Forensic psychiatric evaluation of persons with posttraumatic stress disorder undergoing criminal trial

The aim of our study was to determine if there is a difference between the type of crime committed by persons diagnosed with posttraumatic stress disorder (PTSD) and that committed by other offenders. The study included 389 male patients at the Department of Forensic Psychiatry in Popovaca who underwent forensic psychiatric evaluation to establish a psychiatric diagnosis, evaluate the mental capacity, and provide advice on further treatment. The data on the number of individuals with PTSD vs. other psychiatric disorders and the data on family violence vs. other criminal acts were analyzed with chi2 test. Of a total of 389 forensically evaluated male patients, 45 (11.6%) suffered from PTSD. Study subjects with PTSD only or PTSD comorbid with the other psychiatric disorders committed family violence significantly more often than subjects diagnosed with the other psychiatric disorders chi2(1) = 40.092, P < 0.001. Subjects with PTSD, whether or not comorbid with the other psychiatric disorders, committed family violence significantly more often than subjects with other psychiatric diagnoses.     

Initial Health Assessments and HIV Screening under the Affordable Care Act

Background

The Centers for Disease Control and Prevention (CDC) estimates that 156,300 (95% CI 144,100–165,900) Americans living with HIV in 2012 were unaware of their infection. To increase knowledge of HIV status, CDC guidelines seek to make HIV screening a routine part of medical care. This paper examines how routinely California primary care providers test for HIV and how providers’ knowledge of California’s streamlined testing requirements, use of sexual histories, and having an electronic medical record prompt for HIV testing, relate to test offers.

Methods

We surveyed all ten California health plans offered under health reform’s Insurance Exchange (response rate = 50%) and 322 primary care providers to those plans (response rate = 19%) to assess use of HIV screening and risk assessments.

Results

Only 31.7% of 60 responding providers reported offering HIV tests to all or most new enrollees and only 8.8% offered an HIV test of blood samples all or most of the time despite the California law requiring that providers offer HIV testing of blood samples in primary care settings. Twenty-eight of the 60 providers (46.6%) were unaware that California had reduced barriers to HIV screening by eliminating the requirement for written informed consent and pre-test counseling. HIV screening of new enrollees all or most of the time was reported by 53.1% of the well-informed providers, but only 7.1% of the less informed providers, a difference of 46 percentage points (95% CI: 21.0%—66.5%). Providers who routinely obtained sexual histories were 29 percentage points (95% CI: 0.2%—54.9%) more likely to screen for HIV all or most of the time than those who did not ask sexual histories.

Conclusion

Changing HIV screening requirements is important, but not sufficient to make HIV testing a routine part of medical care. Provider education to increase knowledge about the changed HIV testing requirements could positively impact testing rates.     

Eugenic and sexual folklores and the castration of sex offenders in the Netherlands (1938-1968)

This contribution questions the positive/negative eugenics dichotomy that typifies the historiography on the eugenic movement in the Netherlands and the claim that this movement was mostly marginal because only positive eugenics was pursued. From 1938 to 1968 in the Netherlands, after a decade of debates, 400 sex offenders who had been committed to asylums for the criminally insane were 'voluntarily' and 'therapeutically' castrated. For political reasons debates on castration, meant to create consensus, eliminated any reference to or connotation with eugenics, yet these policies were unthinkable without them. This article shows that thinking about social and sexual problems and their solutions in the 1930s were permeated by eugenic folklore which in turn was informed by sexual folklore. Both eugenic and sexual lore, as common sense, or as ways of knowing, were about individual and collective loss of self control which was referred to with a catch-all phrase: 'hypersexuality'. Although sexual classifications used in diagnosing sex offenders suggested the existence of discrete sexual categories, homosexuality for instance was not seen as a sexual alternative or as an identity but as the extent to which an offender suffered from a form of hypersexuality that threatened the fabric of society.     

Inquiry into homicides by psychiatric patients: systematic audit should replace mandatory inquiries.

Inquiries into homicides committed by psychiatric patients are currently mandatory under Department of Health guidance. They are often broadly defined in their terms of reference and almost always address not only the cause of the incident but also professional skill, practice, and culpability. Concurrent pursuit of both purposes is unlikely to maximise "learning from experience." Also, since inquiries can set their own thresholds for culpability, doctors can potentially be judged to a higher standard than would be required by the General Medical Council or negligence law. Lack of strict legal process increases the inherent potential unfairness to doctors. Investigation of cause and culpability should be separated and inquiries restricted to the former. There should also be a standing secretariat for inquiries to set terms of reference and to collate and distribute findings of inquiries. Widespread mandatory systematic audit of professional practice and service efficiency concerning risk assessment and management should largely replace costly ad hoc mandatory inquiries after homicides.     

How Spaniards Became Chumash and other Tales of Ethnogenesis

In the 1970s, a network of families from Santa Barbara, California, asserted local indigenous identities as "Chumash." However, we demonstrate that these families have quite different social histories than either they or supportive scholars claim. Rather than dismissing these neo-Chumash as anomalous "fakes," we place their claims to Chumash identity within their particular family social histories. We show that cultural identities in these family lines have changed a number of times over the past four centuries. These changes exhibit a range that is often not expected and render the emergence of neo-Chumash more comprehendible. The social history as a whole illustrates the ease and frequency with which cultural identities change and the contexts that foster change. In light of these data, scholars should question their ability to essentialize identity.     

Eugenic and sexual folklores and the castration of sex offenders in the Netherlands (1938–1968)

This contribution questions the positive/negative eugenics dichotomy that typifies the historiography on the eugenic movement in the Netherlands and the claim that this movement was mostly marginal because only positive eugenics was pursued. From 1938 to 1968 in the Netherlands, after a decade of debates, 400 sex offenders who had been committed to asylums for the criminally insane were ‘voluntarily’ and ‘therapeutically’ castrated. For political reasons debates on castration, meant to create consensus, eliminated any reference to or connotation with eugenics, yet these policies were unthinkable without them. This article shows that thinking about social and sexual problems and their solutions in the 1930s were permeated by eugenic folklore which in turn was informed by sexual folklore. Both eugenic and sexual lore, as common sense, or as ways of knowing, were about individual and collective loss of self control which was referred to with a catch-all phrase: ‘hypersexuality’. Although sexual classifications used in diagnosing sex offenders suggested the existence of discrete sexual categories, homosexuality for instance was not seen as a sexual alternative or as an identity but as the extent to which an offender suffered from a form of hypersexuality that threatened the fabric of society.     

Psychopathy and developmental instability

Psychopaths are manipulative, impulsive, and callous individuals with long histories of antisocial behavior. Two models have guided the study of psychopathy. One suggests that psychopathy is a psychopathology, i.e., the outcome of defective or perturbed development. A second suggests that psychopathy is a life-history strategy of social defection and aggression that was reproductively viable in the environment of evolutionary adaptedness (EEA). These two models make different predictions with regard to the presence of signs of perturbations or instability in the development of psychopaths. In Study 1, we obtained data on prenatal, perinatal, and neonatal signs of developmental perturbations from the clinical files of 643 nonpsychopathic and 157 psychopathic male offenders. In Study 2, we measured fluctuating asymmetry (FA, a concurrent sign of past developmental perturbations) in 15 psychopathic male offenders, 25 nonpsychopathic male offenders, and 31 male nonoffenders. Psychopathic offenders scored lower than nonpsychopathic offenders on obstetrical problems and FA; both psychopathic and nonpsychopathic offenders scored higher than nonoffenders on FA. The five offenders from Study 2 meeting the most stringent criteria for psychopathy were similar to nonoffenders with regard to FA and had the lowest asymmetry scores among offenders. These results provide no support for psychopathological models of psychopathy and partial support for life-history strategy models.     

The Mauritian Piracy Act: A Comment on the Director of Public Prosecutions v Ali Abeoulkader Mohamed Decision

In 2011 Mauritius adopted the Piracy and Maritime Violence Act (the Act). The Act does not expressly state that Mauritian Courts have jurisdiction over offenses committed outside of Mauritius. In Director of Public Prosecutions v Ali Abeoulkader Mohamed & Ors, the Mauritian Supreme Court dealt with the issue of whether the Act applied to non-Mauritius citizens where the alleged piracy acts had been committed outside of Mauritius on the high seas. This article assesses the Supreme Court's decision and suggest ways that the Act can be strengthened.     

Low cerebrospinal fluid 5-hydroxyindoleacetic acid concentration differentiates impulsive from nonimpulsive violent behavior

Relationships of impulsive and nonimpulsive violent behavior to cerebrospinal fluid (CSF) monoamines and their metabolite concentrations were studied in thirty-six violent offenders. A relatively low 5-hydroxyindoleacetic acid (5HIAA) concentration was found in the CSF of impulsive violent offenders. This was not true for the offenders who had premiditated their acts. Other CSF monoamine or metabolite concentrations were not significantly different between the two groups. Of the groups studied, impulsive violent offenders who had attempted suicide had the lowest 5HIAA levels. A low CSF 5HIAA concentration may be a marker of impulsivity rather than violence.     

Delinquency in women

From observation of some 1,000 women who were committed to a California correctional institution because of felonious offense it was concluded that:1. Delinquency results from certain identifiable factors, particularly basic defects in early family relationships, various aberrant psychological states including many forms of mental illness; physical illness or injuries, particularly those producing brain damage and resulting in abnormal psychological conditions; general environmental factors, and specific environmental factors.2. Certain personality-types and certain life-environmental situations appear to be associated with certain patterns of offenses.3. Correction and rehabilitation may be achieved to a greater degree as correctional institution treatment programs are increasingly implemented with psychiatric personnel, and as increased guidance and support are made available through parole divisions.     

DELINQUENCY IN WOMEN

From observation of some 1,000 women who were committed to a California correctional institution because of felonious offense it was concluded that:1. Delinquency results from certain identifiable factors, particularly basic defects in early family relationships, various aberrant psychological states including many forms of mental illness; physical illness or injuries, particularly those producing brain damage and resulting in abnormal psychological conditions; general environmental factors, and specific environmental factors.2. Certain personality-types and certain life-environmental situations appear to be associated with certain patterns of offenses.3. Correction and rehabilitation may be achieved to a greater degree as correctional institution treatment programs are increasingly implemented with psychiatric personnel, and as increased guidance and support are made available through parole divisions.     

The Culture of Poverty: An Adjustive Dimension

The "Moynihan controversy" concerning the existence of a subculture of poverty among the Negro poor has been marked by polar positions. There are those who feel that much of the "deviant behavior" of this group is actually normative and transmitted in the socialization process. Others maintain that such behavior is not normative and represents merely situational responses to extreme poverty and other forms of deprivation. The data in this paper, derived from interviews with a sample of the Negro population of Philadelphia, indicate that Negroes living in poverty hold attitudes that can be characterized as a "subculture of poverty." On the other hand, the data also suggest that such attitudes represent but one segment of the total range of attitudes and reference values held by this population, many of which are shared by the larger society. Furthermore, the evidence indicates that these attitudes serve to maintain the mental health of those living in a severely disadvantaged social situation. [deviant behavior, Negro, poverty]     

GEOGRAPHIC VARIATION IN THE LIFE HISTORY OF MASTOCARPUS PAPILLATUS (RHODOPHYTA)1

Variation in the geographic distribution of the life histories of Mastocarpus papillatus was investigated. Carpospores were isolated from 377 female gametophytes collected from eight localities on the Pacific coast of Baja California, Mexico, and California, U.S.A., and grown in laboratory culture. All carpospores from a single female gave rise either to basal discs with gametophyte-like uprights or crustose plants formerly referred to the genus Petrocelis. Early stages in the development of each type of germling were observed, and environmental factors affecting development were suggested. Based on carpospore germlings, females from each location were scored as having either the 1) sexual life history (crustose germlings) or 2) direct-development life history (discoid germlings with uprights). All females from the two southernmost locations in Baja California exhibited the sexual life history. In the three locations from the central-southern California coast, 70-95% of the females exhibited the sexual life history and the remainder exhibited the direct-development life history. In two of the three populations from the central-northern California coast, 70-90% of the females exhibited the direct-development life history and the remainder the sexual life history. In the third location from the central-northern California coast, the northernmost location sampled in the current study, 60% of the females exhibited the sexual life history and 40% the direct-development life history. The relative ecological advantages and disadvantages of the life histories are unknown as are the environmental factors that produced the ratios of sexual to direct-development females observed at each location.     

Cross-Sectional Analysis of the 1039 U.S. Physicians Reported to the National Practitioner Data Bank for Sexual Misconduct, 2003–2013

Background

Little information exists on U.S. physicians who have been disciplined with licensure or restriction-of-clinical-privileges actions or have had malpractice payments because of sexual misconduct. Our objectives were to: (1) determine the number of these physicians and compare their age groups’ distribution with that of the general U.S. physician population; (2) compare the type of disciplinary actions taken against these physicians with actions taken against physicians disciplined for other offenses; (3) compare the characteristics and type of injury among victims of these physicians with those of victims in reports for physicians with other offenses in malpractice-payment reports; and (4) determine the percentages of physicians with clinical-privileges or malpractice-payment reports due to sexual misconduct who were not disciplined by medical boards.

Methods and Results

We conducted a cross-sectional analysis of physician reports submitted to the National Practitioner Data Bank (NPDB) from January 1, 2003, through September 30, 2013. A total of 1039 physicians had ≥ 1 sexual-misconduct–related reports. The majority (75.6%) had only licensure reports, and 90.1% were 40 or older. For victims in malpractice-payment reports, 87.4% were female, and “emotional injury only” was the predominant type of injury. We found a higher percentage of serious licensure actions and clinical-privileges revocations in sexual-misconduct–related reports than in reports for other offenses (89.0% vs 68.1%, P = < .001, and 29.3% vs 18.8%, P = .002, respectively). Seventy percent of the physicians with a clinical-privileges or malpractice-payment report due to sexual misconduct were not disciplined by medical boards for this problem.

Conclusions

A small number of physicians were reported to the NPDB because of sexual misconduct. It is concerning that a majority of the physicians with a clinical-privileges action or malpractice-payment report due to sexual misconduct were not disciplined by medical boards for this unethical behavior.     

Improving Negative Emotion Recognition in Young Offenders Reduces Subsequent Crime

Background

Children with antisocial behaviour show deficits in the perception of emotional expressions in others that may contribute to the development and persistence of antisocial and aggressive behaviour. Current treatments for antisocial youngsters are limited in effectiveness. It has been argued that more attention should be devoted to interventions that target neuropsychological correlates of antisocial behaviour. This study examined the effect of emotion recognition training on criminal behaviour.

Methods

Emotion recognition and crime levels were studied in 50 juvenile offenders. Whilst all young offenders received their statutory interventions as the study was conducted, a subgroup of twenty-four offenders also took part in a facial affect training aimed at improving emotion recognition. Offenders in the training and control groups were matched for age, SES, IQ and lifetime crime level. All offenders were tested twice for emotion recognition performance, and recent crime data were collected after the testing had been completed.

Results

Before the training there were no differences between the groups in emotion recognition, with both groups displaying poor fear, sadness and anger recognition. After the training fear, sadness and anger recognition improved significantly in juvenile offenders in the training group. Although crime rates dropped in all offenders in the 6 months following emotion testing, only the group of offenders who had received the emotion training showed a significant reduction in the severity of the crimes they committed.

Conclusions

The study indicates that emotion recognition can be relatively easily improved in youths who engage in serious antisocial and criminal behavior. The results suggest that improved emotion recognition has the potential to reduce the severity of reoffending.     

Environment Under the Federal Employees Health Benefits Program: A Report of the Bureau of Research and Planning, California Medical Association

Active and retired federal employees, together with their dependents, represent the single largest group of persons enrolled in any voluntary health insurance program in the United States. The extent of their coverage and enrollment is of particular interest to physicians in California since this state has the largest proportion of all federal employees enrolled among all states. Of the almost 5(3/4) million federal employees and their dependents, enrollment in California was almost 609,000 or slightly over 10 per cent of all those covered. Better than 3 out of 5 individuals covered were enrolled in service type plans both in the U.S. and in California. Of all persons enrolled in comprehensive group practice and individual practice plans in the U.S., almost one-half were in California alone. Almost 4 out of 5 individuals enrolled were in high option plans. "... an indication that most employees were satisfied with their initial choice of plans."     

Prevention of suicide

Suicide is the ninth major cause of death in the nation. California, according to the latest comprehensive figures (1949), ranks about 50 per cent above the national average. Yet the importance of suicide as a cause of death is gravely underestimated. At hospitals and other agencies only emergency treatment is given before discharge of persons who attempt suicide, although it is known that many will repeat the attempt. Rarely is psychiatric evaluation carried out or definitive treatment prescribed. Suicidal symptoms are often ignored in other cases. Physicians have a responsibility, as in any disorder, to recognize signs and symptoms of impending suicide and to use all means of prevention. Prevention could be forwarded by the education of physicians and laymen in detecting early signs of depression, in recognizing accident proneness, and in insisting upon legal control of use of barbiturates, a common means of suicide. Lay associations should encourage individuals with suicidal impulses to go to psychiatric clinics for help. Police should learn how to deal with suicidal attempts, and hospitals should include psychiatric examination and advice as to treatment of all such persons. Suicidal attempts should be registered and reported to public health officers in the same way as are other dangerous diseases. More research should be done on case records of these patients, in order to better understand motivations and means of prevention.     

The next generation of exoskeletons: lighter, cheaper devices are in the works

Many researchers and engineers are busy in their laboratories working on devices that will bring mobility to people who have lost function in the lower body due to an accident, stroke, multiple sclerosis, or other disorders. "Several pretty sophisticated exoskeletons are already on the market now, and they are all similar to each other in terms of technologies, but we're not ready to replace the wheelchair yet," said exoskeleton developer Homayoon Kaz Kazerooni, Ph.D., professor of mechanical engineering at the University of California (UC) at Berkeley. "Eventually, we will have devices that are used by individuals on a daily basis to replace wheelchairs but not with the existing technology. We're at the beginning of a much bigger era in exoskeletons."     

Reproductive controls and sexual destiny

Murphy considers the moral implications of the future possibility that certain reproductive technologies could offer the prospect of controlling sexual orientation. He discusses three arguments for and three against prenatal intervention to ensure heterosexual progeny and to avoid homosexual progeny. Interventions would appear to be immoral if motivated by heterosexism, a doctrine asserting the superiority of heterosexuality which Murphy believes is intellectually indefensible in its premises and morally wrong in its consequences. He argues, however, against legally banning the use of interventions to determine sexual orientation because "there are important freedoms to preserve in the domain of reproductive control and because it is not clear that the use of these interventions would adversely affect the interests of existing or future persons."     

Probation linked supervised disulfiram in the treatment of habitual drunken offenders: results of a pilot study.

Sixteen habitual drunken offenders agreed to take disulfiram in liquid form under supervision as a condition of a probation order. They knew that failure to take medication, as with failure to observe any other condition of probation, could result in their being returned to court. Three defaulted but only two of the remainder committed further offences. Nine were entirely successful. At the end of the study the average period of abstinence for the whole group was 30 weeks compared with six weeks during the previous two years. Nine risked drinking alcohol but none suffered any serious consequences or side effects. This technique may be a judicially acceptable and more hopeful alternative to prison for these offenders.