Forensic neuropsychiatric evaluation of a personal injury case.

Civil litigation involving the forensic neuropsychiatric evaluation of a personal injury case requires an assessment of damages and causation. The expert witness is obliged to integrate data from three critical sources of information: the review of records; the results of neuropsychological testing; and the findings from the clinical examination. In civil litigation involving a personal injury claim, the expert witness can be expected to address causation and prognosis of any neuropsychiatric damages. We discuss the undertaking of a forensic neuropsychiatric evaluation, psychiatric disorders often encountered in personal injury litigation, provide case vignettes and describe a number of special types of forensic neuropsychiatric evaluations, for example, Workers' Compensation, VA Disability and Social Security Disability.

Commentary: the cost of converting religious morals into politics.

Theologically informed positions are grounded in core beliefs and may be rationally discussed. We analyze Dr. Norko's suggestion on how, in the public square, to address moral disagreements. We point out the dangers of "deliberative democracy" as an approach to resolving conflicts over basic values. We suggest an alternative approach, better grounded in reason, as a way of bringing religious and secular views into a discussion of the death penalty.

Legal fallacies of antipsychotic drugs.

Advances in the biological sciences have dramatically improved the understanding of schizophrenia and related psychotic illnesses. One of the most compelling findings is the substantial degree to which cognition is impaired in these illnesses and the remedial effects that antipsychotic drugs have in treating these cognitive impairments. Despite these promising discoveries, legal cases and scholarship remain replete with pejorative associations with antipsychotic drug action. References to antipsychotic medications as mind-altering drugs and their effects as "synthetic sanity" misconstrue the beneficial effects these medicines have on cognition. We review the prevailing legal attitude of antipsychotic medications and contrast these views with prevailing scientific knowledge. We conclude that legal opinion is misinformed about the effects of antipsychotic medications on cognition.

Expert testimony in capital sentencing: juror responses.

The U.S. Supreme Court, in Furman v. Georgia (1972), held that the death penalty is constitutional only when applied on an individualized basis. The resultant changes in the laws in death penalty states fostered the involvement of psychiatric and psychologic expert witnesses at the sentencing phase of the trial, to testify on two major issues: (1) the mitigating factor of a defendant's abnormal mental state and (2) the aggravating factor of a defendant's potential for future violence. This study was an exploration of the responses of capital jurors to psychiatric/psychologic expert testimony during capital sentencing. The Capital Jury Project is a multi-state research effort designed to improve the understanding of the dynamics of juror decision-making in capital cases. South Carolina data (n = 214) were used to investigate the impact of expert testimony on the mitigating factor of mental illness and the aggravating factor of future dangerousness. Ordered logit regression analyses revealed significant correlations (p < .005) between the presence of a defense psychiatrist or psychologist expert witness during the sentencing phase and jurors' having the impression that the defendant was mentally disturbed. Similar analyses revealed no significant relationship between the presence of state-introduced psychiatric testimony and jurors' having the impression that the defendant, if not executed, would be violent in the future. These findings seem to contradict the view that psychiatric testimony on future dangerousness in death penalty cases has a powerful impact on jurors. The jurors in this study were significantly influenced, however, by psychiatric/psychologic testimony in the area of a defendant's mitigating mental abnormality.

Factors predictive of changes in the legal status of psychiatric inpatients.

The objective of this study was to identify factors predictive of duration of involuntary hospitalization, i.e., factors that would predict early versus late conversion to voluntary status. Charts of 209 patients admitted involuntarily to an acute psychiatric inpatient unit were studied using a naturalistic, prospective design. Multivariate regression analysis was used to determine the effect of a number of variables in predicting duration of involuntary hospitalization. Of all variables studied, only smoking preference was found to be a statistically significant predictor of duration of involuntary hospitalization. Smokers were converted to voluntary status earlier than non-smokers. The authors concluded that clinicians may not be using commitment statutes as per recommended legal guidelines. Patients who smoke may be applying overt and covert pressure on clinicians with regard to conversion to voluntary status to gain smoking privileges.

Commentary: forensic education and the quest for truth.

Forensic psychiatry is the subspecialty that applies psychiatric knowledge to answering legal questions. There are ethics dilemmas inherent in its practice and in functioning at the interface of psychiatry and the law. The development of the American Academy of Psychiatry and the Law (AAPL) Ethics Guidelines was an effort to assist forensic psychiatrists in dealing with these dilemmas and the moral adventure of practicing in their field. The responses to the Guidelines that explored other frameworks for dealing with the ethical practice of forensic psychiatry are acknowledged, with an emphasis on applied clinical ethics. The study of ethics in forensic psychiatry should be added to Dr. Scott's list and should be part of the effort to teach AAPL members and forensic psychiatry fellows about important developments in their discipline.