Forensic assessment of somatoform and functional neurological disorders

Functional neurological disorders (FND) and somatization are common in clinical practice and medicolegal settings. These conditions are frequently disabling and, if arising following an accident, may lead to claims for legal compensation or occupational disability (such as social security disability insurance). However, distinguishing FND and somatization from symptoms that are intentionally produced (i.e., malingered or factitious) may pose a major forensic psychiatric challenge. In this article, we describe how somatoform disorders and FND lie along a spectrum of abnormal illness‐related behaviors, including factitious disorder, compensation neurosis, and malingering. We provide a systematic approach to the forensic assessment of FND and conclude by describing common litigation scenarios in which FND may be at issue. Forensic testimony may play an important role in the resolution of such cases.

The Role of the Child Psychiatrist in Court Cases Involving Child Victims of Sexual Assault

Many jails and prisons in the United States do not have enough mental health professionals (MHPs) to meet the mental health needs of the people incarcerated in these facilities. This article examines strategies used to address MHP shortages in U.S. jails and prisons, including compensation incentives, telemental health services, interdisciplinary health care, flexible work schedules, and training rotations in correctional settings. These measures may help alleviate some of the shortages of MHPs in correctional facilities; however, these shortages will likely persist without broader policy reforms that decrease the size of U.S. correctional pop- ulations or increase the number of MHPs across the country.

Addressing Shortages of Mental Health Professionals in U.S. Jails and Prisons

Many jails and prisons in the United States do not have enough mental health professionals (MHPs) to meet the mental health needs of the people incarcerated in these facilities. This article examines strategies used to address MHP shortages in U.S. jails and prisons, including compensation incentives, telemental health services, interdisciplinary health care, flexible work schedules, and training rotations in correctional settings. These measures may help alleviate some of the shortages of MHPs in correctional facilities; however, these shortages will likely persist without broader policy reforms that decrease the size of U.S. correctional pop- ulations or increase the number of MHPs across the country.

A “What, When, Who, Where, Why, and How” Guide to Forensic Psychiatric Consultation in Criminal Mitigation

Mentally ill and emotionally disturbed offenders comprise a significant group of those whose criminal conduct has brought them into the criminal justice system. This is a worldwide phenomenon. However, it may be even more pronounced in the United States Criminal Justice System.

Criminal Responsibility and Legal Insanity

Chapter 15 from Forensic Psychology: Crime, Justice, law, Interventions, Fourth Edition explores the history and caselaw as well as describes the forensic mental health assessment of criminal responsibility, and in particular – the not guilty by reason of insanity defence in criminal cases. Particularly, the mental illness defence is explored through examination of case law and case studies from the United States in which the author, John Matthew Fabian, has been involved.

A Review of Statutes and the Role of the Forensic Psychiatrist in Cyberstalking Involving Youth

Adolescents are increasingly exposed to Internet-facilitated crime as they spend more time online. The mental health risks and legal consequences for youth involved in cyberstalking are growing areas of concern. The nature of online stalking presents several challenges regarding investigation, fair adjudication, fact-finding, and legislation. Laws governing online stalking behaviors inconsistently reference the age of a victim or perpetrator as a factor for consideration in case disposition. During adjudication, the forensic psychiatrist may be asked to evaluate the victim or perpetrator involved in cyberstalking. This article focuses on the current legal landscape governing cyberstalking behavior involving adolescents, the roles a forensic psychiatrist may assume in this context, and the opportunity to bring a developmental perspective to these cases. Paul Elizondo, DO, Dale E. McNiel, PhD, and Rene´e Binder, MD

Response of US psychiatric programs to the COVID-19 pandemic and the impact on trainees

Since the start of the COVID-19 pandemic, trainees have experienced a variety of changes to trainee program policies and guidelines. Overall, poor communication and trainee dissatisfaction with departmental response correlated with concern of infection and anxiety/burnout. Insights garnered from this study could provide scaffolding for the best practices to reduce trainee physician anxiety/burnout for the […]

Pharaohs, philosophers, and Freud—Tracing bias in modern correlates of hysteria.

‘Hysteria’ is a historical term that encompasses several modern-day neuropsychiatric conditions. The chronicle of this illness is fraught with prejudice from the time of its inception through subsequent adaptations. Relics of cultural misconceptions have been carried forward into contemporary correlates of the illness. The consequences of these follies in present-day are best understood through a […]

Do no harm in due process – a historical analysis of social determinates of institutionalization in the USA

Involuntary hospitalization has been a fundamental function of psychiatric care for mentally ill persons in the USA for centuries. Procedural and judicial practices of inpatient psychiatric treatment and civil commitment in the USA have served as a by-product of socio-political pressures that demanded constant reform throughout history. The origin of modern commitment laws can best […]

fMRI in the Courtroom: A (Very Brief) Overview

On the evening of May 9, 1991, a postdoctoral fellow named Kenneth Kwong ran a new MRI sequence at Massachusetts General Hospital and, remarkably, “saw a bright blob coming out of the visual cortex” (1). This experiment—the first to use blood oxygenation level-dependent (BOLD) functional magnetic resonance imaging (fMRI) in a human subject—led to a […]

Effects of temporary psychiatric holds on length of stay and readmission risk among persons admitted for psychotic disorders

The practice of involuntary psychiatric commitment is central to the acute treatment of persons with severe mental illness and others in psychiatric crisis. Deciding whether a patient should be admitted involuntarily requires weighing respect for autonomy against beneficence, considering the clinical needs of the patient, and navigating ambiguous legal standards. The relative dearth of information […]

A Case of Biopharmaceutical-Induced Catatonia and the Implication of a Novel Mechanism

Catatonia can be described structurally as a motor dysregulation syndrome with a concomitant behavioral component. However, despite its initial recognition nearly 150 years ago, the exact pathophysiological causes underlying this syndrome are still somewhat unknown and are potentially variable. This report reviews a case of a patient with multiple catatonic episodes precipitated by the use […]

Risk of suicide after discharge from inpatient psychiatric care: a systematic review

The findings of this review suggest that significant suicide predictors both common and unique to those established for suicide in the general population exist and can be utilised in a clinically meaningful way, despite the difficulties inherent in studying this population.KEY POINTSThe risk of suicide after psychiatric hospitalisation is high.Factors that predict suicide after psychiatric […]

Pseudologia Fantastica: An Elaborate Tale of Combat-related PTSD

Pseudologia fantastica (PF), also known as mythomania or pathologic lying, is a well-known yet controversial phenomenon in psychiatry. There is no firm conceptualization of PF, nor are there any widely accepted diagnostic criteria for PF. The condition may be related to low self-esteem, and it shows some overlap with narcissistic personality disorder and other Diagnostic […]

Indications for Psychotherapy in Adults in Later Life

Since its inception more than 100 years ago, theories and techniques of psychotherapy have experienced tremendous growth and diversification. There has been a gradual increase in our knowledge of aging as well as in our experience conducting psychotherapy with older adults. Although the core principles of psychotherapy are mostly similar to those pertaining to younger […]

What Neuroscience Can and Cannot Answer | Journal of the American Academy of Psychiatry and the Law

We truly live in the golden age of neuroscience. Advances in technology over the past 20 years have given modern neuro-researchers tools of unprecedented power to probe the workings of the most complex machine in the universe (as far as we know).

Current Regulation of Mobile Mental Health Applications

James A. Armontrout, MD, John Torous, MD, Marsha Cohen, JD, Dale E. McNiel, PhD, and Renée Binder, MD — The Journal of the American Academy of Psychiatry and the Law — In recent years, the availability of software that is targeted toward the general public and designed to assist in the diagnosis and treatment of […]

6-13-18 NARTC Webinar – mTBI Claims in Litigation

Topics To Be Covered: 1. Asessing Emotional Disorders 1. Definitions – what is a TBI? – what makes a mild TBI “mild?” 2. 3-legged stool assessment: neurology, neuropsychology & psychiatry. 3. Neurology – Imaging Studies and Structural Assessment. • MRI. • DTI. • Tractography. 4. Problems with correlating imaging studies with mTBI studies. 5. Neuropsychology […]

A Medical Student-Run Child and Adolescent Psychiatry Clinic: One Institution’s Experience

This report describes a student-run psychiatry clinic with a dual mission of education and service, and the challenges associated with these sometimes competing goals. This clinic serves a vital need within our community and may be an example of the role that student-run clinics can have in fostering interdisciplinary care, psychiatric recruitment, and training for […]

Vetting System for Pilots May Lessen Chances of Germanwings Repeat

The following article from the newspaper of the American Psychiatric Association is a follow up on previous blog posts on this fpamed.com site concerning the GermanWings crash, pilot depression and cockpit screening for potentially dangerous signs of mental illness. From the American Psychiatric Association’s PsychiatricNews: by Aaron Levin, 07 May 2015 No evaluation process is […]

Co-pilot in Germanwings Crash Alleged to Have Hidden Mental Illness from Employer

Mark I Levy MD Forensic Psychiatrist Medical Director Forensic Psychiatric Associates, LP Asst. Clinical Professor, Psychiatry, UCSF School of Medicine According to a March 28, 2015 article in the New York Times, the co-pilot who locked the pilot out of the cockpit and deliberately crashed a German Wings aircraft flying from Spain to Germany, killing […]

Employment Rights for People with Bipolar Disorder

A recent article in the Bipolar Network News (BNN) bipolarnews.org Vol. 19, Issue 1, 2015, highlights that according to the Americans with Disabilities Act (ADA) Amendments Act of 2008 (ADAAA) patients with Bipolar Disorder are covered under the ADA. The Equal Employment Opportunity Commission (EEOC), charged with enforcing the ADAAA, has made it clear in […]

Engaging veterans with substance abuse disorders into a research trial: success with study branding, networking, and presence

The focus of this paper is on the recruitment and retention strategies used for a study addressing multiple risk behaviors among veterans with alcohol or drug problems. Focused on clients in substance abuse treatment, challenges with research recruitment and retention were anticipated due to low motivation to change additional risk behaviors, frequent and abrupt changes […]

Study Finds Gene Methylation a Marker of PTSD Vulnerability

from Psychiatric News Alert: The Voice of the American Psychiatric Association and the Psychiatric Community This journal article may provide an important new piece to the puzzle of trying to understand PTSD vulnerability and resiliency factors. It could bring us closer to biological testing for PTSD vulnerability which could eventually be used to screen applicants for […]