bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of Heart Failure Admissions Under Observation Versus Short Inpatient Stay
Authors: Masri Ahmad , Althouse Andrew D. , McKibben Jeffrey , Thoma Floyd , Mathier Michael , Ramani Ravi , Teuteberg Jeffrey , Marroquin Oscar , Lee Joon S. , Mulukutla Suresh R.
Published: February 2018

Background

Patients with heart failure (HF) are admitted either under observation (OBS) or inpatient stays; however, there is little data on whether this designation reflects the clinical status of a patient, with significant logistical and financial implications. We sought to compare the outcomes of patients with
HF
admitted OBS versus inpatient stay (≤2 days; INPT).

Methods and Results

From January 1, 2008 to September 30, 2015, our multisite health system saw 21 339 unique patients totaling 52 493 hospital admissions with a primary diagnosis of
HF
. Patients were excluded if they underwent cardiac surgery (n=611), heart transplantation (n=187), or left ventricular assist device insertion (n=198), or if they died during hospitalization (n=1839). Of the remaining 50 654 discharges, 2 groups were identified:
INPT
group and
OBS
group. Outcomes were
HF
readmission, all‐cause readmission, and all‐cause mortality within 1 year of discharge. Hazard ratios were computed using the Andersen‐Gill method in the Cox proportional‐hazards model. A total of 8709 admissions (17%) occurred in the INPT group and 2648 admissions (5%) occurred in the
OBS
group.
HF
readmission rate at 1 year was 55.3% in
INPT
versus 66.5% in
OBS
(hazard ratio, 0.75; 95% confidence interval, 0.71–0.80;
P
<0.01). All‐cause readmission rate at 1 year was 70.7% in
INPT
versus 82.5% in
OBS
(hazard ratio, 0.74; 95% confidence interval, 0.70–0.78;
P
<0.01). All‐cause mortality at 1 year occurred in 25.2% of
INPT
versus 24.2% of
OBS
(hazard ratio, 1.03; 95% confidence interval, 0.95–1.12;
P
=0.46).

Conclusions

HF
admissions designated INPTs were associated with lower readmission rates and equivalent mortality to those designated OBS.
A revision of Holothuria (Halodeima) kefersteinii (Selenka, 1867) and the revival of Holothuria inornata Semper, 1868 from sea cucumbers collected in Mexico and Central America
Authors: HONEY-ESCANDÓN MAGALI , SOLÍS-MARÍN FRANCISCO A.
Published: February 2018

In 1958 Deichmann synonymized Holothuria inornata Semper, 1868 with Holothuria kefersteinii (Selenka, 1867). This nomenclature has been adopted until now. However, some specimens recently collected from the Mexican Pacific matched the original description of H. inornata Semper (1868) whereas others matched the original description by Selenka (1867). A morphological, molecular and ecological study of the specimens was conducted to confirm the identification of these specimens. The morphological characters of our specimens were compared with those contained in the original descriptions and figures of the types of both species. Besides the different color pattern of live specimens of both species, the main differences found are the presence of straight distally perforated rods in the dorsal papillae, and the presence of Holothuriophilus trapeziformis Nauck, 1880 in the cloaca of H. inornata, versus the absence of these kind of rods in the dorsal papillae, and the absence of symbionts in the cloaca in H. kefersteinii. The species identified by Deichmann (1958) as H. kefersteinii is, in fact H. inornata. Both species might have been confused because the morphology of preserved specimens is very similar and the presence of the straight rods in papillae might have been overlooked during identification. A more thorough review of the ossicles from the specimens, together with the comparison of ossicles from the type specimens, has allowed the resurrection of long-forgotten species, H. inornata
Hurricane with a History: Hawaiian Newspapers Illuminate an 1871 Storm
Authors: Businger Steven , Nogelmeier M. Puakea , Chinn Pauline W. U. , Schroeder Thomas
Published: February 2018

High literacy rates among Native Hawaiians in the nineteenth century and publication of more than 100 Hawaiian-language newspapers from 1834 to 1948 produced the largest archive of indigenous writing in the Western Hemisphere. These newspapers extend our knowledge of historical environmental events and natural disasters back into the early nineteenth century and deeper into precontact times. Articles reporting observations of meteorological events allowed the authors to reconstruct the track and intensity of an 1871 hurricane that brought devastation to the islands of Hawaii and Maui and to discern historical patterns of droughts and floods in Hawaii. These findings illustrate the value of Hawaiian-language newspapers as resources for science research and science education.
An Empirical Model for Estimating Soil Thermal Diffusivity from Texture, Bulk Density, and Degree of Saturation
Authors: Xie Xiaoting , Lu Yili , Ren Tusheng , Horton Robert
Published: February 2018

Soil thermal diffusivity κ is an essential parameter for studying surface and subsurface heat transfer and temperature changes. It is well understood that κ mainly varies with soil texture, water content θ, and bulk density ρb, but few models are available to accurately quantify the relationship. In this study, an empirical model is developed for estimating κ from soil particle size distribution, ρb, and degree of water saturation Sr. The model parameters are determined by fitting the proposed equations to heat-pulse κ data for eight soils covering wide ranges of texture, ρb, and Sr. Independent evaluations with published κ data show that the new model describes the κ(Sr) relationship accurately, with root-mean-square errors less than 0.75 × 10−7 m2 s−1. The proposed κ(Sr) model also describes the responses of κ to ρb changes accurately in both laboratory and field conditions. The new model is also used successfully for predicting near-surface soil temperature dynamics using the harmonic method. The results suggest that this model provides useful estimates of κ from Sr, ρb, and soil texture.
Napoli and the loss of innocence: Three theatrical hypotheses
Authors: Furno Raffaele
Published: February 2018

The layers of Neapolitan culture have pinned down the representation of the city to two shifting paradigms: Napoli as a nourishing mother, pregnant in luxurious views of her Gulf and generous products of her land, and, on the opposite side, Napoli as a whore and a witch, a dark sterile entity that devours her children. Both ways, female markers have characterized the construction of Napoli’s cultural identity in the imagery of her intellectuals, story-tellers, and writers. This article will analyze such female reincarnations through the theatrical work of three of the city’s major authors: Eduardo de Filippo’s Filumena Marturano (1946), Roberto de Simone’s melodrama La Gatta Cenerentola (1976), and Annibale Ruccello’s Le cinque rose di Jennifer (1980). Through the metaphor of the lost virginity of the female body, and using different stage languages including drama, comedy, music, and fairy tales, Neapolitan theatre has used tradition and local culture to project Napoli into a wider contemporary intellectual debate. This, I deem, was made possible by the fluid and hybrid nature of “being Neapolitan” which consists of deeply grounded linguistic, religious, culinary, and performative roots and, at once, of a keen awareness that those same roots travelled hundreds of miles and originated from foreign sources, marking Napoli as a quintessential multicultural, proto-European city.
The psychoanalytic anatomy of a crime
Authors: Asch Stuart S.
Published: February 2018

A psychiatric study is presented of a man arrested on a charge of buying a car with a forged check. Using psychoanalytic principles it was possible to delineate not only the current psychic conflict that provoked the criminal act, but also the specific childhood psychological determinants. The data are used to discuss the merits of various legal dispositions possible in this case. The suggestion is made that similar studies of criminals and criminal acts may offer more guidance for both psychiatry and jurisprudence.
Police behavior (part I)
Authors: Cruse Daniel , Rubin Jesse
Published: February 2018

Police and citizen behavior occurring during radio patrol activities was studied in Miami. Four specially trained policemen-observers rated behavior of 12 observed patrolmen interacting with 1,400 citizens during 1,000 separate contacts.

Police behavior was found to be predominantly controlling in nature. Citizen behavior was predominantly cooperative and nonviolent. Stress was perceived by patrolmen in 7% of calls and altered police behavior in 1.5% of calls, a small but significant amount. Surprisingly, neither citizen behavior nor types of neighborhoods affected police behavior. Inactivity on patrol increased both police controlling behavior and police fatigue. Recommendations are made regarding police research, training and operations.
Disproportionate Disability: The Freud-Charcot Syndrome Rediscovered
Authors: Shands Harley C. , Meltzer James D.
Published: February 2018

Eighty-eight out of 120 people referred for psychiatric evaluation by the Workmen's Compensation Board were found to suffer from catastrophic disability although their residual physical impairment was minimal. A smaller sample of claimants suffering from this “disproportionate disability” syndrome were compared with a psychiatric control group. It was found that the claimants had a statistically significant inability to solve verbal similarities. This specific cognitive limitation leaves them vulnerable to the severe and chronic disorganization that is the hallmark of the syndrome. They seem unamenable to psychodynamically oriented psychotherapy. and may respond more favorably to supportive treatment and environmental manipulation.
The conflict and reconciliation of the ethical interests of therapist and patient
Authors: Foster Henry H.
Published: February 2018

In this article attention is focused on the failure of the medical and legal professions to police themselves. One cause of this failure stems from the lack of communication about ethical and moral principles in the training of the attorney and the physician. The role of the psychiatrist is then singled out for consideration in regard to important ethical interests between the psychiatrist and patient. There are four major areas of conflict that are explored: (1) human experimentation, (2) informed consent, (3) confidentiality and privilege, (4) the professional obligation to exercise due care. The ramifications and potential difficulties for the psychiatrist-patient relationship concerning these issues are explored.
Meeting Grounds for Psychiatry and Law: A Role for the Psychiatric Resident as Consultant
Authors: Arons Bernard S.
Published: February 2018

As a psychiatric consultant to a mental health advocacy service, the author attempts to enter into and facilitate the interaction between lawyer and ward psychiatrist. This paper describes some aspects of the consultation, suggests theoretical approach for such a consultation, and draws a comparison with other similar programs. The role of psychiatric consultant is an important meeting ground for psychiatry and law.
Szasz and the Law: An Alternative View
Authors: Weinberg Lee S. , Vatz Richard E.
Published: February 2018

In a previous issue C. G. Schoenfeld attempted to disprove Thomas Szasz’ theory that mental illness is a “myth” and to dispute Szasz’ contention that current views of “mental illness” promote violent subjugation of human freedom in institutional and legal settings. This article argues that typical of many who criticize Dr. Szasz, Mr. Schoenfeld misunderstands and misrepresents Szasz’ rich theoretical arguments concerning “mental illness” and the prevalent use in law and institutional psychiatry of medical models for analyzing human behavior. Additionally, the authors urge responsible researchers to further pursue the implications of an accurate understanding of Szasz’ arguments for legal theory and practice.
The developing law on competency to stand trial
Authors: Slovenko Ralph
Published: February 2018

The plea of competency to stand trial has become one of the more controversial issues in the administration of criminal justice. The definition of friability is nebulous, and its practical application leaves much to be desired. At the same time the plea makes possible a needed flexibility in the administration of the law. In recent years, as a result of publicity, various restrictions have been placed on the implementation of the plea. The developing law and sundry problems arising under the plea are discussed in the following article.
Civil Commitment, Burden of Proof, and Dangerous Acts: A Comparison of the Perspectives of Judges and Psychiatrists
Authors: Simon Rita J. , Cockerham William
Published: February 2018

This study compares judges’ and psychiatrists’ perspectives on “dangerousness” as the criterion for involuntary civil commitment. Even though the “reasonable expectations” that a person would be dangerous to self, others, or to property were viewed at about the same levels of probability by both judges and psychiatrists, there were important differences between the two professions. Judges and psychiatrists disagreed on the extent of dangerousness inherent in specific acts, and judges appeared to be more willing to commit persons to a mental hospital with greater degrees of uncertainty than were psychiatrists.
Legal Professionals’ Perceptions of the Insanity Defense
Authors: Burton Nancy M. , Steadman Henry J.
Published: February 2018

To obtain information on perceptions and uses of the insanity defense in New York, 293 legal professionals were surveyed. The respondents indicated that the main problems with the defense center on: poor statutory definitions and vagueness in the law which cause its uneven application; a lack of understanding of the law by juries and the public; overreliance on psychiatric testimony which is imprecise and superficial; and the inaccurately perceived lack of judicial review over the release of acquitted defendants to the community by the Department of Mental Hygiene.
The MMPI in Criminology: Abuses of Application
Authors: Dietrich Shelle G. , Berger Louis S.
Published: February 2018

The valid use of any psychological test is specified by the constraints under which that instrument was developed. Typically, a test is assumed to be valid for some specific population, for a particular setting, and for well-defined areas of application. Violation of any of these conditions may constitute misapplication or even serious abuse of a test, rendering it invalid; e.g., tests developed for clinical assessment may be invalid for criminological applications. The paper examines these issues. The MMPI provides the prototype example for the discussion. The logical and historical development of the test is traced. Typical abuses found in forensic applications are identified and discussed and suggestions for remedying these are offered.
The Psychological Test of Sex and the Transsexual: A Legal Response
Authors: Bassis Lisa M.
Published: February 2018

Transsexualism is not new, but it is only recently that the law has adopted a facilitative role; setting forth legal precedents to assist a transsexual's adjustment in society once a new gender role is assumed. After defining the eight factors considered in the medical definition of sex, the article discusses the making of a legal definition–-using recent U.S. and foreign cases. In light of these definitions, the author finds that the court erred when it concluded that Renee Richards should be classified by a psychological test of sex for purposes of competing in the U.S. Open Tennis Tournament.
One Role of the Social Scientist in the Courtroom: The Maria Pitchford Case
Authors: Van Wormer Katherine
Published: February 2018

Sociologists have been involved in various aspects of the criminal justice system. The author examines the role of the sociologist in jury selection. Using as a background her involvement in a recent trial, she discusses the basic strategies involved in selecting a jury.
On the Legal Aspects of Tardive Dyskinesia
Authors: Slovenko Ralph
Published: February 2018

Of the various drug therapies, the antipsychotic medication is presenting some novel twists to old issues in law and psychiatry. From what is known, its benefits are high but so are its risks. To wit, the risk of tardive dyskinesia. Presented here for consideration are legal issues of standard of care, informed consent, the right of institutionalized patients to refuse treatment, statute of limitations, and causal nexus.
Effects of Psychiatric Legislation: An Example from Kansas
Authors: Frydman Louis L.
Published: February 2018

Although psychiatric legislation has been significantly influencing psychiatric practices over the past two decades, few attempts have been made to study the actual effects of legislative enactments. The examination of the impact of the 1976 revision of the Kansas Mental Health Code reveals a 42% decrease in commitment proceedings and a 14% decline in the percentage of involuntary admissions over a 2-year period. However, the passage of the new law did not have a lasting effect on the rights of inpatients. Seclusion rates, decreasing sharply when the legislation was enacted, returned to their earlier levels within 2 years.
Competency to Stand Trial: A Historical Review and Some New Data
Authors: Poythress Norman G. , Stock Harley V.
Published: February 2018

Both the public and the professional community view the participation of mental health professionals in the criminal justice system with some misgiving. A review of earlier studies of psychiatric participation in the assessment of defendants' competency to stand trial reveals a legitimate basis for these misgivings. The present study reports the reliability of opinion formation on the issue of competency to stand trial in 44 cases by clinical psychologists specially trained in the assessment of competency. The perfect reliability achieved in this study and other recent papers reporting similar, favorable results, document the progress mental health professionals have made in developing assessment techniques that reach respectable levels of reliability and validity.
Malpractice in Psychiatry and Related Fields
Authors: Slovenko Ralph
Published: February 2018

In any negligence or malpractice action the aggrieved party must establish by a preponderance of the evidence: (1) that the defendant has failed to conform to a certain standard of conduct, (2) that there is a reasonable cause-and-effect relationship between that conduct and the alleged injury, and (3) that the loss or injury is of a type of concern to the law. When applied to psychiatry and related fields, the author finds that, in a malpractice action, with the exclusion of similar facts evidence, establishing fault or causation is usually a happenstance.
Developing Legal Trends in Psychiatric Malpractice
Authors: Horan Dennis J. , Guerrini Marianne E.
Published: February 2018

Innovative techniques in psychiatric therapy–-particularly those involving physical contact between doctor and patient–-have formed the basis for a growing number of malpractice claims brought against psychiatrists and other mental health care professionals. After a review of the standard of care by which the law judges a psychiatrist, this article will present an overview and analysis of the various legal theories that may subject a psychiatrist to civil liability for professional malpractice. The article will conclude that the psychiatrist faced with such a suit must be prepared to offer justification and expert testimony to support the therapeutic value of any physically invasive therapeutic techniques employed.
The Mentally Ill Offender: A Comparison of Prison Inmates, Forensic Psychiatric Patients, and General Psychiatric Patients
Authors: Mullen James M. , Reinehr Robert C.
Published: February 2018

The study examines the question of appropriate placement of forensic psychiatric patients, by comparing population characteristics of a penal institution, a general psychiatric hospital, and a maximum security forensic psychiatric facility. Results suggest that forensic patients resemble general psychiatric patients more closely than they resemble prisoners. In demographic areas the patient groups are quite similar and quite different from the prisoner group. The results of psychological testing are equivocal, but support the impression patient groups differ from prisoners. The study suggests courts are reasonably successful in identifying those offenders placed in mental health institutions rather than in a criminal justice setting.
Participation by Psychologists in Insanity Defense Proceedings: An Advocacy
Authors: Delman Richard P.
Published: February 2018

There are many arguments against participation by psychologists in insanity defense proceedings. The critics' concerns focus on ethical problems, the utility of testimony, and scientific imprecision. These arguments seem to be based on political and moral as well as scientific positions. An affirmative case for participation is made by examining the commonality among all insanity defense rules: Can mental illness impair a person's decision-making power to the extent that he or she is incapable of making a free-will choice to commit the crime alleged? This question does appear to be answerable.
The Past and Present of the Right to Treatment: A Slogan Gone Astray
Authors: Slovenko Ralph
Published: February 2018

The theoretical justification of a constitutional “right to treatment” has been that it makes up for the “deprivation of liberty” stemming out of involuntary commitment. The Supreme Court, however, in 1975 rejected this quid pro quo theory. Though it went without acceptance, the loss of liberty rationale underlying it has had an impact, and will continue to do so.
The Least Restrictive Alternative to Involuntary Hospitalization, Outpatient Commitment: Its Use and Effectiveness
Authors: Hiday Virginia Aldigé , Goodman Judge Rodney R.
Published: February 2018

For two years, all court-ordered outpatient treatment in one civil commitment court was followed for the maximum time of an initial commitment, three months. Based on involuntary readmissions and involuntary commitments, outpatient commitment for the dangerously mentally ill was found to have a high success rate; only 12.5% of the respondents were involuntarily rehospitalized during the time frame. For the select group of respondents ordered to outpatient treatment by this court, outpatient commitment provided an effective, less restrictive alternative to involuntary hospitalization.
State Intervention and Childhood Multiple Personality Disorder
Authors: Elliott Deni
Published: February 2018

Multiple personality disorder is a mental disorder caused, in part, by childhood trauma, most usually severe and sustained physical, sexual, and emotional abuse. Although the disorder is usually diagnosed in adults, evidence shows that it develops during childhood, with the first personality split typically occurring before the age of eight. Using a criterion of harm, this article argues that the diagnosis of multiple personality in a child ought serve as prima facie evidence for child abuse, even if compelling physical evidence is lacking. Medical, social, and legal problems raised by the diagnosis of childhood multiple personality disorder are discussed.
Psychiatric training and involuntary commitment
Authors: Many Seth E.
Published: February 2018

This article contrasts through example and discussion a ritual indoctrination versus a rational procedure in the training of the psychiatrist. The use of trainees as professional surrogates, conflict-of-interest problems, and confusion and lack of discrimination between forensic/psychiatric and service/training issues are discussed. The pivotal role of the trainee in the commitment procedure demands immediate relief. Longer-term provision of standards of training and competency is suggested.
Guidelines for forensic hypnosis
Authors: Relinger Helmut , Stern Thomas
Published: February 2018

The past 20 years have witnessed a dramatic increase in the forensic use of hypnosis. While often very productive, hypnotic interrogation also presents potential for abuse. Because forensic hypnosis has been unregulated and, at times, inappropriately used, some state courts have ruled that hypnotically enhanced recall is inadmissible as evidence. The following guidelines were developed in an attempt to standardize forensic hypnosis procedures and eliminate potential for abuse. The credentials and conduct of the hypnotist are delineated and procedural guidelines for the referring party are provided.
The Desire to Abolish Capital Punishment: A Psychoanalytically Oriented Analysis
Authors: Schoenfeld C. G.
Published: February 2018

The main arguments usually advanced by those who desire to abolish capital punishment are analyzed. The conclusion reached is that all these arguments are seriously flawed—so much so, as to cause one to wonder whether the abolitionists who espouse them are moved by unrecognized unconscious motives. The abolitionists, it is suggested, may unconsciously identify themselves with the criminals whose lives they seek to protect, rather than with the victims of these criminals, as do most law-abiding citizens. It is urged that the law concern itself not with meeting the presumed atypical unconscious emotional needs of the abolitionists, but with fulfilling the demands for justice of the vast majority of citizens.
An Empirical Study of Custody Agreements: Joint versus Sole Legal Custody
Authors: Phear W. P. C. , Beck J. C. , Hauser B. B. , Clark S. C. , Whitney R. A.
Published: February 2018

The public records of 500 divorces involving minor children were abstracted from the files of a county probate and family court. The families’ demographics and the chronology of the marriages and their dissolution are reported, as are the varieties and frequencies of the custody and visitation decisions. The provisions made for the children's current and future physical, financial, and educational needs are summarized together with the incidences of post-divorce litigation.
“Nothing but the Truth” … a Reexamination of Malingering
Authors: Rogers Richard , Cavanaugh James L.
Published: February 2018

Malingering is examined in the broadening context of adversarial evaluations and their potential impact on clients’ openness and honesty. Traditional “moralistic” conceptualizations of malingering are critiqued, and an alternative adaptive model suggested. Several conceptual issues are addressed, including the study of malingering through simulation designs and the role of memory impermanence and interpersonal factors in the assessment of malingering. Finally, recent psychometric and psychophysiological measures of malingering are briefly reviewed.
The Legal Perils of Psychotherapeutic Practice (Part II): Coping with Hedlund and Jablonski
Authors: Meyers C. J.
Published: February 2018

This article addresses itself to the willingness of courts of law to hold psychotherapists accountable for the damage done by their patients. Most especially, it examines the implications of the recently decided Hedlund and Jablonski cases and of their progenitor, Tarasoff, recommending a course of action for coping with the problems these cases create.
The Evolution of Tarasoff: Recent Developments in the Psychiatrist's Duties to Warn Potential Victims, Protect the Public, and Predict Dangerousness
Authors: Greenberg Linn Turner
Published: February 2018

Since 1976, several courts have found California's Tarasoff decision persuasive, requiring psychotherapists to warn potential victims of threats of danger posed by patients under therapists’ care. Other courts have found that confidentiality of the patient-psychotherapist relationship is paramount. Some courts have found a duty to warn is owed only to a specifically identified victim. When no victim has been identified, other courts still have found a duty of the psychotherapist to exercise reasonable care to protect the public. Although some courts have held that a duty exists when a psychotherapist should have predicted violence, but did not, no clear standard for reasonableness in predicting dangerousness has emerged. Courts have looked to expert testimony regarding such predictions even though the APA and other authorities maintain that no such standard exists.
Insanity Plea: Statutory Language and Trial Procedures
Authors: Pasewark Richard A. , Randolph Robert L. , Bieber Stephen
Published: February 2018

In a period of approximately six years, Wyoming experienced three different laws governing the insanity plea. These were (1) the McNaughton rule with an irresistible impulse clause and a single-faceted trial procedure; (2) ALI rule with bifurcated trial; and (3) ALI rule with single-phased trial. No significant differences were observed in each of these periods with respect to such matters as the frequency and success of the plea, general characteristics of defendants making the plea, and court dispositions of these defendants.
Factors Correlated with Psychiatric Recommendations of Incompetency and Insanity
Authors: Daniel A. E. , Beck Niels C. , Herath Adolph , Schmitz Mark , Menninger Karl
Published: February 2018

One hundred and twenty criminal defendants referred to a state hospital forensic unit underwent extensive examinations for the purpose of arriving at psychiatric recommendations regarding competency to stand trial and criminal responsibility. Seventy variables were abstracted from these evaluations via use of a simple checklist. A series of discriminant function analyses utilizing these variables indicated that highly accurate predictions could be made regarding psychiatric recommendations with respect to both competency and responsibility. Factors most influential in determining these recommendations included mental status at the time of the offense, psychotic symptomatology, and DSM-III diagnoses.
Psychological and Demographic Factors Associated with Individuals Using the Insanity Defense
Authors: Boehnert Caryl E.
Published: February 2018

Thirty men who were found not guilty by reason of insanity were compared to 30 men who relied on the defense but were found guilty, and with 30 men who were evaluated for the defense but opted to plea bargain. Demographic and psychological test data were obtained for each subject. There was significant psychopathology found across groups, more suggestive of major mental illness than of psychopathy. When data on the heinousness of each individual crime were examined, NGRI subjects were found to commit the least heinous offenses, and those on death row were found to commit the most heinous. Directions for future research and the operation of the legal system in general are discussed.
Judicial Expansion of the Tarasoff Doctrine: Doctors’ Dilemma
Authors: Crocker Elizabeth M.
Published: February 2018

The Tarasoff case established that a psychotherapist has a legal obligation to breach a patient's confidence in certain circumstances. The subsequent judicial expansion of the original Tarasoff doctrine raises additional legal issues that confront a psychotherapist in a Tarasoff-type dilemma where the law holds the protection of third parties outweighs the patient's right to confidentiality.
Considerations of Social Science in a Reconsideration of Parham v. J.R. and the Commitment of Children to Public Mental Institutions
Authors: Schmidt Winsor C.
Published: February 2018

Commitment of children to public mental institutions is a particularly difficult policy problem. In Parham v. J.R., the U.S. Supreme Court used behavioral science studies in an unsophisticated and noncomprehensive manner for support of specific value positions. Available behavioral science: (1) belies the proposition that mental illness symptomatology begets stigma; (2) reflects poor professional performance by attorneys, rather than hearing disutility; (3) indicates more functional competence in children than the law presumes; and (4) supports legal procedure as therapeutic and facilitative to decision making and distributive justice, rather than obfuscative. Children facing admission to an unaccredited mental facility should receive notice, effective counsel, and a preadmission hearing before a judge or jury.
An Alternative Approach to Writing Forensic Mental Health Reports
Authors: Meyers C. J.
Published: February 2018

Judges, considering themselves relatively immune to the corrupting influence of irrelevant, unsubstantiated, or prejudicial evidence, will generally admit for their own scrutiny testimony they would hold inadmissible in a jury trial. In a bench trial, therefore, the forensic mental health expert can approach his job in the role of an advisor presenting an unbowdlerized overview to a broadly empowered professional administrator rather than in the role of a presenter of material, carefully edited according to the rules of evidence, designed to preserve the naiveté of a committee of amateur fact finders. This article argues the practical wisdom of modifying the content of forensic reports to match the powers and limitations of the prospective recipients, exemplifying its thesis with a sample report.
Tardive Dyskinesia Litigation and the Dilemmas of Neuroleptic Treatment
Authors: Gualtieri C. Thomas , Sprague Robert L. , Cole Jonathan O.
Published: February 2018

The problem of liability over the occurrence of late side effects of neuroleptic treatment in mentally ill and mentally retarded patients has been underscored by four recent court decisions, in which enormous sums were awarded to plaintiffs who developed tardive dyskinesia. Four cases, Clites, Faigenbaum, Hedin, and Headley, are described in detail, and relevant issues in psychiatric malpractice are discussed. It is likely that the threat and the reality of tardive dyskinesia litigation will influence psychiatric practice in important ways. The gravity of the situation is compounded by the complexity of the medical issues, the potential numbers of litigants, and the structure of current psychiatric practice, which sometimes militates against careful adherence to established guidelines for the prevention of tardive dyskinesia.
The Specificity of Evaluations of Competency to Proceed
Authors: Miller Robert D. , Germain Edward J.
Published: February 2018

The legal system's expectation of forensic experts evaluating criminal defendants for competency to proceed to trial is that their reports will offer global and conclusive opinions on whether defendants are competent. Competency evaluations involve estimates of defendants’ capacities to do a variety of acts, and the evaluator is seldom in a position to anticipate which of those acts a defendant will actually be required to perform. The authors argue that, except in cases in which the defendant is so impaired that he could not be expected to perform any of the required acts, a competency report should not offer global opinions on competency, but rather address the defendant's apparent capacity to perform each of the acts which he might be called upon to perform.
Electroconvulsive Therapy, Malpractice, and Informed Consent
Authors: Taub Sheila
Published: February 2018

The author presents an overview of the use of electroconvulsive therapy in treating mental illness, of current research into ECT's safety and effectiveness, and of the legal treatment of ECT in malpractice and patients' rights litigation. She concludes that ECT may be overregulated because the law has not kept pace with changes in knowledge and procedures concerning ECT, with the result that some patients who might benefit from ECT may be deprived of a relatively safe and effective form of treatment.
Differentiating Successful and Unsuccessful Insanity Plea Defendants in Colorado
Authors: Pasewark Richard A. , Jeffrey Richard , Bieber Stephen
Published: February 2018

Of 133 Colorado male defendants employing the insanity plea from 1980 to 1983, 36 were adjudicated insane and 97 found guilty. Considering all defendants, they were found to be primarily single, Caucasian, somewhat older and better educated than the usual defendant group, unemployed at the time of the insane offense, and with a history characterized by chronic unemployment, prior psychiatric treatment, drug abuse, alcohol abuse, and previous arrests. Acquittees differed significantly from convicted defendants in being older and better educated. They were more likely to have been diagnosed as schizophrenic and less likely to have had a history of drug abuse. No difference was found between the groups with respect to all other variables examined, including severity of instant offense, ethnicity, and number of prior arrests.
Assessment of Criminal Responsibility: Empirical Advances and Unanswered Questions
Authors: Rogers Richard
Published: February 2018

Clinical issues in the assessment of criminal responsibility have been largely obscured by the emotional and political responses to Hinckley's acquittal. In spite of this, empirical advances have recently been made in the evaluation of insanity which include progress toward standardizing screening procedures with the MSE, and the operationalizing of legal standards with the R-CRAS. Important questions remain on the influence of extraclinical factors, effects of new statutory proposals, and an etiological understanding of psychotically based criminal behavior.
Objectivity and Advocacy in Forensic Psychiatry after Ake v. Oklahoma
Authors: Showalter C. Robert , Fitch W. Lawrence
Published: February 2018

In its landmark opinion in Ake v. Oklahoma, the United States Supreme Court enunciated a broad right to psychiatric assistance for criminal defendants who raise the defense of insanity or whose mental condition is relevant to sentencing in a capital case. Recognizing such assistance as essential to the proper functioning of the adversary process in cases in which an issue concerning the defendant's mental condition has been raised, the opinion may be read to pose an ethical dilemma for the psychiatrist who regards his or her assessment as objective and, hence, not a proper subject for adversarial presentation or inquiry. The authors contend, however, that rather than inviting psychiatrists to compromise their objectivity in these cases, in fact the Supreme Court's ruling challenges psychiatrists to demonstrate and assure their objectivity by revealing and explaining the bases for their opinions, thereby enhancing their utility in the criminal justice process and, ultimately, their credibility in the minds of the public.
Evaluation of Competency to Stand Trial: Frequency of Repeated Referrals
Authors: Aubrey Moss
Published: February 2018

The rate at which criminal defendants are referred for evaluation of competency to stand trial and the frequency at which those defendants had prior referrals for similar exams are reported. The rate of repeated referrals is quite high. One-third of the defendants had prior referrals during one calendar year, and over half had prior referrals during the 12-year period covered by the clinic's files. Possible reasons for such repetitive referrals are examined.
Effects of the Dangerousness Standard in Civil Commitment
Authors: Hiday Virginia Aldigé , Smith Lynn Newhart
Published: February 2018

This study presents data from a large statewide sample of civil commitment respondents, which challenge beliefs about the deleterious effects of the dangerousness standard on the mentally ill and on mental hospitals. Using objective behavioral criteria, this study finds that the mentally ill brought into the civil commitment process and those committed by the courts to involuntary hospitalization are not limited to the violent, much less the violent to others. Their dangerousness is often toward self and is nonviolent. Many even have no allegations of dangerous behavior. Furthermore, most who are violent do not reach high levels of violence. Reasons for continuation of the beliefs that the dangerousness standard causes the abandonment of the nondangerous mentally ill and causes the filling of mental hospitals with the violent are discussed.
Blacks and Violent Crime: A Psychoanalytically Oriented Analysis
Authors: Schoenfeld C. G.
Published: February 2018

This article offers a psychoanalytic explanation of why blacks commit a disproportionate number—half—of violent crimes in the United States. Slavery and its crippling psychological effects are discussed, as are the devastating psychological consequences of the hundred years of discrimination, segregation, and antiblack terror that followed. The conclusion reached is that black aggression was stimulated inordinately by all this, while simultaneously the black superego was decisively weakened and rendered incomplete and conflicted. These psychological difficulties have persisted and become endemic among the poor, uneducated, lower-class blacks who populate the rotting core of many American cities. Unlike their parents and grandparents, however, they no longer fear imminent bodily harm or death at the hands of violent whites and no longer turn their aggression back upon themselves and become depressed, but feel free to externalize their aggression in periodic riots and violent crime. The solutions suggested in this article include the elimination of social policies that stimulate the aggression of blacks by threatening their sense of self-worth, and the promotion of social policies that help to strengthen their superegos; e.g., minimizing the number of fatherless black households. Ways of using the criminal law to reinforce the black superego are also considered.
Omnipotence and the Law: A Psychoanalytically Oriented Analysis
Authors: Schoenfeld C. G.
Published: February 2018

This article seeks to illuminate the effect of unconscious infantile omnipotence fantasies upon the law and some of its major officials. First, psychoanalytic discoveries about the omnipotence ideas of infants and young children are detailed, and an attempt is made to relate these ideas to the current overestimation of the status and effectiveness of international law. Then the possible relationship between such infantile notions and today's incredible litigiousness is discussed. Considered next in the light of infantile omnipotence beliefs is a series of landmark Supreme Court decisions since 1793—including the disastrous Dred Scott decision that helped to precipitate the Civil War. One of the possibilities raised is that the acceptance of the antimajoritarian concept of “judicial review” reflects the displacement of unconscious omnipotence fantasies from parents onto judges. Discussed next is the implicit logic of currently popular (but clearly unsound) Critical Legal Studies doctrines that, in effect, assign “omnipotence” both to judges and to the law they are presumably free to manipulate in the service of political goals. Finally, an attempt is made to understand why the public tends to ascribe “omnipotence” to judges and prosecutors and why the unconscious omnipotence notions of judges, prosecutors, and policemen are likely to affect their own official behavior.
The Immutability of (Homo)Sexual Orientation: Behavioral Science Implications for a Constitutional (Legal) Analysis
Authors: Green Richard
Published: February 2018

The Supreme Court ruled in Bowers v. Hardwick that there is no fundamental right under a substantive due process analysis to engage in homosexual behavior. Therefore, the remaining constitutional route to protecting homosexuals against discrimination is the equal protection clause of the fourteenth amendment. For the highest level of protection there, a class of persons must be declared “suspect. ” To so qualify, the class should demonstrate, inter alia, that the trait for which it is stigmatized is immutable. Crowing research evidence exists for an innate origin of homosexuality. More importantly, whatever its origins, the low rate of sexual reorientation via psychiatric intervention satisfies the concept of immutability. The Court's criteria are met for applying the strictest of scrutiny to laws that discriminate against homosexuals.
Sexual Relationships between Therapist and Patient—different Countries, Different Treatment
Authors: Coleman Phyllis G.
Published: February 2018

This article discusses legal and ethical problems that may result from therapists having sexual relations with current or former patients. A comparative analysis of the approach of several different countries revealed a consensus that such relationships should be absolutely prohibited. Additionally, the apparent reluctance to address the issue of sexual relationships between therapists and former patients in the United States is often reflected throughout the world.

Not intended to be an exhaustive or scientific survey, this article reviews primarily anecdotal information to raise awareness of the universality of possible harm to the patient who becomes sexually involved with either her current or her former therapist. The article proposes rules that would respond to potential harm suffered by patients. Because it has been proved that patients suffer as a result of such relationships with current therapists, the author concludes that such behavior should be legally and ethically proscribed regardless of the country in which treatment occurs. However, because there is no evidence of actual harm resulting from sexual relationships following proper termination, the author recommends that such relationships be presumed acceptable. This presumption would be rebutted by proof of actual harm to the former patient. Based on the fact that proper termination requires successful resolution of the transference and countertransference, the author suggests certain guidelines for making this determination and advocates the use of an independent therapist as the final decision-maker.
Child Custody Arrangements: A Study of two New Jersey Counties
Authors: Shrier Diane , Simring Sue K. , Greif Judith B. , Shapiro Edith T. , Lindenthal Jacob J.
Published: February 2018

The current prevalence of joint custody awarded in New Jersey, where joint custody is an option, was estimated through a review of 567 family court records covering 1985–87 from two New Jersey counties where divorce decrees involving minor children had been issued. A rate of 11% was found in the county that ranked among the lowest in per capita income and of 19.5% in the county that ranked most affluent in New Jersey–-significantly greater than the estimated 5% of joint custody awarded in New Jersey in 1978. However, in California, where a presumption for joint custody had existed, a study of two counties found that 58% of parents divorcing in 1985 sought joint custody. In both states the predominant mode of joint custody was joint legal custody with physical custody to the mother.
A Typology of Violent Delinquent Adolescents
Authors: Mezzich Ada C. , Coffman Gerald , Mezzich Juan E.
Published: February 2018

The present study identified four types (Stable Behavioral Handicapped, Brighter and Reactive Late Starter, Early Frequent, and Serious Offender) and two higher order types (Fair Adaptive Functioning Late Starter and Under socialized Aggressive Early Starter). This typology may be useful to (1) identify those adolescents who are already violent delinquents and those who are at risk for becoming violent delinquents, (2) create effective matched treatment and prevention procedures, and (3) investigate etiologic mechanisms of criminal behavior.
Legal and Legislative Trends in Drug Testing
Authors: Ravid Renée
Published: February 2018

This article examines the issues of medical confidentiality and legal defensibility that drug testing raises in view of recent judicial and legislative trends. Random and routine drug testing has raised questions of wrongful discharge, unlawful search and seizure, and invasion of privacy. Recent court rulings have upheld routine drug and alcohol testing of employees without individualized suspicion if necessitated by public safety or security interests. Under the Americans with Disabilities Act of 1990, employers may still implement policies, including drug testing, to ensure that the recovered or recovering individual is not currently using illegal drugs.