Failure to treat: an American policy perspective.

Throughout its two and a half centuries in existence, US mental health policy has repeatedly failed people living with schizophrenia. The failures are cyclical-the inhumane conditions uncovered in the first 75 years of existence were addressed with the construction of state asylums to deliver moral treatment. One hundred years later, the asylums were themselves revealed to be inhumane.

Breaking Down Silos Within a Multihospital System: Lessons From the California Department of State Hospitals' Response to the COVID-19 Pandemic.

The California Department of State Hospitals and Department of Public Health collaborated to develop infection control programs in five inpatient psychiatric hospitals in response to COVID-19. In the retrospective observational study described here, conducted from March 2020 through February 2023, we calculated seven-day rolling averages of COVID-19 cases overlaid with key interventions, communication strategies, and policies implemented to break down silos for a consistent and coordinated response. Our findings may inform others regarding effective strategies and partnerships with public health experts during future outbreaks.

The Influence of Race on Detected and Undetected Sexual Offense Histories: A Comparison of White and Black Men Committed as Sexually Violent Persons.

Understanding the difference between the proportion of sexual offenses that are officially detected versus the total number of sexual crimes that occur has been of interest to decision makers for some time. Previous studies have not considered possible racial differences. More aggressive responses by police and the criminal justice system as well as cultural differences in victim type/reporting rates may result in differences between detection rates of Black versus White men.

Electroconvulsive Therapy for the Treatment of Somatic Delusions.

Somatic delusions occur in various psychiatric disorders and are associated with higher mortality and lower quality of life. In this case report, we present a 68-year-old man with the diagnosis of schizoaffective disorder, bipolar type with associated somatic delusions, and auditory hallucinations. His somatic delusions were alleviated by the 20 ECT treatment with additional clinical improvements in his speech, thought processes, and judgment.

Forensic Evaluation of Refugees from Myanmar.

Forensic evaluators may have little experience and knowledge of the political context of Myanmar, the Burmese people, and the refugee crisis. Oppression of several ethnic minority groups has marked Burmese military rule of Myanmar for several decades. Protracted trauma exposure, both pre- and post-migration, among refugee populations increases the risk for mental health disorders, particularly depression, anxiety, alcohol abuse, and posttraumatic stress disorder.

How online data informs forensic mental health evaluations of sexual behavior: An overview.

The Internet plays a pervasive role in modern life including the expression of human sexuality and sexual offending. A range of online sexual activities may be of interest in forensic mental health evaluations (FMHE), including those which are clearly illegal or those which are legal but functionally problematic. Online sexual offenses will clearly prompt forensic evaluators to consider the role of the Internet in these offending behaviors.

Receptor-Independent Therapies for Forensic Detainees with Schizophrenia-Dementia Comorbidity.

Forensic institutions throughout the world house patients with severe psychiatric illness and history of criminal violations. Improved medical care, hygiene, psychiatric treatment, and nutrition led to an unmatched longevity in this population, which previously lived, on average, 15 to 20 years shorter than the public at large. On the other hand, longevity has contributed to increased prevalence of age-related diseases, including neurodegenerative disorders, which complicate clinical management, increasing healthcare expenditures.

Pathways for VA and community stakeholder management of military veterans with sexual offenses: Sexual and nonsexual recidivism rates and risk factors in military veterans released from California sexually violent predator (SVP) commitment.

Military veterans with sexual offenses committed after discharge are often eligible for Veterans Affairs (VA) services including health care. There are few, if any, studies of sexual recidivism among military veterans with sexual offense histories to guide clinical management. This study examined diagnostic and postrelease sexual and nonsexual recidivism among military sexual offenders released from California sexually violent predator (SVP) commitment.

Illuminating Sociocultural and Ethnocultural Consciousness in Forensic Practice.

In recent decades, there has been an evolution in forensic psychiatry and psychology toward closer examination of the professionals' attitudes and intentions in their practice. We theorize that the progressive change reflects increased attention to the experiences of evaluators and evaluees in their social worlds. This cultural focus complements the traditional emphasis on biomedical elements, such as neuropsychiatric disorders.

Comparing the pharmacology and pharmacokinetics of antipsychotics: Choosing an antipsychotic and dosing a long-acting injectable.

In this paper, we will discuss the pharmacologic properties of antipsychotics, including those that are the same in structure and those that differentiate one from another. We will bring to you how differential pharmacologic properties can explain differential efficacy and differential tolerability. We will review how to use plasma drug levels and long-acting injectables to enhance compliance early in the illness, and to manage both forms of treatment resistance (pharmacokinetic and pharmacodynamic failures).

Addressing Systemic Bias in Violence Risk Assessment.

Criminal history plays a prominent role in violence risk assessments. For people in nondominant groups, disproportionate criminal justice involvement may unfairly and inaccurately elevate violence risk in evaluations. Criminal justice reports continue to document higher rates of arrest and convictions for those in minoritized racial groups.

Vaccine breakthrough infections with SARS-CoV-2: Why older adults need booster vaccinations.

Objectives: COVID-19 vaccinations are highly efficacious in preventing severe illness that can lead to hospitalizations and death, but incidents of vaccine breakthrough (VBT) infections persist. We examined VBT infections within a congregate setting to help guide public health practices.

Study Design: This is a retrospective cohort study of VBT infections identified via polymerase chain reaction (PCR) testing between 2/1/2021-11/1/2021.

Clozapine Use and Forensic Outcomes in Psychiatric Inpatients Deemed Incompetent to Stand Trial.

Referrals for competency restoration increased in the past decade, with the majority of incompetent to stand trial (IST) patients having schizophrenia; 25 percent of schizophrenia patients are treatment resistant. Clozapine is superior to other antipsychotics for treatment resistance but remains underutilized, particularly in forensic settings. Despite the impact of treatment resistance on the legal system, the literature on clozapine for IST patients is limited to two papers comprising 26 patients.

Examining the 4-D Model in Persons Enrolled in the Top DD Internet Intervention.

The 4-dimensional (4-D) model of trauma-related dissociation differentiates between dissociative experiences involving trauma-related altered states of consciousness and symptoms of distress that do not appear to involve alterations in normal waking consciousness across four phenomenological dimensions (i.e., our experience of time, thought, body, and emotions).

Reset for systematic action: Removing VA barriers to housing and treatment for military veterans with sexual offenses.

Though the U.S. Department of Veterans Affairs (VA) provides housing, residential treatment, and mental health care to justice involved veterans, those with sexual offenses face daunting obstacles to securing such services, including exclusion from housing programs, and lack of mental health services to treat sexual deviancy disorders.

Are TOPF and WRAT WR Interchangeable Measures among Psychiatric Inpatients?

Objective: To examine whether Test of Premorbid Functioning (TOPF) and Wide Range Achievement Test-Word Reading subtest (WRAT WR) are interchangeable measures, and the relationship between these measures and intelligence, among patients with schizophrenia.

Method: In this archival study, the authors examined neuropsychology referrals of an inpatient forensic state hospital. Patients with a schizophrenia spectrum disorder (SSD) who received the Wechsler Adult Intelligence Scale-Fourth Edition or the Wechsler Abbreviated Scale of Intelligence-Second Edition and either TOPF or WRAT WR were considered for inclusion.

California Sexually Violent Predator (SVP) Evaluations in the Field: Static-99R and Diagnostic Field Reliability.

Tests and diagnoses used in sexually violent predator (SVP) evaluations must be reliable, as reliability is foundational to validity. The current study contained a stratified sample of evaluations of 395 individuals referred as potential SVPs between 2012 and 2017. Each individual was initially evaluated by at least two experts.

Let's lower the floor: Clinical utility of the D-KEFS TMT with a forensic psychiatric inpatient population.

Trail-making tests are widely used as part of neuropsychological assessments, although the prevalence of processing speed deficits in schizophrenia spectrum disorders may limit their utility when administered to this population. In response, our study sought to explore D-KEFS TMT performance among a forensic-oriented schizophrenia spectrum sample, with the goal of generating normative data to enhance the utility of the TMT with this population. Archival data was collected from a sample of patients admitted to a forensic maximum-security psychiatric facility.

Electroconvulsive Therapy for Traumatic Brain Injury and Schizoaffective Disorder.

Traumatic brain injury (TBI) is a source of disability and mortality with high rates of psychiatric disorders. Patients with comorbid TBI and psychiatric disorders may be safely treated with electroconvulsive therapy (ECT). In this case report, we present a 34-year-old man with the diagnosis of major neurocognitive disorder due to traumatic brain injury and schizoaffective disorder, bipolar type.

A Preliminary Analysis of Sexual Recidivism and Predictive Validity of the Static-99R in Men Discharged From State Hospitals Pursuant to California's Sexually Violent Predator Act.

We examined the recidivism rates and the predictive validity of the Static-99R in 335 men who were detained or civilly committed and released from California State Hospitals pursuant to the Sexually Violent Predator (SVP) Act, and followed up for approximately 21 years from date of hospital admission. In all, 8.7% were arrested or convicted for a new sexual offense during the total follow-up ( = 335) and 7.

Gender and Malingering in Defendants Deemed Incompetent to Stand Trial.

The relationships between gender and malingering have received little attention in the literature. Our study examined data from 1,748 patients committed as incompetent to stand trial between 2008 and 2017, of whom 397 were women. Scores on a structured assessment of feigned psychiatric symptoms were only slightly higher for men than for women.

Persistent, poor quality competency to stand trial reports: Does training matter?

Consistent with nationwide trends, the number of defendants judicially ordered to the California Department of State Hospitals (DSH) for competency restoration has nearly doubled in recent years. Previous research has shown that the majority of the time, judicial rulings on competency reflect forensic evaluators' opinions. Thus, the quality of competency to stand trial (CST) reports is critical.