Practice Of Forensic Psychiatry Research Articles

The preferences of Hungarian judges with regard to forensic psychiatry and forensic psychology experts

IntroductionAlthough Hungarian forensic psychiatry has a historical legacy dating back to the 1890s, for the past few years there has been a dramatically increasing shortage of forensic psychiatry experts in Hungary, which affects both health care practices and the judiciary.Objectives In order to join the international academic unity of forensic psychiatry including research, education and treatment besides expert witnessing, our workgroup aims to facilitate the development of high-level quality standards in modern forensic psychiatry in Hungary. Based on our pilot study on this topic, in the current nationwide study we attempted to delineate the preferences of Hungarian judges regarding the role of forensic psychiatry and forensic psychology experts in both criminal and civil legal proceedings.Methods With the help of the National Office of the Courts, Hungarian judges were asked to complete a questionnaire that - besides personal characteristics – comprised specific questions in several areas including; hearing the experts; their preferences when assigning experts; the value of the expert’s oral statement in court; the extent of their reliance on the psychiatric or legal knowledge of the experts; and the ways judges assess their own psychiatric and psychological knowledge. They were also asked to disclose their opinion about the attributes of optimally applicable expert opinions. Respondents provided their answers as rating on a 10-point Likert scale; or as percentage estimates. Besides descriptive statistics, we investigated the difference between the two groups of judges using Chi-square statistics and ANOVA with respect to the association between the answers and the main personal characteristics of judges.ResultsThe dataset contains >400 completed questionnaires, returned from all over the country, and the analyses are ongoing. Preliminary results are available for a sample of 125 respondents: 53 criminal court and 72 civil court judges, with 64 of them having a maximum of 14 years and 61 having more than 14 years of work experience. Rating the characteristics of assigned experts, we found a significant association between being a criminal court judge and assigning an expert who is considered as an “acknowledged authority” by peers (p=0.002). Finding it crucial what the assessed people report on the legal case itself was significantly associated with civil court judges (p=0.026).ConclusionsIn the absence of any available nationwide information in Hungary, our study is expected to provide much-needed and fundamental information to the current practice of forensic psychiatry in the country.Disclosure of InterestNone Declared

Balance and Change in Forensic Psychiatry.

The practice of forensic psychiatry requires balance; the forensic psychiatrist encounters the need for balance routinely and in a variety of areas. Balance is necessary for sound judgment and objectivity when striving for excellence in the field. It is also necessary to effectively balance a career in forensic psychiatry with one's personal life. The American Academy of Psychiatry and the Law (AAPL) has stressed the virtue of balance in the preamble of its ethics guidelines, noting the importance of balancing competing obligations to the individual and society. Keeping in mind the importance of balance will assist forensic psychiatry with the many challenges of a postinternet era, such as rapidly changing technology, culture, and society. A substantial challenge for forensic psychiatry, now and in the future, involves data overflow and the so-called big data explosion. Information now flows too fast and in such vast amounts that a single individual can no longer keep pace. Balance may be pursued by adapting and leveraging certain skills to confront these challenges more effectively. The current inflection point of rapid technological, social, and cultural change, stresses the importance of balance through teamwork, technology, and prioritizing civil discourse.

A critical review of undergraduate education and teaching in forensic psychiatry.

Although forensic psychiatry is recognised as a full medical speciality in the UK, training in it is not routinely offered to medical students. With growth both in forensic psychiatry and availability of medical school places, it is a good time to explore the nature and quality of experience already available. 1. To map the literature against the guideline for reporting evidence-based practice educational interventions and teaching checklist. 2. To critically review research and scholarship. 3. To identify gaps in evidence-based education for medical students in forensic psychiatry. A systematic search of three bibliographic databases from inception to December 2021 was undertaken using keywords related to medical students and forensic psychiatry between December 2021 and March 2022. The search was supplemented by citation and hand searching. Eight articles were identified. Collectively, they suggest that education and teaching were implemented at a local level and not linked to theories of learning. Exposure to forensic psychiatry stimulated positive attitudes, which amplified interest in psychiatry. There was insufficient evidence to determine optimal undergraduate education and teaching practice in forensic psychiatry. Forensic psychiatry appears to have much to offer the medical undergraduate as part of core learning in psychiatry, including universal skills and knowledge such as ethical decision-making and handling emotions. There appears to be considerable opportunity for education, teaching and research innovation in undergraduate education and teaching in forensic psychiatry. Interesting areas for development include simulated and coproduced education.

On the issue of objective diagnosis of dissociative identity disorder in the practice of forensic psychiatry

The article presents the possibilities of a new method of neurophysiological research in forensic psychiatry — the variance of the amplitude- frequency characteristics of the alpha rhythm of the EEG on the example of a dynamic study of a patient with dissociation of personality identification

Ezra Griffith, M.D., to Receive Chester Pierce Human Rights Award

Ezra Griffith, M.D., to Receive Chester Pierce Human Rights Award

On the issue of objective diagnosis of dissociative identity disorder in the practice of forensic psychiatry

The article presents the possibilities of a new method of neurophysiological research in forensic psychiatry – the variance of the amplitude-frequency characteristics of the alpha rhythm of the EEG on the example of a dynamic study of a patient with dissociation of personality identification.

Defining the tasks of clinical reasoning in forensic psychiatric evaluation: Psychomedicolegal analysis competency

ObjectiveInconsistency in the quality of forensic psychiatry report has been criticized for several years. Yet, there are limited guidelines to provide minimally satisfactory forensic psychiatry evaluation conducted by psychiatrists. In addition to the impact towards the forensic psychiatry service, this lack of standardized guidelines may impact the relevant competency development and its various teaching methods of forensic psychiatry among general psychiatrists. Therefore, this study aims to identify components of psychomedicolegal analysis competency as a form of clinical reasoning in forensic psychiatry. MethodsA comprehensive literature review and expert panel discussions were conducted simultaneously to formulate an initial list of psychomedicolegal analysis competency. A total of fourteen experts were chosen based on their expertise in different disciplines that have intersections with forensic psychiatry and the general psychiatry curriculum (e.g. general psychiatrist, forensic psychiatrists and psychologist, law practitioner, and medical education director). The expert panel were instructed to score and provide feedbacks on the items of the initial list. Four-point Likert scale were used in order for the experts to express the relevancy of the core competence to forensic psychiatry practice until it reached the consensus. ResultsThe final 60 items of psychomedicolegal analysis competency were developed after three rounds of Delphi technique and reached a consensus (>70% and medians score of at least 3,25). These competency then categorized into four steps 1) preparing the case (Item 1–11), 2) conducting the evaluation (Item 12–41), 3) writing the report (42–51), and 4) giving expert opinion in court (Item 52–60). ConclusionWe developed 60 items of psychomedicolegal analysis competency that can be used as a standardized guide for psychiatrists to conduct forensic psychiatry evaluation, write the report and provide expert opinion in court. Implementation of this guideline can be used to shape further forensic psychiatry education for general psychiatrist and psychiatry residency.

The peculiarities of medico-legal psychiatric expertise in minors, found in the practice of forensic psychiatry

Psychiatric medico-legal expertise is a way to ascertain the deviation from the social and cultural norms of society. In the case of minors, the same legal norms are applied, often without taking into account the fact that the deviant behavior of minors is a form of protest against his capacity for adaptation and psychological, cognitive and social integration. The purpose of the article is to establish the particularities of the medico-legal psychiatric expertise in minors from the perspective of the practice of forensic psychiatry. The paper identified the differences between the classic norms of forensic psychiatry, the specifics of minors' behavioral deviations, Sweden's experience regarding the general theoretical framework in forensic psychiatry, the Theory of Dual Processes and is exemplified by the criminological profile of minors in relation to the norms of social adaptation and medico-legal psychiatric expertise.

Victim Intoxication and Capacity to Consent in Sexual Assault Statutes across the United States.

Alcohol use is common in cases of sexual assault. These cases raise significant questions about a victim's capacity to consent to sexual intercourse. In many United States jurisdictions, intoxicated victims may be considered mentally incapacitated only if they have been administered alcohol or other substances involuntarily. A recent Minnesota Supreme Court case illustrated why reform is necessary in this area of criminal sexual conduct law. We present this case and the results of a review of felony criminal sexual conduct laws in the fifty states of the United States and the District of Columbia. We find that nearly half of the jurisdictions surveyed require that a victim must be involuntarily intoxicated to be considered incapacitated or impaired. We draw on Minnesota's experience with legislative reform of its sexual assault laws as well as judicially mediated reform mechanisms to present a roadmap for overcoming this voluntary intoxication caveat. Finally, we discuss the implications of these laws for victims of sexual assault and for the practice of forensic psychiatry in cases of criminal sexual conduct involving victim intoxication.

The Use of Battered Woman Syndrome in U.S. Criminal Courts.

Although not recognized by any edition of the Diagnostic and Statistical Manual of Mental Disorders, battered woman syndrome (BWS) has been offered as a defense in U.S. criminal courts for several decades. This article reviews examples of criminal cases in which BWS has been used in the United States as well as the implications of BWS for the practice of forensic psychiatry. Historically raised in cases of self-defense, BWS has also been used in criminal defenses involving duress, as well as by prosecutors to explain witness recantations. Case law suggests that expert witness testimony on BWS is often admissible in jurisdictions across the United States, yet its use in criminal defenses has received mixed responses from various courts. We examine limitations on the use of BWS in criminal courts and the potential use of posttraumatic stress disorder as an alternative and more reliable diagnosis in similar legal contexts.

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Ethics in Psychotherapy: Informed Consent, Digital Professionalism, and Sexual Misconduct.

Occupational Hazards versus Professional Duty in Reviewing Potentially Traumatizing Evidence.

Electronic evidence, including real-time recordings of crimes by police cameras and smart phones, is becoming increasingly relevant to the practice of forensic psychiatry. A developing literature in fields parallel to our own has described vicarious trauma experienced by mental health and legal professionals exposed to traumatic material in the line of duty. The impact of potentially traumatizing media on the forensic psychiatric evaluation and on the individual forensic psychiatrist is unknown. Calling upon the research and practices of adjacent fields, as well as the personal experience of the authors, this article outlines the benefits and hazards of examining graphic media, addresses potential strategies to mitigate its traumatogenic potential (including among trainees), and suggests how future scholarship may improve understanding of these hazards and inform strategies to prevent them.

Just Like a Woman: Gender Role Stereotypes in Forensic Psychiatry.

The relationship between violence, gender and mental health is a complex one which is yet to be fully understood. Gender role stereotypes are social constructs that can powerfully influence and regulate human behaviour, including violence; and so it is likely that they also influence the nexus of violence management and mental health which is at the core of forensic psychiatry. In this article, we examine how gender role stereotypes might influence the practice of forensic psychiatry: specifically, in relation to women as violent offenders, as patients in secure psychiatric care and as clinicians working in forensic settings. We identify areas of development in women’s forensic mental health services, and examine whether patriarchal influences and gender role stereotypes may have inadvertently impacted upon these changes. We also consider whether these changes may maintain pre-existing barriers to treatment for both men and women.

Multidirectional (auto- and hetero-) aggression in the practice of forensic psychiatry

IntroductionThe problem of coexistence of heteroaggression and autoaggression most clearly manifests itself in the field of forensic psychiatry. For example, in Russia, about 25% of criminals who committed aggressive actions had a history of suicide attempts.ObjectivesIdentification of specific personality traits in individuals with multidirectional aggression.MethodsIn a continuous one-step study, relatively sane adults of both sexes were examined: 38 persons undergoing forensic examination with multidirectional aggression and 34 violent criminals. A wide range of forensic psychological techniques is used to identify aggression, suicidogenic and inhibitors of aggression. Nonparametric statistical methods were used: Spearman rank correlation coefficient (r) and Mann-Whitney (U).ResultsThe leading role in the genesis of multidirectional aggression, in contrast to other types of aggression, playing the combination (p<0.01) to the presence of motivational aggressiveness (according to the Hand Test, U=556.6; p=0,046) and the willingness to show negative feelings at the slightest arousal (annoyance, irascibility according to BDHI, U=468.2; p=0,012), along with suicidal personal qualities, which is combined with the deficiency of auto- and heteroaggression inhibitors (value orientations; socio-normative, dispositional, communicative, emotional inhibitors, coping strategies, etc.). However, the psychological mechanisms of multidirectional aggression are relatively non-nosospecific and are similar in mentally healthy individuals and individuals with personality and organic mental disorders.ConclusionsMultidirectional aggression in view of the increased risk of recidivism and personal and public danger should be taken into account by forensic experts when recommending psychocorrective measures in places of deprivation of liberty.DisclosureNo significant relationships.

Richard G. Dudley, Jr., MD: Caring in Forensic Psychiatry Practice

A few years ago, I was invited to give a lecture at the Yale Law School on the performative dimensions of the forensic psychiatry report. Before I could even settle down to my task, a member of the law faculty approached me. She asked whether I knew Richard Dudley and placed a copy in my hands of

A Matter of Trust and Distrust: A Qualitative Investigation of Parents' Perceptions About the Use of Mechanical Restraint on Their Adult Children in a Forensic Psychiatric Setting

Increased knowledge about forensic psychiatric patients' relatives' perceptions in regard to the use of mechanical restraint (MR) is necessary, if clinical practice is to be improved and to achieve a reduction in the use and frequency of MR. However, a specific knowledge deficit about relatives' perspectives on the use of MR limits the evidence base considerably. The aim of this study was to investigate the perceptions of MR held by relatives of forensic psychiatric patients' including factors impacting its use and duration. Qualitative interviews were conducted with 15 parents of patients within a forensic psychiatry setting and thematically analyzed. Two main themes were identified, namely, "care and protection" and "inclusion and involvement," and one subtheme, "information." These themes revealed the framework used by parents to construct a sense of "trust or distrust" about the ability of staff to provide adequate and safe care for their adult children in the forensic psychiatric setting. Some parents in this study considered that forensic psychiatric staff used MR as a necessary protection. However, most parents held strong negative perceptions regarding the use of MR and the quality and safety of care provision. It is apparent that parents in this study believed they should be included and involved in the care in situations associated with the use of MR, because they considered that this could reduce its use. Further research is required to target interventions to reduce the use and duration of MR episodes and to improve clinical practice in forensic psychiatry.

A Seat at the Table.

Organized medicine and psychiatry have a long tradition of governmental advocacy and public engagement. The American Academy of Psychiatry and the Law (AAPL), since its founding 50 years ago, has made some forays into these fields. However, its involvement has been less substantial than other similarly situated professional organizations. With its increasing membership and expertise, AAPL now possesses the capacity to dedicate some of its organizational attention, energy, and resources to educating policymakers and the public on current and future topics related to forensic mental health. In addition, an increasing number and type of professional activities related to this discipline are affected by governmental regulation and public opinion. Therefore, the need to become involved in shaping policy is more urgent, particularly in light of the fact that other forensic mental health organizations have been actively involved in governmental advocacy for decades. Finally, as a field and in the near future, we likely will deal with life-changing technological innovations related to the practice of forensic psychiatry. AAPL and its members are perhaps uniquely qualified and have a responsibility to help ensure that these innovations are developed, implemented, and utilized appropriately. This can only be accomplished by having a proverbial seat at the table in the process.

EXPERTISE IN GERECHTSDOSSIERS

EXPERTISE IN CASE FILES The practice of forensic psychiatry in the Netherlands, 1811-1930 Research on the history of Dutch forensic psychiatry has hardly taken into account how psychiatrists functioned in practice. This article, based on 485 court cases of (child)murder, rape and arson, provides an inventory of the role of psychiatrists in the courtroom. It distinguishes between three regimes of knowledge: a first regime in the first half of the nineteenth century, when there is much overlap between lay and expert knowledge on the mind; the second from ca. 1880, when increasingly reference is made to scientific concepts and reports became standardized; and a third regime around 1920, when an emphasis on scientific methods found its way into the reports. An analysis of verdicts shows that the judges often agreed with the expert reports. The relationship between the judges and psychiatrists can be qualified as one in which judges accorded room for experts, who, however, remained subservient to the judiciary.

Evidence-Based Practice in the Evaluation and Treatment of Sexual Offenders

This editorial addresses evidence based medical practice in forensic psychiatry and particularly in the field of paraphilia. John M. Bradford is a Professor in the Department of Psychiatry and Behavioural Neurosciences, McMaster University. He is an Emeritus Professor at the University of Ottawa where he was a founder of the Royal Ottawa Institute of Mental Health Research. He is a Founder of Forensic Psychiatry, granted by the Royal College of Physicians and Surgeons of Canada. Abdullah H Alqahtani is an Assistant Professor and Consultant Psychiatrist at King Fahd University Hospital, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia. He is currently completing a clinical fellowship in forensic psychiatry at McMaster University - St. Joseph’s Healthcare Hamilton. Andrew T. Olagunju is an academic psychiatrist with a Senior Lecturer position at the College of Medicine, University of Lagos, Nigeria. He is also completing a clinical fellowship at McMaster University - St. Joseph’s Healthcare Hamilton.

The Limits of Confidentiality: Informed Consent and Psychotherapy.

The Limits of Confidentiality: Informed Consent and Psychotherapy.