Forensic psychiatric issues in intellectual disability.

Forensic psychiatrists and neuropsychiatrists are likely to encounter individuals with intellectual disability as they are over-represented in the judicial system. These individuals may have the full range of mental illnesses and comorbid conditions, including physical infirmity, sensory deficits, language impairment, and maladaptive behaviors. They are frequently disadvantaged in the judicial system due to lack of comprehension, lack of accommodations, and stigmatization. Decision making capacity may need to be assessed for health care, sexual autonomy, marriage, financial management, making a will, and need for guardianship. The usual approach to conducting an evaluation needs adaptation to fit the unique characteristics and circumstances of the individual with intellectual disability. The forensic consultant can assist attorneys, defendants, and victims in recommending accommodations and the expert witness can provide education to juries.

Psychiatric disorders in people with intellectual disability (intellectual developmental disorder): forensic aspects.

PURPOSE OF THE REVIEW: Persons with intellectual disability come into frequent and underreported contact with the legal system. Advances in forensic psychiatry help better identify persons with intellectual disability in forensic contexts, inform evaluation and treatment, and elucidate unique characteristics of this population. With the release of Diagnostic and Statistical Manual of Mental Disorders (DSM-5), forensic psychiatrists must adjust to changes in the diagnostic process. RECENT FINDINGS: This review examines the past year's contributions to the literature, including predictors among offenders with intellectual disability, concurrent diagnoses, efficacy of competence restoration, means of studying individuals with intellectual disability, and impact of DSM-5. SUMMARY: Impoverished personal relationships are found to be an important predictor of offense among persons with intellectual disability. A Personality Disorder Characteristics Checklist allows screening for personality disorders (indicative of increased risk of violence) among intellectual disability offenders. Referrals to specialists for treatment more often occur for violent and sexual offenses than for other offenses. Competence restoration is historically low among those with intellectual disability, specially compared with those referred for substance abuse and personality disorders. However, the Slater Method results in higher rates of restoration than traditional training methods. DSM-5 alters the definition of intellectual disability, moving from an IQ-oriented diagnosis system to a multifaceted approach, introducing more flexibility and nuance.

Do forensic practitioners distinguish between testifying and consulting experts? A pilot study.

Forensic mental health professionals (n=44) reviewed a series of statements that an attorney might make to a consulting or testifying expert. Each statement was rated for its degree of appropriateness to either the consulting or the testifying role. In light of increasing attention paid to this topic in the forensic practice literature, as well as long-standing distinctions recognized by the legal profession, it was originally hypothesized that participants would differentiate clearly between these roles; however, results of this pilot study indicate that forensic practitioners do not possess a consistent sense of which activities rest most comfortably within testimonial as opposed to consulting duties.

Clinicians imagine a patient's view: Rating disclosures of confidential information.

Consent to disclosure of confidential information is a cornerstone of the clinician-patient relationship; however, changes in the legal, regulatory, and technological landscape affecting patient confidentiality have brought increasing conflict between ethics-based commitments and the realities of practice. In this pilot study, 119 mental-health clinicians completed a questionnaire that measured levels of disapproval of disclosures of confidential information to various third parties. Clinicians were asked to respond as though they were patients whose information was to be disclosed. Clinicians, taking a patient's perspective, most disapproved of disclosures to anyone who wanted the information and to entities that marketed pharmaceutical, medical, or other products. They were progressively less uncomfortable with disclosures to family members, for educational use without consent but with de-identification, to insurance companies, to pharmacists, to journals, for educational purposes in training other clinicians, and for research. They were least disapproving of disclosures to other clinicians. Based on this initial study of clinicians taking a patient's perspective, clinicians will do well to inform patients about disclosure practices at least as fully as they themselves would want to be informed.