AAPL Practice Guideline for the forensic psychiatric evaluation of competence to stand trial.

Competence to stand trial is a legal construct used to identify those criminal defendants who have the requisite mental capacity to understand the nature and objective of the proceedings against them and to participate rationally in preparing their defense. This Practice Guideline has described how psychiatrists should evaluate individuals concerning their competence to stand trial. The Guideline describes acceptable forensic psychiatric practice for such evaluations.

Psychiatric malpractice case analysis: striving for objectivity.

Forensic psychiatrists, acting as expert witnesses, must be able to perform objective analyses of psychiatric malpractice cases. Accurate malpractice case analysis requires careful attention to relevant legal concepts and consideration of potential biasing influences. If forensic psychiatrists are to avoid a reliance on "experts policing experts," individual forensic psychiatrists must be fully prepared to police themselves by recognizing and avoiding certain errors in malpractice case analysis.

Capacity of forensic patients to consent to research: the use of the MacCAT-CR.

The ability of psychiatric patients and prisoners to provide informed consent to participate in clinical research has given rise to much debate. Forensic psychiatric patients present a particular concern regarding their competence to consent to research, as they are both patients and prisoners. The primary goal of this research was to evaluate whether, by employing structured assessments of capacity to consent to research, we could determine if this combined vulnerability leads to differences in competence from the published abilities of nonforensic psychiatric patients.

Sell v. U.S.: involuntary medication to restore trial competency--a workable standard?

Competency to Stand Trial (CST) evaluations are common in the U.S. criminal justice system.

Sex offender registration and community notification challenges: the Supreme Court continues its trend.

All states and the District of Columbia have passed sex offender registration and community notification laws. While the specific provisions of these statutes vary, all have public safety as a primary goal. The authors discuss two recent cases heard by the United States Supreme Court that challenged the constitutionality of Alaska's and Connecticut's statutes.

Patients' rights and psychiatrists' duties: discharging patients against medical advice.

Every psychiatrist who treats voluntary inpatients has had or will have patients who leave the hospital against medical advice (AMA). Studies reveal that between 6 and 35 percent of voluntary psychiatric inpatients are discharged AMA. These patients often are acutely ill and have severe symptoms at discharge.

Managed care and ERISA: synopsis and case law review.

Managed care organizations (MCOs) have become the predominant health care model in the United States. Through cost containment arrangements with providers, incentives for patients to pursue less costly care and reductions in the provision of unnecessary care, MCOs are more intimately involved in the delivery of health care than their former fee-for-service insurance company counterparts. However, this new role has not implied increased liability, largely because of The Employee Retirement Income Security Act of 1974 (ERISA).

Resource document on mandatory outpatient treatment.

Mandatory outpatient treatment, or outpatient commitment, refers to court-ordered treatment for patients who suffer from severe mental illness and who are unlikely to be compliant with such treatment without a court order. Many states already have commitment statutes that permit mandatory outpatient treatment, and others are considering enacting new legislation or amending existing statutes. This Resource Document was prepared under the auspices of the American Psychiatric Association's Council on Psychiatry and Law to provide information to those who are drafting mandatory outpatient treatment legislation.

Monitoring and diagnosis of cytomegalovirus infection in renal transplantation.

In this study, the utility of the cytomegalovirus antigen (CMV-AG) and the shell vial (SV) tests in the diagnosis and monitoring of posttransplant CMV infection were compared. Previous retrospective studies from the authors' center suggested that the CMV-AG test, which uses monoclonal antibodies to detect viral antigen in circulating peripheral blood leukocytes (PBL) may be both a more sensitive and specific test. A cohort of 32 renal transplant recipients was followed-up prospectively with serial CMV-AG testing, as well as conventional culture and SV for blood and urine and tests for immunoglobulin M (IgM) antibody.

Pharmacokinetics and clinical tolerance of intravenous and oral cyclosporine in the immediate postoperative period.

The clinical tolerance and pharmacokinetics of cyclosporine during a prolonged intermittent intravenous infusion (3.5 mg/kg/day three times) followed by an 8 mg/kg daily oral dose was evaluated in eight renal transplant recipients in the immediate postoperative period. Cyclosporine was analyzed from whole blood samples by HPLC.

Pre-aortic left renal vein compression syndrome (Magoss and Walshe syndrome).

A case of a pre-aortic left renal vein compression by the aorta is reported. The clinical presentation was characterized by the left flank pain varying with body body position. Renal venography was crucial for the diagnosis of this lesion.

Circulating immune complexes after kidney transplantation.

Sera from patients who had received renal allografts were studied for the presence of circulating immune complexes by using platelet aggregation technique combined with density gradient centrifugation. A simple and highly reproducible modification of the platelet aggregation technique, employing the use of relatively small amounts of blood from pretested donors as the source for platelets, is described. Immune complexes were detected in post-transplantation sera from 3 out of 16 patients.

Studies on heterophile antibodies in transplantation sera.

By means of double diffusion in gel reactions, "heterophile" antibodies were demonstrated in human renal transplantation sera. Of thirty-two recipients of renal allografts, 12 (37 per cent) had antibodies to extract of bovine erythrocyte stromata, and 5 (19 per cent) of 26 recipients produced antibodies to extract of sheep erythrocyte stromata. These antibodies became detectable 1-6 months after transplantation and persisted for several months or years.