Welcome to volume 58 of the Australian Journal of Forensic Sciences

The authors note that although the psychiatric hospitals is often used as a means of preventing the suicide of disturbed patients, some hospitalized patients succeed in committing suicide; such as an event is distressing for hospital staffs as well as for patients and families. However, the authors believe that the occasional occurrence of in-hospital suicide is inevitable. They present data on the frequency and characteristics of suicides among hospitalized psychiatric patients in Los Angeles County during the period from 1967 to 1972.?23AUTHOR

The "first generation" of research studies on the prediction of violent behavior found such prediction to be highly inaccurate. Many social policy changes were implemented or recommended on the basis of that research. More recently, a second generation of research and theory on violence prediction has begun to develop that emphasizes the limitations of the existing body of research, points to possible improvements in predictive technology, and evaluates public policies involving violence prediction only in the context of the feasible alternatives to those policies.

Concerns raised in response to proposals that general hospitals admit patients who currently receive acute care in state hospitals have focused primarily on certain assumptions about the characteristics of involuntary patients in contrast to their voluntary counterparts. The author compared a group of voluntary and involuntary patients in seven state hospitals. Contrary to some recent reports, legal status was not associated with chronicity, prevalence of psychosis, extent of social ties as measured by marital status and living situation, or need for seclusion or restraint. The two groups differed significantly in median length of stay but in an opposite direction from that previously reported.

The authors' goal was to determine the levels of trauma and psychiatric symptoms in a randomly selected group of Cambodian refugees and to determine the relationship between the amount of trauma experienced and subsequent psychiatric symptoms. Data on traumatic experiences and symptoms of posttraumatic stress, dissociation, depression, and anxiety were collected on 50 randomly selected Cambodian refugees who had resettled in the United States. Subjects experienced multiple and severe traumas and showed high levels of all symptoms measured. Forty-three (86%) of the subjects met DSM-III-R criteria for posttraumatic stress disorder, 48 (96%) had high dissociation scores, and 40 (80%) could be classified as suffering from clinical depression. Correlations between trauma scores and symptom scores and among symptom scores were moderate to large. These results indicate that a high proportion of Cambodian refugees who are not psychiatric patients suffer from severe psychiatric symptoms and that there is a relationship between the amount of trauma they experienced and the severity of these symptoms.

The authors compared the hypnotizability of 65 Vietnam veteran patients with posttraumatic stress disorder (PTSD) to that of a normal control group and four patient samples using the Hypnotic Induction Profile. The patients with PTSD had significantly higher hypnotizability scores than patients with diagnoses of schizophrenia (N = 23); major depression, bipolar disorder--depressed, and dysthymic disorder (N = 56); and generalized anxiety disorder (N = 18) and the control sample (N = 83). This finding supports the hypothesis that dissociative phenomena are mobilized as defenses both during and after traumatic experiences. The literature suggests that spontaneous dissociation, imagery, and hypnotizability are important components of PTSD symptoms.

In an adolescent medicine clinic with more than 1,000 patients during 1982-1984, 11 male adolescents reported a history of sexual molestation by females. This molestation had commonly involved acquaintances and was unlikely to have been accompanied by threats of violence or physical coercion. One-fourth of the victims of both male and female molesters described themselves as sexually dysfunctional, and eight of the victims of male molesters identified themselves as homosexual. Both groups experienced the molestation as highly traumatic.

The suicide of a patient is not an infrequent event in a psychiatrist's practice, and it has a major impact on the clinician as well as on the patient's family and the hospital staff. Dealing with a patient's suicide is a neglected topic in residency training, and many psychiatrists are never taught how to cope with such a situation. The authors review the relevant literature and draw on this as well as on their own clinical experience to recommend specific interventions. They point out that the psychiatrist has a leadership role and a number of responsibilities in the aftermath of a suicide, including notifying the family, the hospital staff, hospital officials, and patients who knew the deceased patient; meeting with the family, the staff, and the patients to encourage discussion and venting of feelings; attending the funeral; and accurately documenting events in the medical record. The psychiatrist should also attend to his or her own needs by seeking support from a colleague and should ensure that a psychological autopsy is performed in order to facilitate learning, improve care of patients in the future, and help bring about closure for the psychiatrist so that the quality of his or her care of other patients is not compromised.

Dyskinesia is found significantly more often among neuroleptic-treated psychiatric patients than among non-neuroleptic-treated patients. The epidemiology of tardive dyskinesia is changing; its reported prevalence among neuroleptic-treated psychiatric inpatients has been progressively rising and has reached 25% during the past five years. The prevalence of persistent tardive dyskinesia that may be attributable to neuroleptics is about 13%. Tardive dyskinesia is not restricted to old, brain-damaged inpatients but also occurs with a noticeable frequency among younger patients, including outpatients, treated neuroleptics. Yet neuroleptics are the most effective available treatment for schizophrenia; hence, any drastic curtailment of their use in the treatment of chronic schizophrenic patients may not be justified. Cautious use of these drugs, along with intensified research on tardive dyskinesia is warranted.

Recent publications have noted a rate of suicide for women physicians considerably higher than that for women in the general population. The authors comment on some of the methodologic problems involved in this research and discuss the interaction between affective disorder and suicide as but a partial explanation of the higher risk of suicide among women physicians. The authors conclude that a number of risk factors are involved both in the relatively high lethality rate of some groups of professional women and in the relatively low lethality rate of women in general.

Six families are described in which 10 sons were involved incestuously with a natural father (N=4) or step-father (N=2). Father-son incest as a part of the spectrum of child abuse appears to be a more frequent clinical entity than was thought previously.

A longstanding controversy is the relative dangerousness and criminality of the mentally ill. The author presents observational data from 1,072 police-citizen encounters in an urban area. The data show that persons exhibiting signs of serious mental disorder were not suspected of serious crimes at a rate disproportionate to their numbers in the population. The patterns of crime for mentally disordered persons and for non-mentally-disordered persons were substantially similar. These data help dispel the myth that the mentally ill constitute a dangerous group prone to violent crime.

Four psychiatric syndromes related to reproductive function in women have been identified: postpartum depression, premenstrual syndrome (PMS), post-hysterectomy depression, and involutional melancholia. The authors review what is known about these syndromes and conclude, first, that postpartum depression comprises three separate syndromes, the most severe of which is most likely a variant of primary affective disorder. Second, research into the syndromal nature, biology, and treatment of PMS is still in its infancy due to a variety of methodological difficulties. Third, the rate of depression among women during the involutional period or following hysterectomy for benign pathology is not higher than it is at other times.

The purpose of this study was to examine factors predicting the development of posttraumatic stress symptoms after a traumatic event, the 1991 Oakland/Berkeley firestorm. The major predictive factors of interest were dissociative, anxiety, and loss of personal autonomy symptoms reported in the immediate aftermath of the fire; contact with the fire; and life stressors before and after the fire. Subjects were recruited from several sources so that they would vary in their extent of contact with the fire. Of 187 participants who completed self-report measures about their experiences in the aftermath of the firestorm, 154 completed a follow-up assessment. Of these 154 subjects, 97% completed the follow-up questionnaires 7-9 months after the fire. The questionnaires included measures of posttraumatic stress and life events since the fire. Dissociative and loss of personal autonomy symptoms experienced in the fire's immediate aftermath, as well as stressful life experiences occurring later, significantly predicted posttraumatic stress symptoms measured 7-9 months after the firestorm by a civilian version of the Mississippi Scale for Combat-Related Posttraumatic Stress Disorder and the Impact of Event Scale. Dissociative symptoms more strongly predicted posttraumatic symptoms than did anxiety and loss of personal autonomy symptoms. Intrusive thinking differs from other kinds of posttraumatic symptoms in being related directly to the trauma and previous stressful life events. These findings suggest that dissociative symptoms experienced in the immediate aftermath of a traumatic experience and subsequent stressful experiences are indicative of risk for the later development of posttraumatic stress symptoms. Such measures may be useful as screening procedures for identifying those most likely to need clinical care to help them work through their reactions to the traumatic event and to subsequent stressful experiences.

Although the relationship between experience of problematic life events and adolescent suicidal behavior has frequently been recognized during the past decade, few studies of life events have been initiated that discriminated between adolescent suicide attempters and depressed adolescents. Therefore, the authors compared adolescent suicide attempters with both depressed and nondepressed adolescents who never attempted suicide with respect to life events that happened in two periods: childhood (defined as the period up to age 12 years) and adolescence (age 12 and older). Using a semistructured interview, the authors gathered life event data about childhood and adolescence from three groups of adolescents: 48 suicide attempters, 66 depressed adolescents who had never made a suicide attempt, and 43 nondepressed adolescents who had never made a suicide attempt. The group of adolescents who attempted suicide differed from both of the other groups in that they had experienced more turmoil in their families, starting in childhood and not stabilizing during adolescence. During adolescence, they were more often sexually abused. During the last year before the attempt, further social instability, such as changes in residence and having to repeat a class, occurred. For suicidal adolescents, the suicide attempt seems embedded not just in the problems every adolescent has to deal with but in greater turmoil in their families, rooted in childhood and not stabilizing during adolescence, in combination with traumatic events during adolescence and social instability in the year preceding the attempt.

(2003). Forensic Sciences from the Judicial Perspective. Australian Journal of Forensic Sciences: Vol. 35, No. 1, pp. 115-132.