Forensic Psychiatry

Proposed changes in the conceptualization of compulsivity and impulsivity in the DSM-V will have important implications in the way clinicians recognize and treat these disabling conditions.

The case of dentist Charles Sell, who suffers from delusional disorder, still awaits resolution. In the meantime, Sell remains incarcerated while his competency to stand trial is debated. Does this serve justice?

Of concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Are there accurate ways to test the cognition and response ability of elderly drivers?

During a trip to Beijing on behalf of the World Psychiatric Association, Dr. Stone witnessed up close how the psychiatry is practiced in today's China. What he found may surprise you--it certainly surprised him.

Psychiatric evaluation of juveniles who commit murder is perhaps one of the most difficult tasks in forensic psychiatry. A study has shown that these inmates are more likely to have been abused, be addicted to drugs or alcohol, or have a serious psychiatric disorder. Additionally, they are more likely to engage in risky behavior without thinking about the consequences.

Osteoporosis is a disorder characterized by low bone mass and microarchitectural deterioration with resulting compromised bone strength and increased risk of fracture.1 The World Health Organization defines osteoporosis based on T-scores, which reflect bone mineral density (BMD) relative to mean BMD for healthy 25-year-old same-sex populations. A T-score between 0 and 21 is considered normal density, a score between 21 and 22.5 indicates osteopenia, and a score of less than 22.5 signifies osteoporosis.2 Severe osteoporosis is defined as a T-score of less than 22.5 combined with a fragility fracture.2

Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.

Telepsychiatry has been hailed as the future of psychiatry. Proponents have claimed that it can reduce costs and allow access to difficult-to-reach patients. What are the promises and pitfalls of this new technology?

When disputes arise concerning custody and visitation, mental health care professionals can inform and assist judges by performing competent custody evaluations.

Allegations of complicity by Chinese psychiatrists in abuse and persecution of members of the Falun Gong continues to trouble the World Psychiatric Association. Are the steps being taken to learn the truth enough? Dr. Stone provides a look at the events that have unfolded to date.

Psychiatrists and other mental health activists have been working in various countries around the globe to bring an end to unjust psychiatric incarceration for political beliefs and to improve living conditions for those patients in psychiatric hospitals. The former Soviet Union, China and India are all current targets of focus for this human rights movement. What are human rights organizations doing and how can psychiatrists help?

Both the mental health and justice communities have been troubled by the increased number of mentally ill individuals in the prison populations. Legislation awaiting passage in the U.S. Congress would fund collaborative programs between these two fields that would try to alleviate this growing problem.

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.

This introduction article elucidates how the various contributions to this special report help make psychiatry such a rich and varied field.

Adults who are severely mentally ill are over-represented in U.S. jails and prisons, leading to an interface between the mental health and criminal justice systems. New intervention strategies involving both systems, such as mental health courts and forensic assertive community treatment, could divert patients away from the criminal justice system and promote engagement in community-based treatment and support services.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.

With proposed cuts in state budgets nationwide, social services--including mental health care--are taking a financial blow. As a result, mental health care facilities are closing and services are disappearing. What will the effect be on patient care?

According to a survey done in 1999, 54% of Oregon's psychiatrists and 75% of the state's psychologists supported physician-assisted suicide, whereas between 20% and 33% of all health care professionals opposed it. The debate continues, as the federal government is trying to take away prescribing privileges for physicians who prescribe life-ending medications.

According to a recent Human Rights Watch report, U.S. prisons hold three times as many people with mental illness as psychiatric hospitals. The majority of these individuals are there because community-based treatments are not available, they have co-occurring substance abuse problems or they have previous involvement with the criminal justice system. Partnering with law enforcement agencies is key to devising workable solutions that ensure individuals with mental illnesses get the treatment they need.

Initially, it seemed that the privacy rule for HIPAA would protect patients' privacy, but in reality it has opened the door for insurance companies and hospitals to view private health care information. How can physicians and patients protect their privacy from further erosion?

The American Psychiatric Association has developed a sweeping vision for reforming mental health care in the midst of a fiscal crisis that it says threatens a wholesale collapse of the system. The plan calls for an investment in mental health services equal to the level of disability that mental disorders cause, an end to behavioral health carveouts and better integration between psychiatry and primary care.

Stereotypical portrayals of people with mental illness are as old as Hollywood itself. What are some of the clinical implications of the continued stigmatization of the mentally ill in television and film?

With the seemingly impending war with Iraq, Dr. Stone revisits the Marxist-based film The Battle of Algiers and is surprised to find Islamic fundamentalism prominently featured throughout. Looking back, he finds nothing in the director's or writer's notes, or in critics' writings on the film, to indicate they were aware of its presence-the film was viewed through the context of the time. Are we still making this deadly error in dealing with Muslim nations?

While fear stirred the nation during the Washington, D.C.-area sniper episodes, some members of the media were irresponsible in their analysis of the sniper's motives. Has this confirmed the general public's false belief that mental illness is linked to violence?

The U.S. Supreme Court's decision on Atkins v. Virginia has transformed the capital punishment landscape for the mentally retarded. This decision also marks an important step in evaluating the competency of death row inmates of any mental capacity. What could be the future outcomes of this landmark decision?

Psychopharmacology can be useful in all stages of couples' therapy. Using a high-functioning couple as a case example, the author illustrates how psychopharmacology, together with psychotherapy, can be used to facilitate treatment success.

New medications for the treatment of various addictions are currently under investigation. However, there are still substantial barriers, on the part of health and social policies and the patients themselves, to patients receiving these new treatments. Many of these issues were explored at the 2001 American Society of Addiction Medicine's State of the Art in Addiction Medicine conference.

What is a psychiatric expert and how does their role differ from that of the clinician? What must you consider before deciding to serve as an expert witness?

What is abandonment? Who is responsible? Where is the line drawn between no liability to treat and abandonment? Read how psychiatrists can protect themselves from the legal ramifications of abandonment.

"Stalking" is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. The stalker may use such means as telephone calls, letters, e-mail, graffiti and placing notices in the media. A stalker may approach or follow the victim, or keep their residence under surveillance.