- Academic forensic psychiatristedit
Silverstone et al. present a study outlining the success of a novel training program implemented in Edmonton, Alberta, Canada, to train police officers to interact with persons who may have a psychiatric disorder. The training was well... more
Silverstone et al. present a study outlining the success of a novel training program implemented in Edmonton, Alberta, Canada, to train police officers to interact with persons who may have a psychiatric disorder. The training was well accepted by the participants and was novel in its use of professional actors to portray persons with mental illness across six model scenarios. I outline the need for such training and comment on certain aspects of this particular program, including overall design, usefulness, and limitations.
Research Interests: Psychology, Law, Police, Medicine, Mental Illness, and 6 moreHumans, Female, Pubmed, Male, Mental Disorders, and Inservice training
Organizing frameworks that affect medical education include requirements for residency education set out by the Accreditation Council for Graduate Medical Education (ACGME), board certification requirements of the American Board of... more
Organizing frameworks that affect medical education include requirements for residency education set out by the Accreditation Council for Graduate Medical Education (ACGME), board certification requirements of the American Board of Psychiatry and Neurology (ABPN), and requirements of the Accreditation Council for Continuing Medical Education (ACCME) for awarding continuing medical education (CME) credits. Physicians rely on a variety of sources to meet these requirements, including medical journals. It is unclear, however, whether journals actually assist physicians in meeting these educational requirements. In this review of articles, we make the first known attempt at a systematic comparison of an academic journal's content areas to national standardized educational indices for physicians. Findings from the 2008 to 2012 content of The Journal of the American Academy of Psychiatry and the Law demonstrated that The Journal's articles cover the gamut of board certification examination topics, although content areas are not weighted in parallel with the examination. Some overlap and differences were seen when comparing journal content with ACGME topic areas. The Journal appears to meet identified gaps in knowledge that CME can address. The importance of balancing readers' educational needs with the ability to provide a resource for unique topics is discussed, along with other implications of these findings.
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The right to represent oneself at trial is well-established, but not absolute. Recently, in Indiana v. Edwards, the United States Supreme Court considered whether states may demand a higher standard of competence for criminal defendants... more
The right to represent oneself at trial is well-established, but not absolute. Recently, in Indiana v. Edwards, the United States Supreme Court considered whether states may demand a higher standard of competence for criminal defendants seeking to represent themselves at trial than that necessary for standing trial with attorney representation. Ultimately, the Court ruled that the Constitution allows states to employ a higher competency standard for pro se defendants. In this analysis of the Court's decision, the authors describe the facts of this case, the legal precedents framing the issues facing the Court, and the Court's rationale for its opinion. The ruling is considered in light of available research involving pro se defendants and whether this ruling is consistent with professional guidelines related to forensic psychiatric practice. Implications of the decision for forensic clinicians and limitations of the decision are discussed.
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This descriptive study compares geriatric defendants (n = 57) found competent to stand trial (n = 36) with those found incompetent (n = 21). A review of the records of 57 consecutive pretrial geriatric detainees who underwent... more
This descriptive study compares geriatric defendants (n = 57) found competent to stand trial (n = 36) with those found incompetent (n = 21). A review of the records of 57 consecutive pretrial geriatric detainees who underwent competence-to-stand-trial evaluation was conducted. The review included comparison of demographic and historical variables, mental status examination (MSE) elements, and trial abilities. Incompetent subjects were older and more frequently had dementia, but did not necessarily have other psychiatric illnesses. Deficits in orientation, memory, abstraction, concentration, calculation, and thought process were associated with incompetence. Deficits in orientation and memory correlated most highly with incompetence. Trial-related deficits associated with incompetence included failure to understand Miranda warnings, legal charges, potential penalties, roles of court officers, pleas, and plea-bargaining and inability to consult with an attorney and be self-protective. The ability to maintain appropriate courtroom behavior was not different between groups. The inability to consult with an attorney and understand Miranda was most predictive of incompetence-to-stand-trial opinions.
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Since 2002, hundreds of thousands of United States troops have returned from the Iraq and Afghanistan theaters, many after multiple deployments. The high suicide rate and high prevalence of mood disorders, substance use disorders, and... more
Since 2002, hundreds of thousands of United States troops have returned from the Iraq and Afghanistan theaters, many after multiple deployments. The high suicide rate and high prevalence of mood disorders, substance use disorders, and posttraumatic stress disorder (PTSD) in this population have been widely reported. Many returning soldiers have had difficulty adjusting to civilian life, and some have incurred legal charges. In this article, I review the prevalence and legal implications of combat-related PTSD in this population, including how symptoms of PTSD may be relevant in criminal responsibility determinations in jurisdictions that use a M'Naughten standard or American Law Institute (ALI) Model Penal Code test for criminal responsibility. Finally, an actual case in which a criminal defendant was found to lack criminal responsibility in a M'Naughten jurisdiction because of PTSD symptoms at the time of the alleged offense will be presented.
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We begin with a brief overview of the Not Guilty by Reason of Insanity (NGRI) and Guilty but Mentally Ill (GBMI) verdicts in the United States and then report on a study of qualified jurors (n=96) in which we examined jurors'... more
We begin with a brief overview of the Not Guilty by Reason of Insanity (NGRI) and Guilty but Mentally Ill (GBMI) verdicts in the United States and then report on a study of qualified jurors (n=96) in which we examined jurors' understanding and attitudes about mental illness verdicts and the disposition of mentally ill defendants. Results indicate that although the jury pool was highly educated, only 4.2 percent of jurors could correctly identify both the definitions and dispositions of defendants found NGRI and GBMI. Jurors with lower educational levels were less likely to identify the dispositional outcome of a GBMI verdict (p<.05). Eighty-four percent of respondents believed that juries should be informed of dispositional outcome before deciding a verdict. Also, 68.4 percent of jurors erroneously believed that a defendant found GBMI could not receive the death penalty. Among jurors who correctly identified the definition of GBMI, those with lower educational levels were more punitive in their attitudes toward disposition of the GBMI defendants, believing they should eventually be sent to prison (p<.05).
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Research Interests: Forensic Science, Intelligence, Homicide, Forensic psychiatry, Adolescent, and 15 moreIntellectual Disability, Medicine, Mental Retardation, Humans, Forensic Sciences, Female, Male, Clinical Sciences, Aged, Middle Aged, Adult, Intelligence tests, Intelligence quotient, Cognition disorders, and Databases as topic
After literature review, this paper presents the largest study to date (n = 270) of psychiatric and neurological characteristics of accused murderers in the United States. This retrospective record review of pretrial detainees undergoing... more
After literature review, this paper presents the largest study to date (n = 270) of psychiatric and neurological characteristics of accused murderers in the United States. This retrospective record review of pretrial detainees undergoing competency to stand trial and criminal responsibility evaluations examined demographic characteristics, psychiatric diagnosis, substance use patterns, Intelligence Quotient (IQ), and results of electroencephalogram (EEG), neuroimaging (MRI or CT) and neurological examination. Substance use and mood/adjustment disorders were common. Neuroimaging was abnormal in 18% of subjects and was associated with lower Performance IQ. EEG and neurological exam findings were not associated with measured cognitive impairment. While 16% of subjects had a FS IQ &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 70, only 6% were diagnosed with mental retardation. Subjects with a psychotic disorder (p = 0.001) or an anxiety disorder (p = 0.005) were more likely to use a knife than other subjects in the study. Violence risk assessment in these patients must not only involve inquiry about firearm availability.
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Research Interests: Psychology and Amnesia
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The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral... more
The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral symptoms can impair a defendant’s understanding of the legal system or their ability to work effectively with an attorney in the preparation of a defense. Therefore, assessments of capacity to stand trial may require special attention to the mental health conditions and symptoms more commonly seen in elderly persons, and the evaluation process may require modification to accurately assess this population and to rule out malingering. Unique challenges are also encountered in the evaluation of elderly defendants for criminal responsibility and in presentencing evaluations. This chapter provides an overview of these challenges and strategies to promote accurate evaluation of the elderly defendant.
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... be done in the context of a therapeutic relationship and not with family members, colleagues, or ... widowed or divorced → 1; O: Organized or serious attempt → 2; N: No social support → 1; ... Suicide attempts in schizophrenia: the... more
... be done in the context of a therapeutic relationship and not with family members, colleagues, or ... widowed or divorced → 1; O: Organized or serious attempt → 2; N: No social support → 1; ... Suicide attempts in schizophrenia: the role of command auditory hallucinations for suicide. ...
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Research Interests: Causation, Duty, Medical Malpractice, Damages, Malpractice, and 3 moreLiability, Lawsuit, and Springer Ebooks
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Research Interests: Psychiatry, Medical Education, Forensic psychiatry, Accreditation, Medicine, and 12 moreCurriculum, Humans, United States, Social Work and Mental Health, Graduate medical education, Academic Psychiatry, Curriculum and Pedagogy, Clinical Competence, Psychiatry and Psychology, Surveys and Questionnaires, Specialty, and internship and residency
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Research Interests: Psychology and Medicine
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Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica... more
Pseudologia fantastica, a psychological phenomenon that has been described in the literature for at least a century, is an understudied and poorly understood entity. Sometimes referred to as pathological lying, pseudologia fantastica involves disproportionate fabrication that may be present for many years or a lifetime. In a forensic context, it can significantly complicate the evaluation of capacity to stand trial and, in certain jurisdictions, criminal responsibility. We review the current literature regarding pseudologia fantastica and present a case to highlight the clinical and forensic challenges it may create. We specifically discuss the complications that pseudologia fantastica may have on the assessment of a defendant&amp;amp;amp;amp;amp;amp;amp;amp;#39;s rational ability to consult with an attorney, a required element of capacity to stand trial. In addition, we discuss the implications of pseudologia fantastica in the evaluation of criminal responsibility.
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This chapter explores the potential risks of cataloging a database of information about juveniles as it relates to sex offenders and their offenses. The information gathered during a juvenile offender's incarceration can be used to... more
This chapter explores the potential risks of cataloging a database of information about juveniles as it relates to sex offenders and their offenses. The information gathered during a juvenile offender's incarceration can be used to identify mental illness, to individualize mental health treatment, to link the juvenile with a variety of treatment resources, and to plan for future mental health treatment after the juvenile offender leaves a correctional facility. The immediate goal of each of these data utilization venues is the provision of appropriate and successful mental health treatment. The ultimate goal of these venues is to prevent future recidivism. Although juvenile offenders are presumed to benefit from assessment and treatment, the protection of society from further harmful acts is inherent in both of these goals. The evaluation of juvenile sex offenders is particularly fraught with implications for society as well as for the juvenile's future life. Significant rec...
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Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in... more
Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations. Where possible, it specifies standards of practice and principles of ethics and also emphasizes the importance of analyzing an individual defendant's case in the context of statutes and case law applicable in the jurisdiction where the evaluation takes place. The recommendations in the Guideline both reflect and are limited by evolving case law, statutory requirements, legal publications, and the current state of psychiatric knowledge. The authors have taken note of nationally applicable case law, federal constitutional standards, statutory language, and federal and state interpretations of the rights or statutes, recognizing that jurisdictions may differ in their specific interpretation or application of statutes or general constitutional standards. The review of cases concerning specific psychiatric diagnoses illustrates general U.S. trends, and psychiatrists must remain cognizant of their jurisdictions' interpretations of statutes or constitutional requirements. By surveying a variety of practices and approaches to data gathering and case analysis, the authors believe that this Guideline will stimulate additional collegial discussion about what is necessary and sufficient for adequate evaluations of adjudicative competence. The notion that psychiatrists should apply expertise to competence assessments stems from the principal that, before allowing a defendant to face criminal prosecution and possible punishment, courts need reasonable assurance--based, if necessary, on a careful, individualized evaluation--that the defendant has adequate mental capacity to make a defense. At a minimum, a psychiatrist's opinion about adjudicative competence should reflect an understanding of the jurisdictional standard and of how the defendant's mental condition affects competence as defined with the jurisdiction. The psychiatrist's report should clearly describe the opinion and the reasoning that leads to it. Psychiatrists who provide mental health expertise concerning adjudicative competence give trial courts information needed to assure that defendants can appropriately protect themselves and that criminal proceedings will be accurate, dignified,and just.
Research Interests: Law, Forensic psychiatry, Pubmed, The, Insanity Defense, and 3 moreStatutory law, Statute, and GuideLine
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In In re Campbell , 830 S.E.2d 14 (S.C. 2019), a sex offender who had been civilly committed under the South Carolina Sexually Violent Predator (SVP) Act appealed his commitment to the South Carolina Supreme Court. The South Carolina... more
In In re Campbell , 830 S.E.2d 14 (S.C. 2019), a sex offender who had been civilly committed under the South Carolina Sexually Violent Predator (SVP) Act appealed his commitment to the South Carolina Supreme Court. The South Carolina Supreme Court reversed and remanded because prejudicial evidence
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Medical writing comes in many forms: textbooks, peer-reviewed articles, research reports, literature reviews, practice guidelines, editorials, and case reports. Publishing affords the medical community opportunities to make important... more
Medical writing comes in many forms: textbooks, peer-reviewed articles, research reports, literature reviews, practice guidelines, editorials, and case reports. Publishing affords the medical community opportunities to make important points, provoke debate, educate each other and the general public
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The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral... more
The assessment of the elderly defendant presents a specific set of challenges in the forensic psychiatric evaluation process. In this special population, a neurocognitive disorder or the presence of cognitive, psychiatric, and behavioral symptoms can impair a defendant’s understanding of the legal system or their ability to work effectively with an attorney in the preparation of a defense. Therefore, assessments of capacity to stand trial may require special attention to the mental health conditions and symptoms more commonly seen in elderly persons, and the evaluation process may require modification to accurately assess this population and to rule out malingering. Unique challenges are also encountered in the evaluation of elderly defendants for criminal responsibility and in presentencing evaluations. This chapter provides an overview of these challenges and strategies to promote accurate evaluation of the elderly defendant.
The Alaska Supreme Court held that expert witness testimony given by Ms. Oxford qualified under section 1912(e) of the ICWA because knowledge of the minor’s specific Native culture was not directly relevant to the determination of present... more
The Alaska Supreme Court held that expert witness testimony given by Ms. Oxford qualified under section 1912(e) of the ICWA because knowledge of the minor’s specific Native culture was not directly relevant to the determination of present danger to herself or others as the result of a serious mental illness. The court examined the ICWA and its regulations, the BIA Guidelines, and prior Alaska case law. ICWA identifies the requirements for child custody proceedings involving Indian children. It states that any removal of an Indian child from the parent must be in settings where “the continued custody of the child by the parent or Indian custodian is likely to result in serious emotional or physical damage to the child” (25 U.S.C. § 1912(f)). The ICWA regulations also outline requirements for expert witness testimony. Though ICWA regulations indicate a qualified expert witness is someone who has knowledge on “the prevailing social and cultural standards of the Indian child’s Tribe” (2...