Forensic Psychiatry

In a question-and-answer discussion with Dr Phillip Resnick, clinicians gained valuable insights into the legalities of psychiatry and how best to treat patients and protect the public (and themselves).

DEBATE When you get facts wrong, as Dr Halpern does, it is hard to end up with the right conclusions. He suggests incorrectly that my approach to forensic ethics leads to the conclusion that participation in interrogation is permissible, when exactly the opposite is true.

DEBATE In 2005, the Board of Trustees of the American Psychiatric Association (APA) prepared a Position Statement entitled Psychiatric Participation in Interrogation of Detainees

Dr Allen Frances pleads for the United States Supreme Court to “step up to the plate” and halt the “disturbing misuse” of the “makeshift” psychiatric diagnosis of Paraphilia NOS (nonconsent).

Every year, more than 1 million children are exposed to sexual or physical abuse or neglect in the US. The research summarized here clearly demonstrates that exposure to stress before adulthood can result in persistent effects on both mental and physical health.

Would you be surprised to find out that Freud is gaining a foothold in China? As psychoanalysis and related therapies are slipping in the USA, psychoanalysts from the US are beginning to train a cadre of interested clinicians in China.

The next I heard of the Prince, my hopes that he had reshaped his consciousness in a more healthy direction were dashed. The Prince was in solitary confinement as punishment for another attempt to establish his empire.

He had returned to a familiar place, and his peers welcomed him back. The word "recidivist" comes from the French word "recidiver," meaning to "fall back." This was not the first time he had fallen back. He would surely tell you that his return was not by choice, but sometimes such things are hard to determine.

As I came closer, I could see Mr P more clearly. He was in his own world, wearing a Walkman with earphones on. I puzzled for a brief moment over this-was this to shut out attempts to talk him down? I could also see more clearly the rivulets of blood dripping from the incisions on his wrists to the concrete ground below.

If surveys conducted by physician recruiting companies accurately reflect current trends in the job market, the news is very good for psychiatrists-and less promising for many patients with mental health disorders.

The most disturbing turbulence at the boundary between psychiatry and the law is the misuse of a makeshift psychiatric diagnosis to justify the involuntary, indefinite psychiatric commitment of rapists. This is a disguised form of preventive detention and an abuse of psychiatry.

A Federal appeals court has supported an earlier ruling by a lower court that established the unconstitutionality of gassing disruptive mentally ill inmates in their cells.

With the transition of patients with mental illness from the beds of psychiatric institutions into the community the need for knowledgeable mental health professionals continues to grow. Correctional psychiatry has evolved in recent years and presents special challenges for clinicians, which this handbook deftly addresses. Contributing authors with various backgrounds provide a broad range of expertise.

The subject of physician participation in interrogations continues to surface as an issue of debate.

It is rather difficult for me to avoid turning this greeting article into an homage to Dr Pies. My mirroring of his farewell piece2 with my title and preliminary quotes was meant to signify my great respect for him. How much I have learned and benefited from his wisdom, patience, knowledge, and compassion over the past 4 or so years cannot be measured.

At the end of life, psychiatrists are often asked to assess a patient’s capacity to refuse treatment, but the role of the psychiatrist in this situation is much broader.

Perhaps one of the positive things to come out of the Kansas v Hendricks wave of sexually violent predator (SVP) commitment laws during the past decade is that our knowledge base on sex offenders has grown tremendously.

DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a “paradigm shift.” Work groups were instructed to think creatively, that everything was on the table. Accordingly, and not surprisingly, they came up with numerous pet suggestions that had in common a wide expansion of the diagnostic system-stretching the ever elastic concept of mental disorder. Their combined suggestions would redefine tens of millions of people who previously were considered normal and hundreds of thousands who were previously considered criminal or delinquent.

DSM5 first went wrong because of excessive ambition; then stayed wrong because of its disorganized methods and its lack of caution. Its excessive and elusive ambition was to aim at a "paradigm shift.”

Mark Twain observed that "the past may not repeat itself, but it sure does rhyme." An unfortunate rhyme in psychiatric history is the recurrence of fad diagnoses. Childhood Bipolar Disorder is the most dangerous current bubble, with a remarkable forty-fold inflation in just one decade.

I had lunch with Death some 12 or so years ago, as a chief resident in psychiatry. He was a bit hard to converse with. In fact, the exact opposite of how he had been when presenting grand rounds just an hour before.

I invite you to log on and have a good look around at the topic centers filled with clinical information on more than 100 psychiatric disorders. You’ll find the latest psychiatric news, clinical guidelines, details about ongoing clinical trials (for which your patients might be eligible), and patient education information. You’ll find podcasts on topics that range from ethical dilemmas to ways to market your practice. You’ll find archival and brand-new content from Psychiatric Times, and links to our 10 most popular articles. You can earn CME credits and access a number of psychiatric clinical scales. You’ll find classified job listings and details about our upcoming virtual career fair this spring. The site is also home to SearchMedica.com-a search engine specifically designed for psychiatrists and mental health professionals. And if you are moved to post your thoughts and comments about various articles, you can register and do so easily now.

You have prescribed an atypical antipsychotic for a patient who is undergoing psychotherapy. You need to check for signs of the metabolic syndrome with a physical exam. . . but is it ethical to touch the patient for this clinical purpose? Listen to ethicist Dr Cynthia Geppert examine the issues in her series “Living the Questions: Cases in Psychiatric Ethics.

The CASE Approach is built to uncover pieces of a puzzle that enhance the likelihood of an accurate clinical formulation of risk.

Hy Bloom provided an expert psychiatric report in a multiple murder case in which the accused, who had schizophrenia and depression, had killed his wife and 2 children. Before the murders, the accused had been seeing a psychiatrist and family physician for treatment of the mental disorders.

The United States Census Bureau projects that by 2010 nearly 13% of the US population will be over the age of 65. The elderly are one of the most rapidly growing segments of the US population and are expected to account for more than 20% of the total population by 2050.1 In 2001, the prevalence of dementia in North America was 6.4%. A 49% increase in the number of people with dementia is expected by 2020, and a 172% increase by 2040.2 Patients with dementia may lack the capacity to consent to treatment. The need to evaluate capacity to consent to treatment will therefore increase as the aging population grows.

It is my privilege and pleasure to highlight this Special Report on forensic psychiatry. (The first articles in this series appeared in the November issue and are posted on www.psychiatrictimes.com.) The respected authors provide us with the most recent thought on subjects that should be of interest to every practicing psychiatrist.

Practical approaches to integrating 3 aspects of a suicide assessment have been well delineated for adults and adolescents.

November/December 2009 Special Report: Forensic Psychiatry

A few simple steps can enhance your assessment of a patient’s suicide risk-and thereby reduce your own risk for liability if the patient does commit suicide. Phillip J. Resnick, MD, professor of psychiatry and director of forensic psychiatry at Case Western Reserve University in Cleveland, described those measures in a lecture today at the US Psychiatric Congress in Las Vegas.