Monday, June 24, 2013

General Psychiatry News Review In Brief

In Debate Over Military Sexual Assault, Men Are Overlooked Victims - NYT

The New York Times

June 23, 2013

In Debate Over Military Sexual Assault, Men Are Overlooked Victims

Sexual assault has emerged as one of the defining issues for the military this year. Reports of assaults are up, as are questions about whether commanders have taken the problem seriously. Bills to toughen penalties and prosecution have been introduced in Congress.
But in a debate that has focused largely on women, this fact is often overlooked: the majority of service members who are sexually assaulted each year are men.
In its latest report on sexual assault, the Pentagon estimated that 26,000 service members experienced unwanted sexual contact in 2012, up from 19,000 in 2010. Of those cases, the Pentagon says, 53 percent involved attacks on men, mostly by other men.
“It’s easy for some people to single out women and say: ‘There’s a small percentage of the force having this problem,’ ” said First Lt. Adam Cohen, who said he was raped by a superior officer. “No one wants to admit this problem affects everyone. Both genders, of all ranks. It’s a cultural problem.”
Though women, who represent about 15 percent of the force, are significantly more likely to be sexually assaulted in the military than men, experts say assaults against men have been vastly underreported. For that reason, the majority of formal complaints of military sexual assault have been filed by women, even though the majority of victims are thought to be men.
“Men don’t acknowledge being victims of sexual assault,” said Dr. Carol O’Brien, the chief of post-traumatic stress disorder programs at the Bay Pines Veterans Affairs Health Care System in Florida, which has a residential treatment program for sexually abused veterans. “Men tend to feel a great deal of shame, embarrassment and fear that others will respond negatively.”
But in recent months, intense efforts on Capitol Hill to curb military sexual assault, and the release of a new documentary about male sexual assault victims in the military, “Justice Denied,” have brought new attention to male victims. Advocates say their plight shows that sexual assault has risen not because there are more women in the ranks but because sexual violence is often tolerated.
“I think telling the story about male victims is the key to changing the culture of the military,” said Anuradha K. Bhagwati, executive director of the Service Women’s Action Network, an advocacy group that has sharply criticized the Pentagon’s handling of sexual assault. “I think it places the onus on the institution when people realize it’s also men who are victims.”
The Department of Defense says it is developing plans to encourage more men to report the crime. “A focus of our prevention efforts over the next several months is specifically geared towards male survivors and will include why male survivors report at much lower rates than female survivors, and determining the unique support and assistance male survivors need,” Cynthia O. Smith, a department spokeswoman, said in a statement.
In interviews, nearly a dozen current and former service members who said they were sexually assaulted in the military described fearing that they would be punished, ignored or ridiculed if they reported the attacks. Most said that before 2011, when the ban on openly gay service members was repealed, they believed they would have been discharged if they admitted having sexual contact — even unwanted contact — with other men.
“Back in 1969, you didn’t dare say a word,” said Gregory Helle, an author who says he was raped in his barracks by another soldier in Vietnam. “They wouldn’t have believed me. Homophobia was big back then.”
Thomas F. Drapac says he was raped on three occasions by higher-ranking enlisted sailors in Norfolk in 1966. He said he had been drinking each time and feared that if he told prosecutors they would assume it was consensual sex. Parts of his story are corroborated in Department of Veterans Affairs records.
“If you made a complaint, then you are gay and you’re out and that’s it,” he said.
Mr. Drapac, 66, said that over the coming decades he kept the rapes to himself, combating recurring nightmares and doubts about his sexuality with alcohol and drugs. But he began seeing a Department of Veterans Affairs therapist several years ago, and decided to tell his story recently after seeing accounts of female sexual assault victims.
“The best thing going on right now is that the women’s issue is coming to the fore and you see some mention about male rapes,” he said.
Many sexual assaults on men in the military seem to be a form of violent hazing or bullying, said Roger Canaff, a former New York State prosecutor who helped train prosecutors on the subject of military sexual assault for the Pentagon. “The acts seemed less sexually motivated than humiliation or torture-motivated,” he said.
But such attacks can be deeply traumatizing, causing men to question their sexuality or view themselves as weak. Some said their own families seemed ashamed of them.
“Being a male victim is horrible,” said Theodore James Skovranek II, who said he was sexually hazed in the Army in 2003. Some people told him the attack, in which another soldier shoved his genitals in his face after they had been drinking with friends, was not a big deal. But it made him question his manhood.
“I walked around for a long time thinking: I don’t feel like a man,” said Mr. Skovranek, who left the Army in 2005. “But I don’t feel like a woman either. So there’s just this void.”
Rick Lawson said that while he was in the Army National Guard in Washington in 2003 and 2004, he was repeatedly sexually bullied by a group of soldiers, including a sergeant who rubbed his groin into Mr. Lawson’s buttocks and jumped into his bunk and pretended to cuddle with him. Later, during preparations for deployment to Iraq, one sergeant handcuffed him and put him in a headlock while another pretended to sodomize him, Mr. Lawson said.
Several months after his unit arrived in Iraq in 2004, Mr. Lawson decided to report the bullying. His assailants were punished with reduced rank, Army records show, but he had to finish his deployment while living near them on the same base.
After he returned to Washington, he received a diagnosis of post-traumatic stress disorder and was discharged from the Army in 2006. He struggled with depression and lost a job, then decided to start an advocacy group for veterans.
“A lot of people say this problem exists because we are allowing women into the military or because of the repeal of ‘don’t ask, don’t tell,’ ” he said, referring to the ban on openly gay service members. “But that is absurd. The people who perpetrated these crimes on me identify as heterosexual males.”
Although the vast majority of military sexual assaults are by men, a small number of men have reported being raped by women.
Richard H. Ruffert, 50, said his boss in an Army reserve unit in Texas forced him to have sex with her by threatening to give him poor reviews. He said the sex continued for about two months in the late 1990s, until he attempted suicide. He then told a commander and, after a lengthy investigation, his boss was transferred. But he believes that she was never punished.
He retired from the military in 2004 and spent several years struggling with nightmares, drug addiction and homelessness, which he blames on the sexual assault. Therapy and working with veterans have helped him, he said.
But he does not feel comfortable dating women anymore. “This has completely changed my life,” said Mr. Ruffert, who appears in the film “Justice Denied.”
Many experts believe that the repeal of “don’t ask, don’t tell” will cause many more men to report sexual assault. That was the case with Lieutenant Cohen, who says he was raped in 2007 by an Army officer he had met in graduate school. At the time, Lieutenant Cohen was preparing to join the Air Force.
After initially remaining silent about the episode, he filed a complaint with Air Force investigators in late 2011, after the ban was rescinded. But the investigation took a surprising turn: after Lieutenant Cohen returned from a five-month tour in Afghanistan, he learned that he had become the subject of the investigation and was no longer viewed as a victim.
The lieutenant, 29, now faces a court-martial trial on multiple charges, including conduct unbecoming an officer. Lieutenant Cohen’s special victims counsel, Maj. John Bellflower, said the Air Force investigators apparently used information provided voluntarily by the lieutenant in bringing the charges against him, a possible violation of his rights.
The military recently told Lieutenant Cohen that it was reopening the sexual assault case. In the meantime, he faces a trial in July that he views as punishment for filing a criminal complaint against a superior officer. The Air Force denies that.
“I think the attention to this issue is absolutely needed,” Lieutenant Cohen said. “But it’s a little bit late. We still have attacks, and we still have retaliation.”

Wednesday, June 19, 2013

Salem witchcraft and lessons for contemporary forensic psychiatry


Salem witchcraft and lessons for contemporary forensic psychiatry.


Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Cleveland, OH 44106.


In 1692 and 1693, in Salem, Massachusetts, more than 150 colonists were accused of witchcraft, resulting in 19 being hanged and one man being crushed to death. Contributions to these events included: historical, religious and cultural belief systems; social and community concerns; economic, gender, and political factors; and local family grievances. Child witnessing, certainty of physician diagnosis, use of special evidence in the absence of scholarly and legal scrutiny, and tautological reasoning were important factors, as well. For forensic psychiatry, the events at Salem in 1692 still hold contemporary implications. These events of three centuries ago call to mind more recent daycare sexual abuse scandals.
[PubMed - in process]

News Reviews: Mike Nova comments: However, this (which I agree w...

News Reviews: Mike Nova comments: However, this (which I agree w...: The New York Times  · 3,087,575 like this about an hour ago  near  New York  ·  "The brain is not the mind," wr...

Tuesday, June 18, 2013

World Psychiatry. 2013 Jun;12(2):111-2. doi: 10.1002/wps.20027. The past, present and future of psychiatric diagnosis. Frances A.

The past, present and future of psychiatric... [World Psychiatry. 2013] - PubMed - NCBI

1 Share
World Psychiatry. 2013 Jun;12(2):111-2. doi: 10.1002/wps.20027.

The past, present and future of psychiatric diagnosis.


Department of Psychiatry, Duke University, Durham, NC, USA.
Free full text

The DSM-5: Classification and criteria chan... [World Psychiatry. 2013] - PubMed

1 Share
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) marks the first significant revision of the publication since the DSM-IV in 1994. Changes to the DSM were largely informed by advancements in neuroscience, clinical and public health need, and identified problems with the classification system and criteria put forth in the DSM-IV. Much of the decision-making was also driven by a desire to ensure better alignment with the International Classification of Diseases and its upcoming 11th edition (ICD-11). In this paper, we describe select revisions in the DSM-5, with an emphasis on changes projected to have the greatest clinical impact and those that demonstrate efforts to enhance international compatibility, including integration of cultural context with diagnostic criteria and changes that facilitate DSM-ICD harmonization. It is anticipated that this collaborative spirit between the American Psychiatric Association (APA) and the World Health Organization (WHO) will continue as the DSM-5 is updated further, bringing the field of psychiatry even closer to a singular, cohesive nosology.
Copyright © 2013 World Psychiatric Association.

Social Science [?] Medicine

1 Share

This post has been generated by Page2RSS

My 12 Best Tips on Psychiatric Diagnosis

1 Share
We already had a crisis in psychiatric diagnosis before DSM-5. It is a sure sign of excess that 25% of us reportedly qualify for a mental disorder and that 20% are on psychiatric medication. Unless checked, DSM-5 will open the floodgates and may turn current diagnostic inflation into future hyperinflation.

International Journal of Law and Psychiatry - from Pubmed - Review

The British Journal of Psychiatry - from Pubmed - Review

World psychiatry: official journal of the World Psychiatric Association (WPA) - from Pubmed - Review

The American Journal of Psychiatry - from Pubmed - Review

My 12 Best Tips on Psychiatric Diagnosis - By Allen Frances, M.D.

My 12 Best Tips on Psychiatric Diagnosis

1 Share
We already had a crisis in psychiatric diagnosis before DSM-5. It is a sure sign of excess that 25% of us reportedly qualify for a mental disorder and that 20% are on psychiatric medication. Unless checked, DSM-5 will open the floodgates and may turn current diagnostic inflation into future hyperinflation.
Below are my 12 tips on how best to ensure accurate and safe diagnosis:
(1) The less severe the presentation, the more difficult it is to diagnose. There is no bright line demarcating the very heavily populated boundary between mental disorder and normality. Milder problems often resolve spontaneously with time and without need for diagnosis or treatment.
(2) When in doubt, it is safer and more accurate to underdiagnose. It’s easier to step up to a more severe diagnosis than to step down from it.
(3) Children and teenagers are especially hard to diagnose. They have a short track record, varying rates of maturation, may be using drugs, and are reactive to family and environmental stresses. The initial diagnosis is likely to be unstable and inappropriate.
(4) Mental illness is hard to diagnose in the elderly. Their psychiatric symptoms may be caused by medical and neurological illness and they are prone to drug side effects, interactions, and overdose.
(5) Take the time and make the effort. It takes time to make the right diagnosis—adequate time for each interview and often multiple interviews over time to see how things are evolving. Except for classic presentations, a quick diagnosis is usually the wrong diagnosis.
(6) Get all the information you can. No one source is ever complete. Triangulation of data from multiple information sources leads to a more reliable diagnosis.
(7) Consider previous diagnoses—but don’t blindly believe them. Based on their tenure, incorrect diagnoses tend to have a long half-life and unfortunate staying power. Always do your own careful evaluation of the patient’s entire longitudinal course.
(8) Constantly revisit the diagnosis. This is especially true when someone is not benefiting from a treatment that is based on it. Clinicians can get tunnel vision once they’ve fixed on a diagnosis, become too married to it, and are blinded to contradictory data.
(9) Hippocrates said that knowing the patient is just as important as knowing the disease. Don’t get so caught up in the details of the symptoms that you miss the context in which they occur.
(10) If you hear hoof-beats on Broadway, think horses, not zebras! When in doubt, go with the odds. Exotic diagnoses may be fun to think about—but you almost never see them. Stick with the bread and butter.
(11) Accurate diagnosis can bring great benefits; inaccurate diagnosis can bring disaster.
(12) Remember the other enduring dictum from Hippocrates: First, Do No Harm.
(excerpted from the introduction to my book, The Essentials of Psychiatric Diagnosis, with permission from Guilford Press).
Read the whole story
· · · ·

Formal training in forensic mental health: Psychiatry and psychology

1 Share
Volume 35, Issues 5–6, September–December 2012, Pages 343–347
Forensic Psychiatry: Expertise, Treatment and Public Policy — Dedicated to Dr. Thomas G. Gutheil
  • Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, United States
Available online 28 September 2012


The field of forensic mental health has grown exponentially in the past decades to include forensic psychiatrists and psychologists serving as the primary experts to the court systems. However, many colleagues have chosen to pursue the avenue of serving as forensic experts without obtaining formal training and experience. This article discusses the importance of formal education, training and experience for psychiatrists and psychologists working in forensic settings and the ethical implications that befall those who fail to obtain such credentials. Specific aspects of training and supervised experience are discussed in detail.


  • Formal forensic training;
  • Forensic psychiatry;
  • Forensic psychology;
  • Forensic mental health

There are no figures or tables for this document.
Copyright © 2012 Elsevier Ltd. All rights reserved.

Predictors of involuntary hospitalizations to acute psychiatry

1 Share


There is little knowledge of predictors for involuntary hospitalizations in acute psychiatric units.


The Multi-center study of Acute Psychiatry included all cases of acute consecutive psychiatric admissions in twenty acute psychiatric units in Norway, representing about 75% of the acute psychiatric units during 2005–2006. Data included admission process, rating of Global Assessment of Functioning and Health of the Nation Outcome Scales.


Fifty-six percent were voluntary and 44% involuntary hospitalized. Regression analysis identified contact with police, referral by physicians who did not know the patient, contact with health services within the last 48 h, not living in own apartment or house, high scores for aggression, level of hallucinations and delusions, and contact with an out-of office clinic within the last 48 h and low GAF symptom score as predictors for involuntary hospitalization. Involuntary patients were older, more often male, non-Norwegian, unmarried and had lower level of education. They more often had disability pension or received social benefits, and were more often admitted during evenings and nights, found to have more frequent substance abuse and less often responsible for children and were less frequently motivated for admission. Involuntary patients had less contact with psychiatric services before admission. Most patients were referred because of a deterioration of their psychiatric illness.


Involuntary hospitalization seems to be guided by the severity of psychiatric symptoms and factors “surrounding” the referred patient. Important factors seem to be male gender, substance abuse, contact with own GP, aggressive behavior, and low level of social functioning and lack of motivation. There was a need for assistance by the police in a significant number of cases. This complicated picture offers some important challenges to the organization of primary and psychiatric health services and a need to consider better pathways to care.

An examination of sexual fantasy, sexual paraphilia, psychopathy, and offence characteristics

1 Share
  • aDepartment of Psychology, University of British Columbia Okanagan, Canada
  • bDepartment of Psychology, University of Saskatchewan, Canada
  • cRoyal Canadian Mounted Police, Canada
Available online 8 February 2013


High-risk sexual offenders are a complex and heterogeneous group of offenders about whom researchers, clinicians, and law enforcement agencies still know relatively little. In response to the paucity of information that is specifically applicable to high-risk offenders, the present study investigated the potential influence of sexual fantasy, sexual paraphilia, and psychopathy on the offending behaviour of 139 of the highest risk sexual offenders in one province of Canada. The sample included 41 child molesters, 42 rapists, 18 rapist/molesters, 30 mixed offenders, and 6 “other” sexual offenders. Two offenders could not be categorized by type due to insufficient file information. Data analyses revealed significant differences between offender types for a number of criminal history variables including past sexual and nonsexual convictions, number of victims, weapon use, and age of offending onset. Further, there were significant differences between offender types for sexual fantasy themes, paraphilia diagnoses, and levels of psychopathy. For example, results revealed that offenders' sexual fantasies were significantly more likely to correspond with the specific type of index sexual offence that they had committed. Further, offenders scoring high in psychopathy were significantly more likely to have a sadistic paraphilia than offenders with either low or moderate psychopathy scores. Results from the current study provide a refined and informed understanding of sexual offending behaviour with important implications for future research, assessment, and treatment, as well as law enforcement practices when working with high-risk sexual offenders.


  • Sexual offenders;
  • High-risk;
  • Fantasy;
  • Paraphilia;
  • Psychopathy

Figures and tables from this article:
Table 1. Percentage of each offender type by sexual fantasy theme.
View Within Article
Table 2. Means and standard deviations for number of sexual convictions, number of nonsexual convictions, and number of victims by sexual fantasy theme.
Note. Fantasy themes were available for 95 of 139 offenders; consequently, the ranges across sexual fantasy themes above do not match the overall ranges of sexual and nonsexual convictions and victims when considered separately.
View Within Article
Table 3. Percentage of offenders by number and type of paraphilias across offender type and psychopathy.
Note. Percentages may not add to 100 due to rounding.
View Within Article
Table 4. Percentage of offenders with specific paraphilias by offender type, psychopathy, and weapon use.
Note. Percentages may not add to 100 due to rounding.
View Within Article
Table 5. Means and standard deviations for number of convictions and number of victims by number and type of paraphilias.
View Within Article
Copyright © 2013 Elsevier Ltd. All rights reserved.
Read the whole story
· · · ·

A bio-psycho-social model of violence related to mental health problems

1 Share
  • aZentren für Psychiatrie Südwürttemberg, Germany
  • bInstitute of Psychology, Health & Society, University of Liverpool, United Kingdom
Available online 5 February 2013



Psychiatry is characterised by bio-psycho-social approaches and therapies. Thus there should be an interest in comprehensive theoretical models for didactic purposes.


A narrative synthesis of key themes in the current literature on psychiatric aspects of violence was conducted with the aim of integrating biological, psychological and sociological ideas in this area.


Two didactical models are proposed for 1) individual disposition and for 2) acting in specific situations, each including available evidence-based knowledge.


The proposed models may be helpful for a comprehensive understanding of all relevant influencing factors in violent mentally ill people and for didactical purposes.


  • Violence;
  • Aggression;
  • Model;
  • Crime;
  • Mental disorder;
  • Forensic

Figures and tables from this article:
Copyright © 2013 Elsevier Ltd. All rights reserved.

A review of the Irish Mental Health Act 2001

1 Share
  • aLucena Clinic, Orwell Road, Rathgar, Dublin 6, Ireland
  • bCentral Mental Hospital, Dundrum Road, Dundrum, Dublin 14, Ireland
  • cCluain Mhuire Mental Health Service, Newtownpark Avenue, Blackrock, Co. Dublin, Ireland
Available online 28 December 2012



The Mental Health Act 2001 (MHA 2001) was implemented in November 2006. Since that time, there has been considerable research into its impact, including the impact on service provision, use of coercive practices and the perceptions by key stakeholders. Our objective is to present a summary of research into the MHA 2001 since its implementation in the Irish state in the context of international standards and practice.


We reviewed the literature presented on Medline and Google Scholar, directly assessed relevant journals and sought abstract information from the College of Psychiatry of Ireland.


There has been a small decrease in the rate of involuntary admission since implementation but there has been no change in the representativeness of diagnoses of individuals admitted involuntarily. Mental Health Tribunals were held for 57% of those admitted involuntarily and 46% of service users found that the Mental Health Tribunal made the involuntary admission easier to accept. One year after discharge, 60% of service users reflected that their involuntary admission had been necessary. Professional groups have expressed concerns regarding workload, training time for junior doctors and paperwork.


The MHA 2001 has brought the practice of involuntary admission further into line with international standards. However, five years after the implementation of the Act international guidelines and practice have highlighted areas in need of further reform, including capacity legislation and consideration of advance directives and community treatment orders. Further research is also lacking on caregivers' or family members' perceptions of the MHA 2001.


  • Coercion;
  • Involuntary admission;
  • Mental Health Act;
  • Human rights;
  • Legislation

Figures and tables from this article:
Full-size image (13 K)
Fig. 1. Flow chart illustrating paper selection for review.CPI: College of Psychiatry of Ireland; IJPM: Irish Journal of Psychological Medicine.1Original research on the topic Oireachtas, 2001, excluding discussion papers and papers addressing learning disability, child and adolescent psychiatry and forensic psychiatry specifically.2 and .3 and .4Prinsloo & Noonan, 2010.
Table 1. Diagnoses of individuals admitted involuntarily between 2007 and 2010 ( and ).
View Within Article
Copyright © 2012 Elsevier Ltd. All rights reserved.
Read the whole story
· · ·
Next Page of Stories
Page 2