refuse
E. Do nothing and observe for worsening symptoms.

How is the role of psychiatrist in correctional facility different than usual practice?

Could someone also please explain role of psychiatrist when a subpoena is issued? Comply and release the records or else.

Is there any resource to get these kinds of questions clarified further. Thanks in advance.

 

[splik]

its a crappy question.

as dor the subpoena it depends who it is from. if it is from a judge t you must release records. if it is from a lawyer you should contact the patient or their lawyer to let them know you have received this and what they would like you to do. if the patients attorney does not wish the records released they will file a motion to exclude. if unsuccessful (for example the records wont be excluded if the patient is suing for psychic injury or mental illness forms even a small part of the claim) then you will ultimately have to release the records.

 

[PistolPete]

My guess is the answer is A and that the question is getting at the face that a prisoner still has capacity to refuse medications until proven otherwise??

 

[Merovinge]

My guess is the answer is A and that the question is getting at the face that a prisoner still has capacity to refuse medications until proven otherwise??

I agree that would be the likely point of the question. Also it being an SSRI vs antipsychotic in a patient with psychosis makes this a bit easier.

 

[SourceOfDenial]

A. Stem says nothing about the patient having a forced treatment order, so he has the right to refuse medication.

 

[WingedOx]

its a crappy question.

.

Eh, it's a bit odd, but more or less straightforward ethics questions. Gotta know the "what to do" as well as the "why." Had at least a few similar types of questions on my actual exam.

 

[smalltownpsych]

It's one of those most right answer questions because C is technically correct, but it is not really the reasoning behind why not to give it to him and E is technically correct although you aren't really doing nothing when you are monitoring for worsening because you are monitoring. I find that the best way to answer these is choose which one sounds the most straightforward and is a logically coherent answer.

 

[st2205]

F. Do not give the prisoner an antidepressant because, in addition to them not wanting it, it will not be helpful.

 

[sujalneuro]

The book says answer is D.... which is confusing...they say the legal rule is that inmate have the right to consent to care but do not necessarily have equally extensive rights to refuse care....Maybe its just wrong!! Again this is from K and S q book from forensic psychiatry chapter...

Thanks!!

 

[SomeDoc]

This was decided in Washington v Harper where the US Supreme Court ruled that in the case of forced medication in correctional facilities:

"an inmate's interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge"

... Although individuals have an interest to be free from unwanted
medical treatment, a prison environment may reasonably have a different set of rules and rights. If an inmate represents a danger to himself or others in the prison, forced treatment may be a justifiable alternative to risking the consequences of forgoing treatment.

VM -- Forced Medication of Prison Inmates, Feb 08 ... Virtual Mentor

 

[WingedOx]

The book says answer is D.... which is confusing...they say the legal rule is that inmate have the right to consent to care but do not necessarily have equally extensive rights to refuse care....Maybe its just wrong!! Again this is from K and S q book from forensic psychiatry chapter...

Thanks!!

I like this question less now.

 

[Merovinge]

This was decided in Washington v Harper where the US Supreme Court ruled that in the case of forced medication in correctional facilities:

"an inmate's interests are adequately protected, and perhaps better served, by allowing the decision to medicate to be made by medical professionals rather than a judge"

... Although individuals have an interest to be free from unwanted
medical treatment, a prison environment may reasonably have a different set of rules and rights. If an inmate represents a danger to himself or others in the prison, forced treatment may be a justifiable alternative to risking the consequences of forgoing treatment.

VM -- Forced Medication of Prison Inmates, Feb 08 ... Virtual Mentor

That's a helpful post for sure. But in this question the guy is violent but his problem is MDD? They aren't even giving us the huge stretch that he has Bipolar much less psychosis and they want to force an SSRI? If he even was trying to kill himself I see the point but an SSRI for aggression with an MDD dx is hogwash.

 

[smalltownpsych]

That's a helpful post for sure. But in this question the guy is violent but his problem is MDD? They aren't even giving us the huge stretch that he has Bipolar much less psychosis and they want to force an SSRI? If he even was trying to kill himself I see the point but an SSRI for aggression with an MDD dx is hogwash.

Just take the pill and shut up or it's 30 days in the hole for you.

 

[SomeDoc]

That's a helpful post for sure. But in this question the guy is violent but his problem is MDD? They aren't even giving us the huge stretch that he has Bipolar much less psychosis and they want to force an SSRI? If he even was trying to kill himself I see the point but an SSRI for aggression with an MDD dx is hogwash.

I agree. Antidepressant monotherapy would not be my first choice either.

 

[WingedOx]

I agree. Antidepressant monotherapy would not be my first choice either.

"b,b,but, the Serotonin in aggression...."