Psychiatric Times Vol 23 No 14

Stanley Robbins' Bookshelf

Although forensic psychiatry is a formal subspecialty, general clinicians are often called upon to perform the bulk of forensic assessment. As such, the need for some basic training in and knowledge of forensic psychiatry is clearer than ever.

Anesthesia-assisted rapid opioid detoxification has been touted as a painless way to kick an addiction. In a randomized trial comparing it to two other rapid detox methods, it was found to be similar on several methods, but resulted in greater risks for life-threatening adverse events. Opioid dependency is a chronic, remitting disorder and the greatest need is not a fast painless method of getting detoxed, but a reliable method of maintaining abstinence.

Are all treatments for schizophrenia created equal? With Phase I of the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study completed, five pharmacological options have been compared in an attempt to answer this question. Results from this portion of the trial have been released and are discussed.

Forensic examinations involving children and adolescents are particularly difficult, due to the vulnerability of this patient population. What ethical guidelines should be followed and what sorts of pitfalls should clinicians attempt to avoid?

Attempting litigation based on a claim of posttraumatic stress disorder can be difficult. What is the proper DSM definition of PTSD and in what ways can and can't it be used in court to properly defend a client? What should the role of the psychiatrist be in this process?

Forensic psychiatry is increasingly emerging into treatment psychiatry as a respected subspecialty. However, there are important clinical and business distinctions between the practice of treatment psychiatry and the practice of forensic psychiatry. The essential components of setting up a forensic psychiatry practice are outlined.

Several significant factors have converged to impact and heighten concern about the potential for malpractice litigation related to psychopharmacology. Current influences as well as frequent sources of professional liability risk related to psychopharmacology are reviewed and suggestions for preventing and reducing risk are made.

Consultation-liaison psychiatrists frequently encounter clinical situations that have legal implications. Competency evaluations, which are the most common legal question in C&L psychiatry, are reviewed in this article. In addition, the authors discuss guardianship, decision making in patients who refuse treatment, confidentiality and the role of the psychiatric consultant in against medical advice discharges.

How did the author of the controversial book Listening to Prozac become a psychiatrist instead of a writer as he had planned, and how did he manage to fulfill both career goals?