Forensic Psychiatry

Impulsive behaviors play an important role in both bipolar and substance abuse disorders. However, results of studies investigating this link are often ambiguous, in part, due to the multidimensional nature of the impulsivity construct and the fact that many studies use a single measurement technique. We describe a model of impulsivity characterized by three components: response initiation, response inhibition and consequence sensitivity. How these components differ from one another in terms of their use, behavioral theory and biological function is discussed, along with measurement techniques.

Proposed changes in the conceptualization of compulsivity and impulsivity in the DSM-V will have important implications in the way clinicians recognize and treat these disabling conditions.

The case of dentist Charles Sell, who suffers from delusional disorder, still awaits resolution. In the meantime, Sell remains incarcerated while his competency to stand trial is debated. Does this serve justice?

Of concern is the safety of our roadways as the effects of aging take their toll upon drivers nationwide. Are there accurate ways to test the cognition and response ability of elderly drivers?

During a trip to Beijing on behalf of the World Psychiatric Association, Dr. Stone witnessed up close how the psychiatry is practiced in today's China. What he found may surprise you--it certainly surprised him.

Psychiatric evaluation of juveniles who commit murder is perhaps one of the most difficult tasks in forensic psychiatry. A study has shown that these inmates are more likely to have been abused, be addicted to drugs or alcohol, or have a serious psychiatric disorder. Additionally, they are more likely to engage in risky behavior without thinking about the consequences.

Osteoporosis is a disorder characterized by low bone mass and microarchitectural deterioration with resulting compromised bone strength and increased risk of fracture.1 The World Health Organization defines osteoporosis based on T-scores, which reflect bone mineral density (BMD) relative to mean BMD for healthy 25-year-old same-sex populations. A T-score between 0 and 21 is considered normal density, a score between 21 and 22.5 indicates osteopenia, and a score of less than 22.5 signifies osteoporosis.2 Severe osteoporosis is defined as a T-score of less than 22.5 combined with a fragility fracture.2

Little attention has been paid to the prevalence of sexual assault and its sequelae among military men. The past-year prevalence of sexual assault among enlisted men ranges from 0.4% to 3.7%, a figure equal to or exceeding the lifetime prevalence among civilian men in some studies. Increased awareness and understanding of male sexual assault as well as routine screening of all patients, regardless of gender, for exposure to sexual victimization will enhance their recovery.

Comorbid substance use disorders may complicate treatment for both the hepatologist and psychiatrist. Comprehensive assessment of psychiatric illness and psychopharmacological management may be critical.

Since the 1990s there has been an increase in research on sexual harassment and its mental health consequences. These researchers discuss the use of alcohol to self-medicate harassment-engendered distress and the need for greater attention to potential alcohol-related consequences of harassment experiences.

Telepsychiatry has been hailed as the future of psychiatry. Proponents have claimed that it can reduce costs and allow access to difficult-to-reach patients. What are the promises and pitfalls of this new technology?

What special issues do psychiatrists face when treating women, children and adolescents, and elderly people with schizophrenia? Are there recommendations for care and monitoring strategies to maintain patients on effective, long-term treatment regimens?

Although a lot remains to be learned, much is already known about the early childhood characteristics that predispose children to antisocial behavior and violence in adolescence and early adulthood, an expert in psychopathology said recently at a National Institutes of Health conference.

When disputes arise concerning custody and visitation, mental health care professionals can inform and assist judges by performing competent custody evaluations.

Allegations of complicity by Chinese psychiatrists in abuse and persecution of members of the Falun Gong continues to trouble the World Psychiatric Association. Are the steps being taken to learn the truth enough? Dr. Stone provides a look at the events that have unfolded to date.

Psychiatrists and other mental health activists have been working in various countries around the globe to bring an end to unjust psychiatric incarceration for political beliefs and to improve living conditions for those patients in psychiatric hospitals. The former Soviet Union, China and India are all current targets of focus for this human rights movement. What are human rights organizations doing and how can psychiatrists help?

Despite the image presented in films, books and television, prostitution places women and children at high risk for PTSD and other comorbid disorders. What experiences lead to this life?

Both the mental health and justice communities have been troubled by the increased number of mentally ill individuals in the prison populations. Legislation awaiting passage in the U.S. Congress would fund collaborative programs between these two fields that would try to alleviate this growing problem.

Cognitive-behavioral therapy can be tailored for use with children who have experienced sexual abuse in order to relieve symptoms of PTSD.

This introduction article elucidates how the various contributions to this special report help make psychiatry such a rich and varied field.

Adults who are severely mentally ill are over-represented in U.S. jails and prisons, leading to an interface between the mental health and criminal justice systems. New intervention strategies involving both systems, such as mental health courts and forensic assertive community treatment, could divert patients away from the criminal justice system and promote engagement in community-based treatment and support services.

What are the qualities of forensic psychiatry? In reviewing the basis on which forensic psychiatry is defined as a specialty or, more accurately, a subspecialty of psychiatry, the author discusses the altered relation between physician and "subject," the consultative role in relation to the legal system, and the areas of specialized knowledge and skills that attend the field.

With proposed cuts in state budgets nationwide, social services--including mental health care--are taking a financial blow. As a result, mental health care facilities are closing and services are disappearing. What will the effect be on patient care?

The distress and functional impairment associated with PTSD may make it difficult for IPV victims to benefit from interventions to increase their safety and reduce their exposure to violence. Empirically supported PTSD treatments include pharmacotherapy and cognitive behavioral therapy. Incorporating these treatments into interventions to improve victims' safety and reduce exposure to violence may improve their effectiveness in protecting women from IPV.

Little attention has been paid in the professional literature to a phenomenon that non-professionals have recognized since ancient times: Trauma can lead to personal growth. This article focuses on how traumatic events set processes in motion that produces new perspectives on the self, relationships and philosophy of life. Implications for clinical work with trauma survivors are discussed.