Mental health criminal defenses in persons with neuropsychiatric disorders.

Persons with neuropsychiatric disorders present specific and unique challenges for forensic experts and defense attorneys in the criminal justice system. This article reviews two potential criminal defenses: legal insanity and the various legal standards or tests of criminal responsibility that are used in jurisdictions throughout the United States (i.e., the M'Naghten standard and the American Law Institute's Model Penal Code), and the partial legal defense of diminished capacity (lacking the mental state necessary to be found guilty of a specific intent crime). The process of evaluating criminal responsibility or diminished capacity is also presented with a specific emphasis on common issues that arise in evaluating defendants with Intellectual Developmental Disorder (Intellectual Disability), Parasomnias, Seizure Disorders, and Neurocognitive Disorders.

Knowledge and Attitudes of Psychiatrists About the Gun Rights of Persons With Mental Illness.

Individuals with mental illness have often been misperceived by the public to pose a higher risk of violence to others. Consequently, the United States government and many individual states have enacted laws barring firearm access for certain individuals with mental illness. Many of these laws allow for eventual restoration of firearm access (i.e., relief from firearm disability (RFD)). This study assesses the knowledge base and attitudes of psychiatrists practicing in South Carolina regarding these gun laws. Results of this study indicate that psychiatrists in South Carolina have significant knowledge deficits pertaining to gun laws that both restrict gun ownership and allow restoration of gun ownership rights for persons with mental illness; these deficits may apply to practitioners in other states as well. The only variable that predicted a greater knowledge about limitations on gun rights was whether a psychiatrist had a patient who was prohibited from gun ownership. South Carolina psychiatrists had more favorable attitudes about restricting gun access for persons with mental illness than about supporting the right of persons with mental illness to own a gun. Finally, if psychiatrists owned a firearm, they were more likely to support the right of persons with mental illness to own a firearm.

Prolonged hospitalization and diagnostic clarification saves U.S. Air Force $650,000 in unwarranted disability payments.

Over the last few decades in health care a premium has been placed on decreasing the length of stay. Cost containment measures and more effective psychotropic medications have fueled this trend. The new paradigm is "diagnose, stabilize quickly, and discharge to outpatient setting." Although in the short run this model saves money, it is at the cost of an accurate diagnosis; however, in the long run the costs far exceed the initial savings, especially in today's dismal economy. This editorial presents a case report where prolonged psychiatric hospitalization and diagnostic clarification saved the U.S. Air Force $650,000 in unwarranted disability payments.

Malpractice Law and Psychiatry: An Overview.

Fortunately, psychiatrists are less likely to be sued for malpractice than most physicians in other specialties. However, once sued, psychiatrists must navigate a complicated and nonintuitive legal process. This article reviews the major elements of a malpractice claim, the litigation process in medical malpractice cases, and the common allegations of negligence that are encountered in such cases. The major types of malpractice insurance coverage are reviewed, and recommendations about liability prevention and how to best respond to a malpractice action are presented.

Implications of Pseudologia Fantastica in Criminal Forensic Evaluations: A Review and Case Report.

Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendant's rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.

Shared psychotic disorder and criminal responsibility: a review and case report of folie à trois.

We present a case of shared psychotic disorder involving three sisters who were successful in establishing an insanity defense on numerous felony charges in the South Carolina criminal court system. Two of the authors of this article were court-appointed examiners in this case. We then present a history of shared psychotic disorder, an overview of the use of this diagnosis in the defense of insanity, and a discussion of the disposition of individuals with "temporary insanity." Finally, we compare shared psychotic disorder, culturally based belief systems, and religious cults, with a focus on their common and contrasting characteristics.

Implications of the Group Model of Supervision and Consultation in Forensic Training.

The clinical case conference has been a hallmark of undergraduate and graduate medical education for decades and affords attendees the opportunity to hear about interesting and difficult cases and to learn from a discussion of the complexities of diagnosis and treatment. In forensic psychiatry, the complexities in a case conference also extend to the formation of a forensic opinion. The application of the clinical case conference to forensic psychiatry has not been described in the literature, although many fellowship programs engage in this activity. In the forensic arena, special ethics concerns may arise regarding confidentiality, dual agency, and conflicts of interest. In this commentary, we discuss the implications of using the group approach to supervision and consultation outlined by Buchanan et al., as it relates to professional development and understanding of ethics among forensic psychiatry trainees. We also discuss the usefulness of this type of group consultation in faculty development, including the satisfaction of the Accreditation Council of Graduate Medical Education's (ACGME) Common Program Requirements and, potentially, one part of the Maintenance of Certification requirements of the American Board of Psychiatry and Neurology, Inc.

Psychiatric advance directives.

Psychiatric advance directives are gaining attention as the number of consumers seeking metal health services increases. Even though medical advance directives have existed for years, psychiatric advance directives are in their infancy. The goal of these directives is to increase patient autonomy and decrease coercive treatment. Although this concept sounds simple, advance directives have generated heated debates that encompass ethics, law, and medicine. Psychiatric advance directives are also not universally accepted--only 14 states currently recognize such directives. This review article discusses the premise behind psychiatric advance directives and explores possible benefits and obstacles to the use of such directives.

A case of delusional parasitosis associated with multiple lesions at the root of trigeminal nerve.

The authors present a patient with multiple pontine lesions who exhibited symptoms consistent with delusional parasitosis. The trigeminal nerve nuclei are located throughout the brainstem. Pathology in either the nuclei or the branches of the fifth cranial nerve has been associated with both sensory and motor disturbances. Delusional parasitosis is a condition in which the patient has the firm belief that small, living organisms have infested his or her skin or other organs. To our knowledge, this is the first case report of delusional parasitosis associated with lesions at the root of the trigeminal nerve.

Clozapine-induced bowel infarction: a case report.

Resistant schizophrenia is often treated with clozapine after other conventional atypical antipsychotics have failed or have resulted in intolerable side effects. Clozapine is generally reserved for secondary use due to its propensity to cause serious side effects, such as life-threatening agranulocytosis and the necessity for life-long blood monitoring. In this case report we present a 40-year-old female patient who suffered from chronic constipation and bowel infarctions after long-term use with clozapine. Although the use of this medication resulted in multiple abdominal surgeries with subtotal colonic resections, the patient's schizophrenic symptoms only responded to clozapine after several repeat failures with other medications; ultimately, she was continued on this medication.

Snapshot of air force psychiatry: wilford Hall medical center.

In line with Psychiatry 2009's mission to strengthen its global presence as a leading source of evidence-based information for practicing clinicians, we are pleased to launch the new column, "Psychiatric Clinics from Around the World." This series will enable readers to become familiar with facilities around the world that provide psychiatric care. We hope you find the column interesting. We start the series with a column featuring Wilford Hall Medical Center, the flagship psychiatric facility of the United States Air Force.United States Air Force psychiatry plays a vital role in Operation Iraqi Freedom and Operation Enduring Freedom (Afghanistan). Outside of the military, little is known about US Air Force psychiatry and the Wilford Hall Medical Center. Wilford Hall Medical Center is the US Air Force's flagship hospital and premiere psychiatric hospital. This article briefly discusses the history of Wilford Hall Medical Center and its psychiatric contributions to the wars in Iraq and Afghanistan.

Executive function and capacity to consent to a noninvasive research protocol.

OBJECTIVE: This study measured the association between executive function and decision-making capacity in subjects consenting to a noninvasive research protocol. METHOD: Subjects consenting to a noninvasive research protocol (N = 21; mean age: 65.5 [standard deviation: 9.2] years) were administered a modified version of The MacArthur Competency Assessment Tool-Treatment (MacCAT-T), Executive Interview (EXIT25), Executive Clock Drawing Task (CLOX), and Mini-Mental State Examination (MMSE). RESULTS: The EXIT25 was the only instrument to correlate with each decision-making capacity domain: understanding, appreciation, and reasoning. CONCLUSIONS: Executive function as measured by the EXIT25 is associated with multiple decision-making capacity domains.