Access to Psychotherapy Notes: Review of Legal Standards for Mental Health Clinicians.

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes.

A Patient-Centered Approach to Opioid Use Disorder.

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Childhood Trauma, PTSD, and the Cautious Forensic Expert.

For centuries, medicine and psychiatry mirrored society's equivocations regarding childhood trauma. Those conflicts have mostly resolved, with widespread agreement that children are commonly exposed to traumatic events that may lead to PTSD and other mental conditions. The psychiatric and legal arguments should no longer be about the reality of childhood trauma in general; instead, experts should focus on the methodology of translating a particular child's narrative truth of maltreatment into a historical account, so that the expert can be qualified to offer criminal or civil court testimony after examining the child.

Sexual Enhancement Treatment for Sexually Violent Predators: Ethical and Legal Implications.

The treatment of sexually violent predators (SVPs) has been controversial since the implementation of sexual predator laws and statutes that seek to balance the civil rights of SVPs and the protection of potential victims. In this paper, we will present the case of an SVP who sought sexual enhancement surgery in order to perform intercourse with his wife. We will also discuss the conflicting legal and ethical issues affecting a decision to implement sexual enhancement therapy for SVPs in an effort to reconcile these divergent positions.

Addressing therapeutic boundaries in social networking.

Facebook is the leading social networking website, with over 500 million users. Prior studies have shown an increasing number of housestaff accessing the site. While Facebook can be used to foster camaraderie, it can also create difficulties in the doctor-patient relationship, especially when boundaries are crossed.

Commentary: Pursuing justice in death penalty trials.

The capital trial, by its nature, is fraught with emotionally disturbing elements that jurors must face when deciding the ultimate fate of a guilty defendant. A confluence of mitigating and aggravating factors influences a capital jury's decision to impose a sentence of death. The presence or absence of defendant remorse in these cases may make all the difference in whether a capital defendant's life is spared.

Psychiatric ethics: foundational and evolutionary.

As with the basic and clinical sciences, the field of medical ethics, in particular, that of psychiatric ethics, has grown and developed during the last four decades, the time when Dr. Eugene Brody edited the Journal of Nervous and Mental Disease. In this paper, the authors will consider a series of ethical problems that psychiatrists have identified in their clinical practice and suggest paths to resolution that may artfully balance conflicts in core moral beliefs.

Psychological responses to continuous terror: a study of two communities in Israel.

Objective: The authors evaluated psychological responses to continuous terror.

Method: Data were collected after 10 months of escalating hostilities against civilians in Israel. The study's participants were randomly selected adults living in two suburbs of Jerusalem, one frequently and directly exposed to acts of terrorism (N=167) and the other indirectly exposed (N=89).

Impact of trauma on children.

Millions of children are affected by physical and sexual abuse, natural and technological disasters, transportation accidents, invasive medical procedures, exposure to community violence, violence in the home, assault, and terrorism. Unfortunately, the emotional impact of exposure to trauma on children is often unappreciated and therefore untreated, and yet the impact of exposures to disaster and violence is profound and long-lasting. This article first briefly discusses the epidemiology of trauma in children, and then reviews the psychiatric and neurodevelopmental impact of trauma on children as well as the effects of trauma on children's emotional development.

A practical method for the evaluation of symptom exaggeration in minor head trauma among civil litigants.

Forensic psychiatrists and psychologists are often called on to provide opinions and render testimony in which minor head trauma accompanied by persistent somatic, cognitive, and/or emotional symptoms is alleged. The frequency of persistent symptoms following such minor head injury is generally low. The forensic clinician therefore must differentiate between subtle brain dysfunction, symptom amplification, psychogenic-based causes for the presence of cognitive and other deficits, or frank malingering.

Forensic evaluation of trauma syndromes in children.

There are significant differences between a clinical evaluation and a forensic evaluation [289-291]. These differences must be kept solidly in mind in performing the evaluation. The forensic evaluator needs to assess the validity of complaints, including the possibility of malingering and the child's ability to describe symptoms accurately, the connection between the symptoms and a given incident, and the potential long-term sequelae of a trauma.

Stress-induced enhancement of auditory startle: an animal model of posttraumatic stress disorder.

An innovative animal model of posttraumatic stress disorder (PTSD) is proposed in which nonhabituation of the acoustic startle response is developed in rats subsequent to tailshock exposure. Subjects (n = 31) received 30 minutes of intermittent tail shock on 2 days followed by exposure to the tailshock apparatus on the third day. Compared to baseline startle reactions, 9 of 31 tailshock-exposed rats developed nonhabituation of startle response reactions during the subsequent 3 weeks of testing.

The future of criminal violence: juveniles tried as adults.

Juveniles tried as adults (JTA) represent a select and small subsample of juvenile offenders. This study seeks to provide a profile of habitually violent JTAs transferred to the adult penal system and to compare them with their adult counterparts. Twenty-nine incarcerated violent male juveniles tried as adults were compared with a sample of 27 incarcerated violent male offenders across demographic, neuropsychological, criminal history, psychopathy, and substance abuse variables.