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How sick is the defendant? Forensic and emergency medical aspects at trial.
Leg Med (Tokyo). 2013 Jan;15(1):38-42
Authors: Buschmann C, Peters M
Abstract
The evaluation of a defendant's ability to stand trial is a core task in the field of legal medicine as a supportive instrument of jurisprudence. Before the trial, the court-appointed expert informs him-/herself regarding existing somatic and psychological illness(-es) within the context of preparing an expert evaluation, then composing the written expert evaluation, which reflects the condition of the subject at the time of the examination and arrives at an assessment of the ability to stand trial. The decompensation or aggravation of illnesses - in particular in stressful situations, as is to be expected for the defendant in the courtroom - can thus be taken into consideration such that alongside the current evaluation of the defendant's health condition, emergency medical treatment may also become necessary in court at times. We present three case reports about forensic and emergency medical aspects at trial, considering how the forensic expert can be able to meet the subsequent challenges.
The evaluation of a defendant's ability to stand trial is a core task in the field of legal medicine as a supportive instrument of jurisprudence. Before the trial, the court-appointed expert informs him-/herself regarding existing somatic and psychological illness(-es) within the context of preparing an expert evaluation, then composing the written expert evaluation, which reflects the condition of the subject at the time of the examination and arrives at an assessment of the ability to stand trial. The decompensation or aggravation of illnesses - in particular in stressful situations, as is to be expected for the defendant in the courtroom - can thus be taken into consideration such that alongside the current evaluation of the defendant's health condition, emergency medical treatment may also become necessary in court at times. We present three case reports about forensic and emergency medical aspects at trial, considering how the forensic expert can be able to meet the subsequent challenges.
PMID: 22981181 [PubMed - indexed for MEDLINE]
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Law & psychiatry: punishing juveniles who kill.
Psychiatr Serv. 2012 Oct;63(10):956-8
Authors: Appelbaum PS
Abstract
Punishment of juvenile murderers forces policy makers to weigh the developmental immaturity of adolescents against the heinousness of their crimes. The U.S. Supreme Court has progressively limited the severity of punishments that can be imposed on juveniles, holding that their impulsivity, susceptibility to peer pressure, and more fluid character render them less culpable for their actions. Having eliminated the death penalty as a punishment, the Court recently struck down mandatory life sentences without prospect of parole. The decision is interesting for its emphasis on rehabilitation, opening the door to further restrictions on punitive sentences for juveniles-and perhaps for adults too.
Punishment of juvenile murderers forces policy makers to weigh the developmental immaturity of adolescents against the heinousness of their crimes. The U.S. Supreme Court has progressively limited the severity of punishments that can be imposed on juveniles, holding that their impulsivity, susceptibility to peer pressure, and more fluid character render them less culpable for their actions. Having eliminated the death penalty as a punishment, the Court recently struck down mandatory life sentences without prospect of parole. The decision is interesting for its emphasis on rehabilitation, opening the door to further restrictions on punitive sentences for juveniles-and perhaps for adults too.
PMID: 23032673 [PubMed - indexed for MEDLINE]
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Privacy in the digital age.
Nature. 2013 May 16;497(7449):287
Authors:
PMID: 23682396 [PubMed - indexed for MEDLINE]
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In the aftermath of State v. Becker: a review of state and federal jury instructions on insanity acquittal disposition.
J Am Acad Psychiatry Law. 2012;40(4):537-46
Authors: Piel J
Abstract
An important topic related to the insanity defense is what jurors should be told about the disposition of a defendant found not guilty by reason of insanity (NGRI). In the federal court system, jurors are not instructed about the consequences of an NGRI verdict. State courts, however, are divided on the question. The federal precedent, Shannon v. United States, and the most recent state case to rule on NGRI juror instructions, State v. Becker, are reviewed in detail. What follows is the author's critique of the principal arguments for and against a jury instruction on NGRI disposition. The author argues in favor of a jury instruction on the consequences of an NGRI verdict.
An important topic related to the insanity defense is what jurors should be told about the disposition of a defendant found not guilty by reason of insanity (NGRI). In the federal court system, jurors are not instructed about the consequences of an NGRI verdict. State courts, however, are divided on the question. The federal precedent, Shannon v. United States, and the most recent state case to rule on NGRI juror instructions, State v. Becker, are reviewed in detail. What follows is the author's critique of the principal arguments for and against a jury instruction on NGRI disposition. The author argues in favor of a jury instruction on the consequences of an NGRI verdict.
PMID: 23233476 [PubMed - indexed for MEDLINE]
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Live deaths online: internet suicide and lethality.
J Am Acad Psychiatry Law. 2012;40(4):530-6
Authors: Klein CA
Abstract
The Internet provides an infinite platform for the portrayal of lethal events. Beyond mere display, however, it dispenses information, allows for participation and sharing of content, and constitutes a virtual interactive forum. The Internet may ultimately shape society's approach to perceiving and dealing with death. Thus, psychiatrists may wish to be aware of these matters so that they may be considered in assessments and clinical care. In this article, the author attempts to identify key online locations where lethality is portrayed and how it may affect the individual patient and practitioner and the population at large.
The Internet provides an infinite platform for the portrayal of lethal events. Beyond mere display, however, it dispenses information, allows for participation and sharing of content, and constitutes a virtual interactive forum. The Internet may ultimately shape society's approach to perceiving and dealing with death. Thus, psychiatrists may wish to be aware of these matters so that they may be considered in assessments and clinical care. In this article, the author attempts to identify key online locations where lethality is portrayed and how it may affect the individual patient and practitioner and the population at large.
PMID: 23233475 [PubMed - indexed for MEDLINE]
Commentary: homicide-suicide in the Caribbean.by Emmanuel MK, Campbell MH
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Commentary: homicide-suicide in the Caribbean.
J Am Acad Psychiatry Law. 2012;40(4):469-71
Authors: Emmanuel MK, Campbell MH
Abstract
With the exception of Guyana and Trinidad, suicide rates in the Caribbean are relatively low compared with those in other countries. Homicide rates, however, have increased over the past 15 years, especially in Jamaica and Trinidad. The link between suicide, homicide, and homicide followed by suicide (H-S) is not well established. A newspaper review of H-S events in a selection of Caribbean territories revealed a surprising number of these events. Characteristics of perpetrators were similar to those documented in the literature. The authors agree with Roma et al. that national tracking systems for H-S are needed. Empirical research on this topic in the Caribbean is also desperately needed.
With the exception of Guyana and Trinidad, suicide rates in the Caribbean are relatively low compared with those in other countries. Homicide rates, however, have increased over the past 15 years, especially in Jamaica and Trinidad. The link between suicide, homicide, and homicide followed by suicide (H-S) is not well established. A newspaper review of H-S events in a selection of Caribbean territories revealed a surprising number of these events. Characteristics of perpetrators were similar to those documented in the literature. The authors agree with Roma et al. that national tracking systems for H-S are needed. Empirical research on this topic in the Caribbean is also desperately needed.
PMID: 23233466 [PubMed - indexed for MEDLINE]
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PTSD as a criminal defense: a review of case law.by Berger O, McNiel DE, Binder RL
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PTSD as a criminal defense: a review of case law.
J Am Acad Psychiatry Law. 2012;40(4):509-21
Authors: Berger O, McNiel DE, Binder RL
Abstract
Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.
Posttraumatic stress disorder (PTSD) has been offered as a basis for criminal defenses, including insanity, unconsciousness, self-defense, diminished capacity, and sentencing mitigation. Examination of case law (e.g., appellate decisions) involving PTSD reveals that when offered as a criminal defense, PTSD has received mixed treatment in the judicial system. Courts have often recognized testimony about PTSD as scientifically reliable. In addition, PTSD has been recognized by appellate courts in U.S. jurisdictions as a valid basis for insanity, unconsciousness, and self-defense. However, the courts have not always found the presentation of PTSD testimony to be relevant, admissible, or compelling in such cases, particularly when expert testimony failed to show how PTSD met the standard for the given defense. In cases that did not meet the standard for one of the complete defenses, PTSD has been presented as a partial defense or mitigating circumstance, again with mixed success.
PMID: 23233473 [PubMed - indexed for MEDLINE]
An unwelcome guest: the unconscious mind in the courtroom.by Kapoor R, Williams A
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An unwelcome guest: the unconscious mind in the courtroom.
J Am Acad Psychiatry Law. 2012;40(4):456-61
Authors: Kapoor R, Williams A
PMID: 23233464 [PubMed - indexed for MEDLINE]
Mental illness in homicide-suicide: a review.by Roma P, Pazzelli F, Pompili M, Lester D, Girardi P, Ferracuti S
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Mental illness in homicide-suicide: a review.
J Am Acad Psychiatry Law. 2012;40(4):462-8
Authors: Roma P, Pazzelli F, Pompili M, Lester D, Girardi P, Ferracuti S
Abstract
Homicide followed by suicide (H-S) is a lethal event in which an individual kills another individual and subsequently dies by suicide. This article presents a review of research carried out in Asia, Australia, Canada, Europe, and the United States of America over the past 60 years on the prevalence of mental illness among the perpetrators of H-S. Analysis of the available data indicated a great disparity in the results of the different studies. Overall, depression was the most frequent disorder reported (about 39% of the cases in the 20 studies that assessed depressive disorders), followed by substance abuse (about 20% in 10 studies) and psychosis (about 17% in 11 studies). This review, therefore, indicated that mental illness plays an important role in H-S. The prevention of these events depends on the identification and treatment of psychiatric disorder in potential perpetrators.
Homicide followed by suicide (H-S) is a lethal event in which an individual kills another individual and subsequently dies by suicide. This article presents a review of research carried out in Asia, Australia, Canada, Europe, and the United States of America over the past 60 years on the prevalence of mental illness among the perpetrators of H-S. Analysis of the available data indicated a great disparity in the results of the different studies. Overall, depression was the most frequent disorder reported (about 39% of the cases in the 20 studies that assessed depressive disorders), followed by substance abuse (about 20% in 10 studies) and psychosis (about 17% in 11 studies). This review, therefore, indicated that mental illness plays an important role in H-S. The prevention of these events depends on the identification and treatment of psychiatric disorder in potential perpetrators.
PMID: 23233465 [PubMed - indexed for MEDLINE]
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Estimated rates of mental disorders in, and situational characteristics of, incidents of nonfatal use of force by police.
Soc Psychiatry Psychiatr Epidemiol. 2013 Feb;48(2):225-32
Authors: Kesic D, Thomas SD, Ogloff JR
Abstract
PURPOSE: To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia.
METHODS: A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties.
RESULTS: More than a third of people on whom the police resorted to using force (n = 1,621, 38%) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5%, OR = 9.03, 95% CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1%, OR = 9.73, 95% CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95% CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95% CI (1.11, 1.78), p = 0.005].
CONCLUSIONS: Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.
PURPOSE: To examine the estimated rates of mental disorders and associated situational characteristics in people involved in nonfatal use of force incidents with police in VIC, Australia.
METHODS: A random sample of 4,267 cases between 1995 and 2008 from a dedicated police Use of Force Register were linked with the state-wide public mental health database and a police contacts database. Rates of ICD 9 and ICD 10 mental disorders recorded on the public mental health database were examined, as well as rates of criminal offending and the characteristics of force used by both parties.
RESULTS: More than a third of people on whom the police resorted to using force (n = 1,621, 38%) had a history of mental disorder. Significant overrepresentations of the estimated prevalence of psychosis [12.5%, OR = 9.03, 95% CI (7.41, 11.01), p < 0.001] and schizophrenia [9.1%, OR = 9.73, 95% CI (7.59, 12.47) p < 0.001] were found. Those diagnosed with mental disorders were 1.52 times more likely to use or threaten to use weapons on police, even after taking into account age, sex, substances intoxication and violent behaviour [95% CI (1.23, 1.91), p < 0.001]; however, they were no more likely to injure or be injured by police than those without a recorded history of mental disorder. There was a noted trend for police to use, or threaten to use, weapons on people with a history of psychosis (other than schizophrenia) [OR = 1.40, 95% CI (1.11, 1.78), p = 0.005].
CONCLUSIONS: Psychoses and schizophrenia are dramatically overrepresented in cases where police resort to using force. Situational characteristics evident in the encounters are suggestive of a sub-group of people with mental disorders presenting with aggressive and otherwise problematic behaviours coupled with histories of criminal offending; this presents significant ongoing challenges for the police.
PMID: 22744175 [PubMed - indexed for MEDLINE]
Conflict of interest: The elephant in your practice.
Afr J Psychiatry (Johannesbg). 2013 May;16(3):161-5
Authors: Kaliski S
PMID: 23739815 [PubMed - in process]
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Can we reverse the rising tide of compulsory admissions?
Lancet. 2013 May 11;381(9878):1603-4
Authors: Johnson S
PMID: 23537604 [PubMed - indexed for MEDLINE]
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Practice informs the next generation of behavioral health and criminal justice interventions.by Wolff N, Frueh BC, Huening J, Shi J, Epperson MW, Morgan R, Fisher W
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Practice informs the next generation of behavioral health and criminal justice interventions.
Int J Law Psychiatry. 2013 Jan-Feb;36(1):1-10
Authors: Wolff N, Frueh BC, Huening J, Shi J, Epperson MW, Morgan R, Fisher W
Abstract
Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these "first generation" interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system. To understand how to make the next generation of interventions more effective, a survey of a national sample of community-based programs serving these clients was conducted. Surveys were completed on-line by direct service staff affiliated with 85 programs and collected data on the characteristics and needs of the client base; characteristics and challenges associated with difficult-to-engage clients; service needs and obstacles; and recommendations for improving program effectiveness. A sample of the survey participants (19 programs from 18 states) attended a day-long workshop to discuss the survey findings and ways to improve treatment adherence and client services. Respondents reported that their clients have a constellation of problems with different origins, etiologies, and symptoms, often crossing over the boundaries of mental illness, addictions, and antisocial pathologies. According to the practitioners working with justice-involved clients with mental illnesses, responding effectively requires knowledge of many different problems, expertise to respond to them, and an understanding of how these problems interact when they co-occur. The poly-problems of these clients suggest the need for an integrated and comprehensive approach, which is challenged by the fragmented and diverse ideologies of the behavioral health, criminal justice, and social service systems.
Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these "first generation" interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system. To understand how to make the next generation of interventions more effective, a survey of a national sample of community-based programs serving these clients was conducted. Surveys were completed on-line by direct service staff affiliated with 85 programs and collected data on the characteristics and needs of the client base; characteristics and challenges associated with difficult-to-engage clients; service needs and obstacles; and recommendations for improving program effectiveness. A sample of the survey participants (19 programs from 18 states) attended a day-long workshop to discuss the survey findings and ways to improve treatment adherence and client services. Respondents reported that their clients have a constellation of problems with different origins, etiologies, and symptoms, often crossing over the boundaries of mental illness, addictions, and antisocial pathologies. According to the practitioners working with justice-involved clients with mental illnesses, responding effectively requires knowledge of many different problems, expertise to respond to them, and an understanding of how these problems interact when they co-occur. The poly-problems of these clients suggest the need for an integrated and comprehensive approach, which is challenged by the fragmented and diverse ideologies of the behavioral health, criminal justice, and social service systems.
PMID: 23182402 [PubMed - indexed for MEDLINE]
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Law & psychiatry: imposed insanity defenses and political crimes.
Psychiatr Serv. 2013 Jan;64(1):4-6
Authors: Appelbaum PS
Abstract
Anders Breivik's murder of 77 people in Norway in 2011 led to an unusual clash of interests. With conflicting psychiatric reports regarding his sanity, prosecutors argued that Breivik should be found not guilty by reason of insanity, whereas the defense strongly maintained that he was sane and responsible for his actions. Imposing an insanity defense on an unwilling defendant pits societal interests in fair adjudications against the right of defendants to control their defense. For crimes with political motivations, an imposed insanity verdict discredits the perpetrator and may distract the public from the threats posed by extreme political views.
Anders Breivik's murder of 77 people in Norway in 2011 led to an unusual clash of interests. With conflicting psychiatric reports regarding his sanity, prosecutors argued that Breivik should be found not guilty by reason of insanity, whereas the defense strongly maintained that he was sane and responsible for his actions. Imposing an insanity defense on an unwilling defendant pits societal interests in fair adjudications against the right of defendants to control their defense. For crimes with political motivations, an imposed insanity verdict discredits the perpetrator and may distract the public from the threats posed by extreme political views.
PMID: 23280453 [PubMed - in process]
The Psychogenic Fugue in Literature | Psychiatric Times
www.psychiatrictimes.com
To understand the psychodynamics of the dissociative fugue, Dr Michael Sperber analyzes some of the characters in a collection of interrelated vignettes set in small town America.
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