Under the lens: Dental expert witnesses in Brazil, Croatia, Indonesia, Italy, Saudi Arabia, and the United Kingdom.

The dentists' main job is to restore health and function to the oral cavity. However, dental professionals can also be involved in medico legal activities as forensic odontologists or by being Expert Witnesses (EW) to testify in professional liability cases, car accidents and work-related injuries. When called to act as an expert witness by the Court, the appointed dentist has to combine both biological and technical knowledge with equivalent medico-legal and forensic knowledge. Spontaneous involvement in medico-legal matters without an adequate training and experience can lead to mistakes with irreversible consequences. As an expert witness, the dentist has precise responsibility with civil and/or penal consequences, depending on the national judicial system. Dental Expert Witness, working either privately or appointed by the Court, has defined responsibilities and is subjected to civil or criminal proceedings (depending on the judicial system) if found wanting. Keeping in mind that there are significant differences regarding the requirements of becoming eligible to be a Dental Expert Witness in different legal systems. In this work the authors investigated the Judicial Systems regarding the appointment of Dental Expert Witnesses in Brazil, Croatia, Indonesia, Italy, Saudi Arabia and the United Kingdom (Table 1), in order to marshal knowledge towards harmonization and the attainment of best practice. This premise acknowledges the fact that forensic odontology must encompass the necessity for robust systems of audit and accreditation for it to be accepted as an "evidence based" forensic discipline. Further steps to ensure quality assurance in legal dentistry and forensic odontology training should be considered to prevent the spontaneous involvement of inappropriately trained dentists to become involved in making decisions that are beyond their competence and expertise.

A naturalistic trial of brief psychodynamic therapy for recurrent major depression.

We examined disposition, course, and outcome for 100 outpatients offered short-term individual dynamic therapy as a primary treatment for recurrent major depression. Evaluations using the Hamilton Rating Scale for Depression (HAM-D) were conducted regularly during the year after referral. Patients failing to show a response (50% decrease in pre-treatment HAM-D scores) were referred for consultation regarding "augmentation" of therapy with antidepressant medication. Nineteen referrals failed to meet inclusion-exclusion criteria, reflecting therapist overestimation of the severity of patients' depressive symptoms; referring therapists also missed other salient clinical issues. Fourteen patients completed assessments but did not start therapy; "decliners" were more likely to report previous admissions and thus may have opted for hospitalization. Sixty-seven patients started therapy; 18 dropped out (26.9%). Of the 49 therapy completers, 23 (46.9%) did not receive augmented treatment; 20 (40.8%) demonstrated evidence of recovery during the year while 3 (6.1%) did not. Of the 26 patients (53.1%) prescribed antidepressants, 16 (32.7%) demonstrated evidence of recovery and 10 (20.4%) did not. Patient clusters also showed distinct trajectories of change on the HAM-D over the year after referral. Patients who received augmented treatment but showed no evidence of recovery scored significantly higher on indices of alexithymia. Clinical implications of the findings are considered.

Group composition and group therapy for complicated grief.

This prospective study investigated the impact of group composition on the outcome of 2 forms of time-limited, short-term group therapy (interpretive, supportive) with 110 outpatients from 18 therapy groups, who presented with complicated grief. The composition variable was based on the patient's level of quality of object relations. The higher the percentage of patients in a therapy group who had a history of relatively mature relationships, the better the outcome for all patients in the group, regardless of the form of therapy or the individual patient's quality of object relations score. The findings have direct clinical implications for composing short-term therapy groups for outpatients with complicated grief and possibly for other types of group therapies and patient problems.

The psychodynamic psychiatry service of the University of Alberta Hospital: a thirty year history.

This paper describes the Psychodynamic Psychiatry Service (PPS) of the University of Alberta Hospital over its 30 years of development. This psychiatric organization consists of three clinical programs-an outpatient clinic and intensive day and evening programs-and an integral evaluation and research unit. The PPS is unique in its group therapy clinical orientation, its psychodynamic theoretical orientation, and its integration of an ongoing research program that establishes empirical validation of its clinical work. The productivity and longevity of this psychiatric organization appear to derive from several strengths, including cooperation between leaders of the clinical and research programs; the institution of staff relations groups in the three clinical programs; the operation of the fully integrated evaluation and research program that serves to provide empirical support for the treatments offered; and a unifying ideology characterized by the valuing of both psychodynamic and group oriented work. Other important factors to the success of the PPS include the strengths of the founder of the service and financial and other support of the academic department in which it is housed. This paper describes the historical development and present structure and functioning of the PPS, the challenges it has been confronted with, and the responses to those challenges. We conclude with factors contributing to its survival and productivity and with thoughts about the future.

NEO-five factor personality traits as predictors of response to two forms of group psychotherapy.

The relationships between patient personality variables and outcome for 107 psychiatric outpatients with complicated grief who completed either interpretive or supportive short-term group therapy were investigated. The personality variables were assessed prior to treatment with the NEO-Five Factor Inventory (NEO-FFI). For patients in both forms of therapy, extraversion, conscientiousness, and openness were directly associated with favorable treatment outcome. In contrast, neuroticism was inversely related to favorable outcome for patients in both forms of therapy. Agreeableness was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but not for those in supportive therapy. The results highlight the importance of assessing patient personality in order to predict response to short-term group therapy. Possible explanations and clinical implications of these findings are discussed.

Expression of affect as a mediator of the relationship between quality of object relations and group therapy outcome for patients with complicated grief.

In a recent study, the patient characteristic quality of object relations (QOR) was directly related to favorable outcome (reduction of grief symptoms) among a sample of 53 outpatients with complicated grief who completed treatment in 1 of 8 time-limited, interpretive therapy groups. Recent research literature has suggested that patient affect variables may mediate the relationship between QOR and outcome. In the present study, affect variables were investigated as potential mediating variables using the procedure developed by R. M. Baron and K. A. Kenny (1986). The balance of positive and negative affect expressed in therapy as rated by both patients and therapists emerged as a significant mediating variable. Explanations for how this variable works as a mediating variable and why it facilitates favorable outcome were offered. Clinical implications are also considered.

Differentiating symptoms of complicated grief and depression among psychiatric outpatients.

OBJECTIVE: This study examined whether dimensions of complicated grief (CG) could be distinguished from dimensions of depression and whether these dimensions were differentially affected by group psychotherapy for CG. METHOD: A total of 398 psychiatric outpatients who had experienced one or more significant death losses provided ratings on standard measures of grief and depression. Factor analysis of the 56 items from these measures was used to explore the possibility that grief and depression symptoms would form separate dimensions of distress. Subsamples of the patients also participated in 1 of 2 forms of short-term group therapy for CG. Repeated-measures analysis of variance and calculation of effect sizes were performed to examine changes in the dimensions following treatment. RESULTS: The grief items formed 3 distinct clusters representing different dimensions of CG. None of the depression items loaded highly on these grief dimensions. The depression items formed 2 distinct clusters. Two of the grief dimensions demonstrated the most improvement following group therapy that addressed CG. There was also evidence for differential effectiveness of the 2 forms of group therapy. CONCLUSIONS: When assessing psychiatric patients who have death losses, clinicians should consider different types of grief reactions. Different types of grief reactions may be responsive to different treatments. In the absence of depressive symptoms, clinicians should not assume the absence of CG.

Relationships among affect, work, and outcome in group therapy for patients with complicated grief.

This study examined the relationships among patient affect (experienced and expressed), work, and outcome in two forms of time-limited, short-term group therapy for complicated grief. Work was defined as the degree to which the patient pursued the primary objectives of the two forms of therapy. Substantial evidence of direct relationships between the experience and expression of positive affect and favorable outcome was found. A direct relationship between work and favorable outcome was also found. Additive and interaction effects indicated that the combination of these two types of predictor variables (positive affect, work) had a stronger relationship to favorable outcome than either variable alone. Some evidence was found for an inverse relationship between the experience and expression of negative affect and favorable outcome. The findings were consistent with a social-functional theory of the impact of affect on others during bereavement. Clinical implications of the findings are considered.

Interpersonal predictors of group therapy outcome for complicated grief.

This study investigated three aspects of patients' interpersonal functioning as predictors of outcome for two forms of group psychotherapy for complicated grief. Patients presented with a variety of death losses and met criteria for complicated grief. The three aspects of interpersonal functioning were the patient's (1) attachment to the lost person, (2) quality of object relations (QOR), and (3) level of recent social role functioning. A more secure attachment to the lost person and better social role functioning were associated with more favorable outcome in both forms of therapy. In addition, patients with higher QOR had more favorable outcome in interpretive therapy while lower QOR patients had more favorable outcome in supportive therapy. The results suggest that each aspect of interpersonal functioning is important to consider when treating patients for complicated grief.

Social support as a predictor of response to group therapy for complicated grief.

This study investigated the effect of perceived social support on the outcome of group therapy for patients who experienced complicated grief following a variety of death losses. One hundred and seven psychiatric outpatients, who received either interpretive or supportive group therapy, rated their perceptions of social support from three sources (family, friends, and a special person) prior to treatment onset. For patients in both forms of therapy, perceived social support from friends was directly associated with favorable treatment outcome. In contrast, perceived social support from family was inversely related to outcome for patients in both forms of therapy. Perceived social support from a special person was directly related to favorable improvement in grief symptomatology for patients in interpretive therapy, but unrelated for those in supportive therapy. The results highlight the importance of assessing the level of support patients perceive from their social networks. The findings also suggest that the effect of perceived social support may also depend on the source of the support. Possible explanations and clinical implications of these findings are discussed.