A Subspecialty of Growing Importance

December 1, 2005

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.

Forensic psychiatry has developed into a formal subspecialty in recentyears. However, as in any other subspecialty of psychiatry, generalpractitioners are encouraged to have some training in and knowledge of forensicpsychiatry. Despite its new subspecialty status, general clinicians still performthe bulk of forensic assessment. Clinicians aware of their lack of trainingoften fear becoming involved in forensic cases, avoid forensic practiceentirely, and suffer undue anxiety when their participation becomesunavoidable.

Clinical psychiatrists can and should familiarize themselves with some ofthe principles and practice of this fascinating and challenging subspecialty.General clinicians receive training in a variety of subspecialties ofpsychiatry, such as child and adolescent psychiatry, geriatric psychiatry, orsubstance abuse. Although encouraged to recognize the limits of theirexpertise, and to refer complicated cases to specialists, general cliniciansare able to evaluate, manage and treat patients in these categories based ontheir basic training if they so choose.

This Special Report has something to offer to both forensic specialists andgeneral clinicians. Psychiatrists with forensic expertise will find thesereviews useful synopses of common and relevant forensic issues. General clinicalpsychiatrists will find that these articles provide useful information shouldthe issues discussed in these articles arise in their clinical practice.Perhaps more importantly, general psychiatrists may find that some of theiranxieties regarding forensic involvement and their own professional liabilityexposure may be minimized by an understanding of forensic issues.

This Special Report reviews a number of areas of forensic practice. PhilipJ. Resnick, M.D., and Renee Sorrentino,M.D., have provided a thorough review of competencyissues that commonly arise in consultation-liaison psychiatry and discuss thecomponents of competency evaluations. Jacqueline M. Melonas,J.D., M.S., R.N., discusses an issue that has increasingly come to affectclinical practitioners: liability risk related to psychopharmacology. Sheprovides suggestions to help practitioners reduce these risks by understandingwhere they lie and how good clinical practice can address them. I offer areview of the thorny issues that arise when the diagnosis of posttraumaticstress disorder, increasingly common in all types of litigation, becomes alegal point of contention. Richard A. Ratner, M.D.,has reviewed the complex ethical issues surrounding evaluations of children andadolescents.

Psychiatrists are discovering that both the forensic and clinical practiceof psychiatry can be professionally rewarding. Robert P. GranacherJr., M.D., M.B.A., offers suggestions to those interested in expanding theirpractices to include forensic psychiatry. The business elements of forensicpractices differ in some ways from those of clinical practice. However, generalclinicians and forensic specialists alike will benefit from a review of thesesound business principles.

Forensic psychiatrists can benefit from reviewing the expertise of theircolleagues. General clinicians will find that the more familiar they are withthis exciting subspecialty, the more confident they will become in the clinicalpractice of psychiatry.

Dr. Gold is a clinical and forensic psychiatristand is clinical associate professor of psychiatry at the Georgetown University School of Medicine. Sheis also associate director of the GeorgetownPsychiatry Residency Program in Psychiatry and Law. She is co-editor of TheAmerican Psychiatric Publishing Textbook of Forensic Psychiatry with Robert I. Simon, M.D.