RESUMEN
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.
Asunto(s)
Criminales , Discapacidad Intelectual , Trastornos Mentales , Trastornos Psicóticos , Humanos , Estados Unidos , Defensa por Insania , Psiquiatría Forense , Trastornos Mentales/psicología , Salud Mental , Derecho PenalRESUMEN
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.
Asunto(s)
Armas de Fuego/legislación & jurisprudencia , Conocimientos, Actitudes y Práctica en Salud , Enfermos Mentales/legislación & jurisprudencia , Psiquiatría , Adulto , Anciano , Derechos Civiles/legislación & jurisprudencia , Femenino , Humanos , Masculino , Persona de Mediana Edad , South CarolinaRESUMEN
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.
RESUMEN
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.
Asunto(s)
Decepción , Trastornos Mentales/psicología , Adulto , Trastorno Depresivo Mayor/psicología , Psiquiatría Forense , Humanos , Entrevista Psicológica , MasculinoRESUMEN
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.
Asunto(s)
Psiquiatría Forense/educación , Procesos de Grupo , Modelos Organizacionales , Derivación y Consulta/ética , HumanosAsunto(s)
Competencia Clínica , Toma de Decisiones Clínicas/métodos , Grupo de Atención al Paciente/organización & administración , Médicos , Cirujanos , Humanos , Comunicación Interdisciplinaria , Selección de Paciente , Médicos/psicología , Médicos/normas , Psiquiatría/métodos , Mejoramiento de la Calidad , Medición de Riesgo/métodos , Medición de Riesgo/organización & administración , Cirujanos/psicología , Cirujanos/normasAsunto(s)
Estriol/efectos adversos , Terapia de Reemplazo de Estrógeno , Estrógenos/efectos adversos , Medicamentos sin Prescripción/efectos adversos , Trastornos Psicóticos/etiología , Síndrome de Abstinencia a Sustancias , Estradiol/administración & dosificación , Estradiol/efectos adversos , Estriol/administración & dosificación , Estrógenos/administración & dosificación , Estrógenos/farmacología , Femenino , Alucinaciones/inducido químicamente , Humanos , Internet , Entrevista Psicológica , Aplicación de la Ley , Lorazepam/uso terapéutico , Persona de Mediana Edad , Posmenopausia , Trastornos Psicóticos/tratamiento farmacológico , Trastornos Psicóticos/psicología , Violencia/psicologíaAsunto(s)
Antialérgicos/efectos adversos , Cetirizina/efectos adversos , Discinesia Inducida por Medicamentos/diagnóstico , Discinesia Inducida por Medicamentos/etiología , Rinitis Alérgica Estacional/tratamiento farmacológico , Antialérgicos/uso terapéutico , Cetirizina/uso terapéutico , Disartria/inducido químicamente , Disartria/diagnóstico , Femenino , Humanos , Síndrome de Abstinencia a Sustancias/diagnóstico , Adulto JovenRESUMEN
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.
Asunto(s)
Acetamidas/efectos adversos , Trastornos de Alimentación y de la Ingestión de Alimentos/inducido químicamente , Hipnóticos y Sedantes/efectos adversos , Pirimidinas/efectos adversos , Trastornos del Sueño-Vigilia/inducido químicamente , Amnesia/inducido químicamente , Amnesia/complicaciones , Relación Dosis-Respuesta a Droga , Trastornos de Alimentación y de la Ingestión de Alimentos/complicaciones , Femenino , Humanos , Persona de Mediana Edad , Trastornos del Sueño-Vigilia/complicacionesRESUMEN
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.
Asunto(s)
Control de Costos , Trastornos Fingidos/diagnóstico , Hospitalización/economía , Personal Militar/psicología , Hospitalización/estadística & datos numéricos , Humanos , Tiempo de Internación/economía , Tiempo de Internación/estadística & datos numéricos , Masculino , Estados Unidos , Adulto JovenRESUMEN
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.
RESUMEN
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.
Asunto(s)
Antipsicóticos/efectos adversos , Fibrilación Atrial/inducido químicamente , Benzodiazepinas/efectos adversos , Trastorno Bipolar/tratamiento farmacológico , Enfermedad Aguda , Antipsicóticos/uso terapéutico , Fibrilación Atrial/diagnóstico , Benzodiazepinas/uso terapéutico , Electrocardiografía/efectos de los fármacos , Humanos , Masculino , Persona de Mediana Edad , OlanzapinaRESUMEN
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.