An evaluation of malingering screens with competency to stand trial patients: a known-groups comparison.

The assessment of malingering is a fundamental component of forensic evaluations that should be considered with each referral. In systematizing the evaluation of malingering, one option is the standardized administration of screens as an initial step. The current study assessed the effectiveness of three common screening measures: the Miller Forensic Assessment of Symptoms Test (M-FAST; Miller, 2001), the Structured Inventory of Malingered Symptomatology (SIMS; Widows & Smith, 2004), and the Evaluation of Competency to Stand Trial-Revised Atypical Presentation Scale (ECST-R ATP; Rogers, Tillbrook, & Sewell, 2004).

Testing factor models of the Psychopathy Checklist: Youth Version and their association with instrumental aggression.

Although there is a documented link between psychopathy and instrumental violence in adult offenders, the association between these constructs has not garnered significant attention in adolescent offenders. In this study, we evaluated the relationship between psychopathy and instrumental aggression in a sample of 122 male adolescents incarcerated in a state facility for serious and chronic offenders. We evaluated the primary (2-, 3-, and 4-factor) models of the Psychopathy Checklist: Youth Version (PCL:YV; Forth, Kosson, & Hare, 2003) and assessed their relationship to a separate 5-item measure of instrumental violence.

Testing a four-factor model of psychopathy and its association with ethnicity, gender, intelligence, and violence.

Although a 2-factor model has advanced research on the psychopathy construct, a 3-factor model was recently developed that emphasized pathological personality and eliminated antisocial behavior. However, dropping antisocial behavior from the psychopathy construct may not be advantageous. Using a large sample of psychiatric patients from the MacArthur Risk Assessment Study (J.

Analyzing the analysis: a response to Wollert (2000).

In a thoughtful critique in the article preceding this one, many arguments are presented about the veracity of assumptions and conclusions I made in my 1998 publication concerning the sexual recidivism base rates for certain incarcerated sex offenders. This article responds to some of the issues raised. First, the ultimate conclusion of the preceding critique is assessed.

The aggressive patient/inmate: beyond denial.

The public is no longer willing to tolerate being repeatedly victimized by a small group of sexually and/or physically aggressive predators. These predators may be found among much larger groups of non-predatory inpatients in psychiatric hospitals or inmates in prisons. These institutionalized people deserve to be treated or incarcerated without fear of being victimized, as well.

The Program of Assertive Community Treatment (PACT): the model and its replication.

The Program of Assertive Community Treatment (PACT) has been investigated in Madison and at other replication sites, and the positive results for clients have led to more widespread dissemination of the PACT model. This chapter presents a basic introduction to the model of care, research findings, and views on PACT model replication.

Managing threatening behavior. The role of talk down and talk up.

Table 3 demonstrates a relationship between DSM-IV Axis I and Axis II diagnoses and hot and cold threats. Patients with an Axis I diagnosis who make hot threats are often emotionally and cognitively out of control, trying to get back into control by threatening. In contrast, patients with an Axis II personality disorder, like most normal people, periodically reach an emotional threshold when they seem to "lose it.

A report on staff injuries and ambulatory restraints: dealing with patient aggression.

1. During a 6 1/2-year period on a unit designed for repetitively aggressive male patients, nursing staff members were the recipients of 95% of aggressions and 97% of serious injuries. 2.

Applying social constructionism in the treatment of patients who are intractably aggressive.

Interventions based on the philosophy of social constructionism can be used for the treatment of patients who are intractably aggressive. The interventions are aimed at disrupting common interactive patterns between the patient and treaters in the treatment milieu and replacing them with patterns that do not allow the intractable symptoms to disrupt treatment efforts. Two case examples illustrate the use of this approach with extremely violent inpatients with long histories of unsuccessful interventions.

Toward the therapeutic use of obscene language: a legal and clinical review.

Obscenity has been the subject of a series of court cases centered around the First Amendment, and its interpersonal effects have been studied by psychotherapists and communications theorists. But little has been written about the impact of the use of obscenity by patients in group settings to discharge their feelings and to dominate and harass staff and other patients. The authors argue that if staff are to be able to work effectively with patient populations who utilize obscenity routinely for these purposes, they must become more comfortable with its use, and to treat it as another symptom of the patients' interpersonal difficulties.

Occupational therapy in geriatric mental health.

Elderly persons with psychiatric disorders often experience a variety of functional deficits that affect their independence, safety, and activity level. The occupational therapist's role in addressing these needs is discussed, as are the possibilities for improvement of the elderly person's autonomy, safety, and integrity. Barriers to optimal service provision in the health care and social service systems as well as in occupational therapy are addressed.

The presentation of expert testimony via live audio-visual communication.

As part of a national effort to improve efficiency in court procedures, the American Bar Association has recommended, on the basis of a number of pilot studies, increased use of current audio-visual technology, such as telephone and live video communication, to eliminate delays caused by unavailability of participants in both civil and criminal procedures. Although these recommendations were made to facilitate court proceedings, and for the convenience of attorneys and judges, they also have the potential to save significant time for clinical expert witnesses as well. The author reviews the studies of telephone testimony that were done by the American Bar Association and other legal research groups, as well as the experience in one state forensic evaluation and treatment center.

Law, psychiatry and rights.

This article deals with the effect of the shift in emphasis from the moral rights to the legal rights concept in psychiatry with reference to matters such as involuntary civil commitment, the right to treatment, the right to refuse treatment, the duty to warn or to protect, the duty to protect future patients from abusive colleagues and the duty to become politically active.

Prearraignment forensic evaluation: the odyssey moves east of the Pecos.

Although the ethical guidelines of both the American Psychiatric Association and the American Academy of Psychiatry and the Law explicitly prohibit the forensic examination of criminal defendants before appointment of counsel, except for the purpose of providing emergency medical care and treatment, the practice continues in many parts of the country. This article presents a recent case in which this practice was challenged on appeal, to serve as a focus for discussion of the evolution of, and rationales for and against, these ethical positions. It will also serve as a focus to examine the legal views concerning such examinations, derived from the appeal of the decision in the case itself as well as decisions in similar cases.

Who's afraid of forensic psychiatry?

Forensic psychiatry has come under mounting criticism from the press and other medical professionals, largely for its participation in the insanity defense. The author argues that the expertise available from the specialty is of increasing importance to psychiatry as a whole, as more and more legal issues become relevant to the practice of general psychiatry, and should be actively encouraged and legitimized rather than ostracized. All psychiatrists should be exposed to forensic principles and practices during their training, and the ability of forensic psychiatrists to serve as transducers between the clinical and the legal/judicial should be increasingly used to present the clinical viewpoint effectively in courts and legislatures.

The impact of the right to refuse treatment in a forensic patient population: six-month review.

In December of 1987, the Wisconsin supreme court held that all involuntarily committed mental patients in the state had the right to refuse psychotropic medication unless a court held that they were incompetent to make treatment decisions. The authors studied the effects of this decision in a 165-bed forensic hospital over the first six months after implementation of the decision. They found that 29 percent of patients already on psychotropic medication initially refused further treatment as opposed to 75 percent of newly admitted patients.

Should forensic patients be informed of evaluators' opinions prior to trial?

There are several articles in the literature that discuss the problems which occur when persons who have been evaluated by forensic clinicians hear the results of those evaluations for the first time in court. The authors agree that the scenarios presented are problematic but suggest that in many cases the problems can be avoided by sharing the information with the person prior to presenting it in court. They present several case examples to illustrate their point.