November/December 2009 Special Report: Forensic Psychiatry

Critical Information for the Practice of Psychiatry
James L. Knoll, IV, MD Psychiatric Times, December 2009

Many forensic psychiatrists are known for never shrinking from a controversial subject. So it is with leading forensic psychiatrists Drs Donna M. Norris and Marilyn Price. In the November issue, they took on a sensitive subject that desperately needs more attention: firearms and mental illness. Much thoughtful work needs to be accomplished here, and Norris and Price are to be commended for bringing this to our attention.  Read More

Keys to Avoiding Malpractice
Carla Rodgers, MD Psychiatric Times, December 2009

In the 33 years since I began medical school, psychiatric knowledge has greatly increased in depth and breadth, rendering much of what I originally was taught about diagnosis and treatment in need of revision. Critical concepts in malpractice have also been codified and studied since that time. We can now educate ourselves on the constituents of malpractice, as opposed to the vague admonitions I received in medical school to “watch out for the lawyers.” Read More

Medical Decision-Making Capacity of Patients With Dementia
Abigail Dahan, MD and Spencer Eth, MD Psychiatric Times, December 2009

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. Read More

Violence Risk Assessment in Everyday Psychiatric Practice
Christopher D. Webster, PhD, Hy Bloom, MD, and Leena Augimeri, PhD Psychiatric Times, December 2009

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. Read More

Firearms and Mental Illness
Donna M. Norris, MD and Marilyn Price, MD Psychiatric Times, November 2009

The right of American citizens to own, register, and carry firearms has a significant history of federal and/or local regulation dating to the early 18th century. With the passage of the federal Gun Control Act of 1968, persons who have been treated for mental illness and/or substance abuse are among a defined group restricted from owning and carrying firearms. While violence is often portrayed in the media as related to persons with mental illnesses, there are limited research data to support this idea. Read More

The Case of Factitious Disorder Versus Malingering
Courtney B. Worley, MPH, Marc D. Feldman, MD, and James C. Hamilton, PhD Psychiatric Times, November 2009

Patients who exaggerate, feign, or induce physical illness are a great challenge to their physicians. Trained to trust their patients’ self-reports, even competent and conscientious physicians can fall victim to these deceptions. In doing so, the treating physician may unwittingly provide support for specious claims of illness or injury by conferring official diagnoses, or by delivering treatments that transform the patient from a pretender into a person with a genuine, although iatrogenic, medical problem (eg, via adrenalectomy, pancreatectomy, serial amputation) Read More

Tarasoff Redux
Daniel W. Shuman, JD Psychiatric Times, November 2009
I take it as an article of faith that anyone who expects to be taken seriously as a mental health law scholar must write at least one Tarasoff article that is taken seriously. Notwithstanding the personal implications and its centrality to mental health professionals, in my 30 years of teaching and writing about the intersection of psychiatry and law, I had managed to avoid that rite of passage. I was not comfortable and found it difficult to say something original on a topic that has been so extensively explored. Read More