Capital sentencing and neuropsychiatry.

The neuropsychiatric contribution to capital sentencing proceedings has grown substantially in recent decades as the consideration of neurological and psychiatric factors in criminal behavior has been increasingly accepted as relevant to the quest for justice. This review article will focus on the legal theories underlying neuropsychiatric input into capital sentencing decisions, as well as some of the investigative techniques and resulting data which may be offered by forensic neuropsychiatrists in this context. The death penalty is unique in its severity and irreversibility, as the courts, including the U.S. Supreme Court, have noted repeatedly. "Death is different," and the recognition of this has generated a set of court decisions and statutes pertinent specifically to capital proceedings, both procedural and substantive.

The pharmacologic treatment of problematic sexual interests, paraphilic disorders, and sexual preoccupation in adult men who have committed a sexual offence.

This paper provides an international perspective on the use of medications to treat problematic sexual interests, paraphilic disorders, and sexual preoccupation in men who have committed a sexual offence. Experts from Canada, the Czech Republic (CR), Russia, the United Kingdom, and the United States met in Prague, CR in May 2017 to review and compare their treatment approaches. This report is a summary of their discussions, including empirical data from CR and Russia which have not previously been published in the English language. All participants agreed that continuing international collaboration would be very useful for the development of ethical international prescribing guidelines, as well as pooling data from studies on the efficacy and utility of pharmacological and other biological treatments for people who have committed sexual offences.

Androgen deprivation treatment of sexual behavior.

Gonadotropin-releasing hormone agonists are underutilized in patients seeking diminution of problematic sexual drives. This chapter reviews the literature on surgical castration of sex offenders, anti-androgen use and the rationale for providing androgen deprivation therapy, rather than selective serotonin reuptake inhibitors or more conservative interventions, for patients with paraphilias and excessive sexual drive. Discussions of informed consent, side effects, contraindications and case examples are provided.

Risk Assessment of Online Child Sexual Exploitation Offenders.

Over the past two decades in the United States, a dramatic increase in access to the Internet has facilitated an increase in the production, viewing, and distribution of child pornography. In this context, forensic mental health professionals may be called on to estimate the risk of future violence, especially of contact sexual offenses, among individuals charged with online sexual offenses. We summarize demographic and clinical characteristics that differentiate online from contact and "mixed" offenders (those who commit both online and contact offenses), offending histories of these three groups, and the current state of knowledge regarding risk of progression from online-only to contact offending. Multiple studies suggest that online, contact, and mixed offenders demonstrate distinct profiles, and wide variations exist in the offense histories of online-offending groups. Longitudinal studies of individuals charged with online offenses are few in number and are mostly limited to detection of formal charges. Nevertheless, available studies suggest that most individuals who are charged with online offenses and who do not have histories of contact offenses are unlikely to engage in future contact offenses. Within the limitations of the current literature, we suggest guidance for the evaluation and treatment of online offenders.

Commentary: Craving diagnostic validity in DSM-5 Substance Use Disorders.

Drs. Norko and Fitch examine questions raised by DSM-5 in the forensic context of criminal defendant diversion to treatment, where eligibility has commonly relied on the view that addiction to alcohol or drugs is distinct from alcohol or drug use, misuse, and abuse. The creation in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), of the new unidimensional spectrum diagnosis of Substance Use Disorder (SUD), which includes three Abuse criteria from DSM-IV, has resulted in a need to re-examine policies that evolved with the DSM-III-R/DSM-IV biaxial abuse-dependence conceptual paradigm. DSM-5 acknowledges the common usage of the term addiction to describe severe problems, and that some clinicians choose to use the word to describe more extreme presentations. Limiting the concept of addiction to the severe form of DSM-5 SUD would maximize validity and support for an expert opinion that an individual has an addiction, as well as facilitate research inquiry into the underlying psychobiological nature of addiction. However, in some contexts, such as criminal diversion, achieving such specificity at the expense of sensitivity may be undesirably restrictive if it excludes appropriate candidates. Future research and experience in both clinical and forensic settings are needed for a fuller understanding of the DSM-5 SUD diagnoses and associated real-world implications.

Drug testing in the workplace: integrating medical review officer duties into occupational medicine.

The authors discuss the social and political climate of drug testing in the workplace, the role of the medical review officer, Federal guidelines, and toxicology methods. The Americans with Disabilities Act is also briefly discussed, and the chapter closes with a case study.