Postpartum Psychosis.

PURPOSE OF REVIEW: Postpartum psychosis is a psychiatric emergency that can affect the health and life of mothers, infants, and families. Postpartum psychosis (PPP) is distinct from non-postpartum psychosis in many ways, and it is crucial to study and understand PPP to identify, treat, and possibly prevent this condition. We therefore sought to review the latest research findings about PPP with the intention of updating readers about the latest evidence base. RECENT FINDINGS: Multiple physiologic pathways have been implicated in the development of PPP, and further understanding these pathways may allow for early detection and treatment. Risk assessment and treatment should include consideration of the woman patient but also the mother-infant dyad and the larger family. It is our hope that this review of research updates in postpartum psychosis may inform clinical practice and promote specialized, evidence-based diagnosis, risk assessment, and treatment.

Showtime's The Affair: the Rashomon effect, eyewitness testimony, and lack of reliability in homicide.

OBJECTIVE: The Rashomon effect explores point of view in storytelling, and the subjectivity of even honest narratives is based on point of view. In 1950, Rashomon was the first film to explore this. Currently, The Affair explores the differences in story based on point of view. Both clinical and forensic psychiatrists must consider point of view when hearing narratives from patients or defendants. CONCLUSION: The Affair provides an excellent contemporary example through which to explore the Rashomon effect in conceptualization of eyewitness testimony and reliability of reporting.

Insanity: A Legal and Cinematic Diagnosis.

The term "insanity" has been retired from medical nomenclature for about 100 years. Formerly interchangeable with the legal term, implying unsoundness of mind, it persists as a legal determination, mainly in criminal matters. However, the most prevalent uses of "insanity" are in colloquial speech and media. We track "insanity" in medical and legal parlance, reasons for its disappearance from psychiatry, and its persistence in popular culture. During the 19th century, specific types of legal insanity fell out of favor, especially "moral insanity," referring to irresistible impulses. The term persisted, for example, in some civil cases and in criminal cases, both denoting lack of capacity. In America, early 20th century focus on disease classification and nomenclature shifted from catchall terms (such as insanity, dementia, mania, and idiocy) to medical labels (psychosis and neurosis). Psychiatrist William Alanson White led the movement to change nomenclature. In 1921, the American Journal of Insanity became the American Journal of Psychiatry. By the time White was the American Psychiatric Association president in 1925, the medical use of "insanity" had been replaced in textbooks by progressive terminology. However, variations on "insane," suggesting loss of reason without diagnostic specificity, have become a staple among film tropes.

The myth of school shooters and psychotropic medications.

There has been an assertion in certain parts of the media, especially social media, that the majority of individuals who have engaged in a school shooting were prescribed psychotropic medications prior to the event. To determine if there is any validity to this assertion, the authors of this article reviewed publicly available information regarding individuals involved in "educational shootings" per FBI publications for active shooters from 2000 to 2017. Sources of information included news reports with official citations, official reports regarding events, available court records, and FBI Freedom of Information Act requests. Secondary data-points were also collected, such as location, number of weapons used, number of victims, legal outcome, and whether the shooter committed suicide. From the information obtained, it appears that most school shooters were not previously treated with psychotropic medications - and even when they were, no direct or causal association was found.

What are the characteristics of first time older sexual offenders?

ABSTRACTBackground:Our objective was to examine and describe the common socio-demographic and clinical characteristics of first time older sex offenders. METHODS: Research papers published in MEDLINE, PsycINFO, and EMBASE were searched systematically. Following removal of duplicates and irrelevant papers, a total of 423 papers were reviewed to determine whether the selection criteria were met. A total of seven publications were included and evaluated by two researchers. RESULTS: Of the seven publications, there were two retrospective research studies and five case reports. There was a higher proportion of neurocognitive disorder in this offender group and the victims were usually vulnerable individuals. Yet, cognitive assessments were rarely done or reported. Two subtypes of older sex offenders were identified: (i) offenders who had offended in the past but were not previously detected; (ii) first-time offenders with a high proportion of neurocognitive disorder. CONCLUSION: There is a paucity of research in first time sex offending by older people. This review has highlighted a need for better designed studies to explore the characteristics of older sex offenders. Better collaboration between forensic and old-age psychiatric services is required for improved assessment and management of older sex offenders.

Staff perceptions of challenging parent-staff interactions and beneficial strategies in the Neonatal Intensive Care Unit.

AIM: To characterise neonatal intensive care unit (NICU) staff perceptions regarding factors which may lead to more challenging staff-parent interactions, and beneficial strategies for working with families with whom such interactions occur. METHODS: A survey of 168 physician and nursing staff at two NICUs in American teaching hospitals inquired about their perceptions of challenging parent-staff interactions and situations in which such interactions were likely to occur. RESULTS: From a medical perspective, staff perceptions of challenging interactions were noted when infants had recent decompensation, high medical complexity, malformations or long duration of stay in the NICU. From a psychological/social perspective, a high likelihood of challenging interactions was noted with parents who were suspicious, interfere with equipment, or parents who hover in the NICU, express paranoid or delusional thoughts, repeat questions, perceive the staff as inaccessible, are managing addictions, or who require child protective services involvement. Frequent family meetings, grieving opportunities, education of parents, social work referrals, clearly defined rules, partnering in daily care and support groups were perceived as the most beneficial strategies for improving difficult interactions. CONCLUSION: This study delineates what staff perceive as challenging interactions and provides support for an educational and interventional role that incorporates mental health professionals.

Bestiality: An introduction for legal and mental health professionals.

Bestiality, or human-animal intercourse, has been a concern of the legal and mental health communities for many years. Ancient legal codes delineated punishments for those who engaged in the behavior, denoting a moral and general societal concern surrounding bestiality dating to ancient times. Despite this longstanding interest in and legal efforts to punish humans for having sex with animals, there has been little research on the behavior. Current available research has largely been siloed based on the populations studied, making it difficult to render any firm conclusions about bestiality's prevalence, frequency, and the risk posed by those who have sex with animals. It is important for clinicians to know the legal status of the behavior in their jurisdictions, to understand possible medical and psychiatric complications and comorbidities, and to know how to evaluate and treat individuals who engage in bestiality or have the related diagnosis of zoophilic disorder. This article provides an overview of the terminology and research pertaining to bestiality, summarizes legal and ethical considerations, and describes clinically relevant information for the evaluation and management of individuals engaged in sex with animals.

Trouble at teens' fingertips: Youth sexting and the law.

The last decade has seen a rapid increase in the use of smartphones among young children and adolescents. One consequence of this phenomenon is sexting. Although researchers of sexting have yet to arrive at a single, cohesive definition for the behavior, it generally involves the transmission of text, pictures, or videos containing sexual material. Different definitions of the behavior have led to widely varying estimates of its prevalence, although some studies have documented relatively high rates of sexting among teenagers. As adolescence is the time period in people's lives where the psychological tasks of identity consolidation and the development of intimate relationships become primary, it is not surprising that many teens utilize sexting as one way of practicing skills associated with successful completion of these tasks. The criminal prosecution of sexting cases, then, raises many legal and ethical questions. Offenders may be prosecuted under state or federal child pornography laws or state-specific sexting laws. Sexting laws, particularly in instances of consensual sext exchange, call into question who they are meant to protect and from what. In this article we review the research on teen sexting, its prevalence, and its association with mental health problems; summarize legal responses to the behavior in the United States; and identify considerations for prosecutors and legal decision-makers facing sexting cases.

Supervising trainees in research: what does it take to be a scholarly project supervisor?

OBJECTIVES: Scholarly projects (SPs) are a compulsory component of psychiatry training in Australasia. This article outlines the role of a research supervisor in supporting a trainee to complete an SP. METHODS: A total of 10 old age and forensic psychiatry SPs were reviewed with regard to aims, methodology, supervisor input, trainee tasks and additional resources. RESULTS: The main supervisor tasks are described and discussed. They include practical advice on study design, ethics applications, critical appraisal, data analysis, academic writing and publication. CONCLUSIONS: Supervising SPs can bring significant rewards in awakening a trainee's interest in research. Key competencies for research supervision are discussed and further recommendations for supervisor support and training are provided.

Transforming an idea into a scholarly project.

OBJECTIVES: This article describes components of a workshop designed to orientate psychiatric trainees to the task of conducting a scholarly project. The aims are: to promote an approach that incorporates principles of adult learning to guide trainees who are undertaking research; to allow trainees to transform their ideas into more tangible research questions; and to enable supervisors to reflect on delivering similar content in scholarly project workshops. METHODS: The workshop comprised: creating a safe space to explore ideas; discussing the process of posing a question or hypothesis; using group interactions to generate concepts; and considering personal values that influence the choice of research methodology to answer a question. RESULTS: Examples are provided from the workshop. The process enabled trainees to generate and distil ideas into more concrete questions and methods in three phases: introductory, exploratory and tangible. CONCLUSIONS: Adult learning principles may assist trainees to develop their ideas for a scholarly project into research questions that are relevant to clinical practice. Harnessing the creative potential of a peer collective may encourage deeper inquiry, shifts to a tangible output and a sustained interest in research.

New Zealand Youth Fitness to Stand Trial: The Impact of Age, Immaturity and Diagnosis on Evaluator Opinions and Court Determinations.

International research suggests that a proportion of youth facing legal charges are at risk of being unfit (or incompetent) to stand trial. In New Zealand, only a fraction of youth coming before Youth Court are referred for fitness to stand trial evaluations. Amid debate surrounding notions that youth offending could be deterred by providing harsher penalties, it is important to consider fitness to stand trial in youth facing criminal proceedings. This study sought to capture a cross-sectional view of how fitness (competency) to stand trial is addressed in the Youth Court, and how evaluator opinions relate to ultimate court findings. A retrospective review of reports for fitness to stand trial in 79 youth consecutively referred to the Regional Youth Forensic Service from 2010 to 2015 was conducted. Data were combined with Youth Court outcomes obtained from the Ministry of Justice. The mean age is 15.6 years. Intellectual disability is associated with unfit opinions and legal findings (p = .002 and p = .03, respectively), and cases disposed through the Intellectual Disability (Compulsory Care and Rehabilitation) Act 2003. Immaturity itself does not appear to have a significant effect on evaluator opinions or court findings of fitness to stand trial. The majority of the referred youth were both opined and found fit.

Mental Illness Among Women Referred for Psychiatric Services in a New Zealand Women's Prison.

This naturalistic exploratory study describes the characteristics of women prisoners referred to the forensic psychiatry service of the largest women's prison in New Zealand. Forensic psychiatrists diagnosed more than one-third of the referred female inmates with psychotic disorders, and they diagnosed post-traumatic stress disorder in one-fifth. The majority of the women reported substance use prior to incarceration, as well as a history of personal victimization by family violence. Of the women prisoners referred to community mental health services at release, two-thirds attended the arranged outpatient mental health follow-up appointment. This study highlights the need for secondary prevention and rehabilitation for female inmates, and it provides suggestions for intervention. Copyright © 2016 John Wiley & Sons, Ltd.

Judicial bypass of parental consent for abortion: characteristics of pregnant minor "Jane Doe's".

Pregnant minors can obtain an abortion without parental consent through a judicial bypass procedure in 38 states. To grant such a petition in Ohio, the Court must determine that the young woman is either "sufficiently mature and well enough informed to intelligently decide whether to have an abortion," or that notification of her parents is "not in her best interest," usually due to abuse. For the sake of anonymity in these emotionally and politically charged cases, the evaluee is referred to as "Jane Doe." This project sought to describe characteristics of teenagers seeking judicial bypass for abortion, which have not been well described in the scientific literature. Data were collected from Jane Doe evaluations completed at a metropolitan juvenile court psychiatric clinic, over 3 years. The mean age of the evaluees (N = 55) was 16.4 years. The vast majority (95%) were granted a judicial bypass. They usually had long-term boyfriends of comparable age. They had often told trusted adults about their pregnancy, though not their parents, due to concerns of violence or being excluded from the family. This study presents the first comprehensive description of characteristics of minors seeking judicial bypasses for abortion. Psychiatrists may apply general principles of informed consent in such evaluations, including ascertaining whether the decision is being made voluntarily, knowingly, and with sufficient decision-making capacity.

Testifying in a mock court: the experiences of forensic advanced trainees.

OBJECTIVES: We aimed to examine the experiences of advanced trainees in forensic psychiatry as they practise testifying as expert witnesses in a mock court setting. METHODS: Five advanced trainees (including the first author) submitted court-ordered forensic reports in advance of attending the mock court. Senior colleagues had roles of Judge, prosecution and defence lawyers. House officers and medical students were summoned as jury. Over a year, each trainee had the experience of direct and cross-examination by opposing legal teams. Following the mock trial, each participant was given immediate feedback and subsequently asked to complete a semi-structured questionnaire. RESULTS: The experience of participating in a mock court has learning value for advanced trainees specialising in forensic psychiatry in anticipation of giving evidence in a court of law. Constructive feedback enabled attendees to gain valuable education in a supportive setting. Of particular value was guidance in the use of technical language in presenting evidence in a court setting, knowledge of the breadth of questions that could be put forth to an expert witness, desensitisation training in an adversarial albeit simulated setting, and acquiring skills in staying calm under pressure. CONCLUSIONS: The importance of a well-written report, good preparation and anxiety management were significant learning points.

Using Star Wars' supporting characters to teach about psychopathology.

OBJECTIVES: The pop culture phenomenon of Star Wars has been underutilised as a vehicle to teach about psychiatry. It is well known to students, registrars, and consultants alike. New Star Wars films are expected out in 2015, which will likely lead to further popularity. The purpose of this article is to illustrate psychopathology and psychiatric themes demonstrated by supporting characters, and ways they can be used to teach concepts in a hypothetical yet memorable way. CONCLUSIONS: Using the minor characters as a springboard for teaching has the benefit of students not having preconceived notions about them. Characters can be used to approach teaching about ADHD, anxiety, kleptomania and paedophilia.

Psychopathology in a Galaxy Far, Far Away: the Use of Star Wars' Dark Side in Teaching.

Star Wars is well known, timeless, universal, and incorporated into shared culture. Trainees have grown up with the movies, and based on their enduring popularity, attending psychiatrists are likely to have seen them too. This article highlights psychopathology from the Dark Side of Star Wars films which can be used in teaching. These include as follows: borderline and narcissistic personality traits, psychopathy, PTSD, partner violence risk, developmental stages, and of course Oedipal conflicts.

Teaching Psychopathology in a Galaxy Far, Far Away: The Light Side of the Force.

Star Wars films are among the top box office hits of all time. The films have been popular internationally for almost 40 years. As such, both trainees and attending psychiatrists are likely to be aware of them. This article highlights a vast array of psychopathology in Star Wars films which can be useful in teaching, even when the characters are considered the "good guys". Included are as follows: histrionic, obsessive-compulsive, and dependent personality traits, perinatal psychiatric disorders, prodromal schizophrenia, pseudo-dementia, frontal lobe lesions, pathological gambling, and even malingering. As such, Star Wars has tremendous potential to teach psychiatric trainees about mental health issues.