A Subspecialty of Growing Importance
A Subspecialty of Growing Importance
Forensic psychiatry has developed into a formal subspecialty in recent
years. However, as in any other subspecialty of psychiatry, general
practitioners are encouraged to have some training in and knowledge of forensic
psychiatry. Despite its new subspecialty status, general clinicians still perform
the bulk of forensic assessment. Clinicians aware of their lack of training
often fear becoming involved in forensic cases, avoid forensic practice
entirely, and suffer undue anxiety when their participation becomes
Clinical psychiatrists can and should familiarize themselves with some of
the principles and practice of this fascinating and challenging subspecialty.
General clinicians receive training in a variety of subspecialties of
psychiatry, such as child and adolescent psychiatry, geriatric psychiatry, or
substance abuse. Although encouraged to recognize the limits of their
expertise, and to refer complicated cases to specialists, general clinicians
are able to evaluate, manage and treat patients in these categories based on
their basic training if they so choose.
This Special Report has something to offer to both forensic specialists and
general clinicians. Psychiatrists with forensic expertise will find these
reviews useful synopses of common and relevant forensic issues. General clinical
psychiatrists will find that these articles provide useful information should
the issues discussed in these articles arise in their clinical practice.
Perhaps more importantly, general psychiatrists may find that some of their
anxieties regarding forensic involvement and their own professional liability
exposure may be minimized by an understanding of forensic issues.
This Special Report reviews a number of areas of forensic practice. Philip
J. Resnick, M.D., and Renee Sorrentino,
M.D., have provided a thorough review of competency
issues that commonly arise in consultation-liaison psychiatry and discuss the
components of competency evaluations. Jacqueline M. Melonas,
J.D., M.S., R.N., discusses an issue that has increasingly come to affect
clinical practitioners: liability risk related to psychopharmacology. She
provides suggestions to help practitioners reduce these risks by understanding
where they lie and how good clinical practice can address them. I offer a
review of the thorny issues that arise when the diagnosis of posttraumatic
stress disorder, increasingly common in all types of litigation, becomes a
legal point of contention. Richard A. Ratner, M.D.,
has reviewed the complex ethical issues surrounding evaluations of children and
Psychiatrists are discovering that both the forensic and clinical practice
of psychiatry can be professionally rewarding. Robert P. Granacher
Jr., M.D., M.B.A., offers suggestions to those interested in expanding their
practices to include forensic psychiatry. The business elements of forensic
practices differ in some ways from those of clinical practice. However, general
clinicians and forensic specialists alike will benefit from a review of these
sound business principles.
Forensic psychiatrists can benefit from reviewing the expertise of their
colleagues. General clinicians will find that the more familiar they are with
this exciting subspecialty, the more confident they will become in the clinical
practice of psychiatry.
Dr. Gold is a clinical and forensic psychiatrist
and is clinical associate professor of psychiatry at the Georgetown University
School of Medicine. She
is also associate director of the Georgetown
Psychiatry Residency Program in Psychiatry and Law. She is co-editor of The
American Psychiatric Publishing Textbook of Forensic Psychiatry with Robert I. Simon, M.D.