Journal of the American Academy of Psychiatry and the Law最新文献

Generative artificial intelligence (AI), with its increasing ubiquity and power, will likely transform forensic psychiatry, sparking both advances and new challenges for the field. A possible consequence of the technology is that it will be used to assist malingerers in learning about and feigning psychiatric symptoms. In this study, the AI chatbot ChatGPT was asked to provide information about the insanity defense and psychosis and to use this information to assist the user in simulating a psychotic illness to avoid legal consequences. We found that ChatGPT 3.5 demonstrated a relatively nuanced understanding of typical symptoms of psychosis and that it could translate that knowledge into practical guidance on how to exploit the mental health system for secondary gain. Our findings suggest that, although significant limitations exist with the technology in its current form, forensic psychiatrists should be prepared for its increasing sophistication and the potential consequences in malingering assessments.

This study examined predictors of child and parent offender removal from the home following substantiated incidents of child neglect in U.S. Army families. Case records (n = 390) were coded to identify neglect types and incident characteristics associated with removal in prior studies. Results indicate that the removal of a child and the removal of a parent from the home following an incident of neglect are associated with distinct neglect types and incident characteristics. In bivariate analyses, failure to provide physical needs (FTP), family mental health problems, and co-occurring abuse were each associated with higher odds of child removal. In multivariate analyses, offender substance use, co-occurring abuse, and early parenting, but not FTP, were associated with child removal. Interaction models indicated that high-severity FTP incidents in families with mental health problems were more likely to result in child removal compared with other neglect incidents. In contrast, incidents involving emotional neglect and service member offenders were associated with higher odds of parent removal. Findings advance understanding of the characteristics of neglect incidents associated with family separations, which can improve the judiciousness of legal decisions regarding removal actions and inform prevention efforts that effectively protect children from harm while minimizing disruptions to family integrity.

Forensic psychiatry has been developing ethics guidelines over the last 50 years. The forensic psychiatry guidelines have taken a somewhat different path from traditional medical ethics based on beneficence and nonmaleficence. In particular, for forensic psychiatrists, the ethics concept of the primacy of striving for an individual's benefit may conflict with duties to the justice system. I posit that correctional psychiatry is a branch of forensic psychiatry that has ethics characteristics of both systems and discuss a way of resolving some of these dilemmas. Even if it is practiced by suitably qualified forensic psychiatrists, correctional psychiatry demands its own variation of ethics principles. This variation involves the additional variable of acknowledgment of the duty to the security of the institution. I develop this theory and apply it to some day-to-day ethics dilemmas with which correctional psychiatrists deal. Developing a code of ethics for correctional psychiatry is important. I apply a theoretical code of ethics to the many daily dilemmas experienced by correctional psychiatrists.

Medical students have limited exposure to correctional health, and their attitudes toward inmates are understudied. We investigated medical students' attitudes toward inmates, assessing whether an intervention can improve their understanding of the correctional system and help them develop more positive attitudes toward inmates. One hundred thirty third-year medical students at the University of Ottawa attended a one-hour lecture on correctional health and adverse childhood experiences (ACEs) and subsequently observed a three-hour correctional telepsychiatry clinic during their clerkship psychiatry rotation. Students completed a preintervention and postintervention questionnaire that included a modified 20-item Attitudes Toward Prisoners (ATP) scale (quantitative) and feedback questions (qualitative). Of 130 students who completed the preintervention questionnaire, 106 completed the postintervention questionnaire (81.5%). Students' mean total modified ATP scores increased significantly after our intervention, from 72.8 to 78.4 (p < 001). Fourteen of 20 ATP items increased significantly, reflecting greater understanding of the correctional system and more positive attitudes toward inmates. Thematic analysis of qualitative feedback revealed students gained a better understanding of the correctional system and increased comfort treating inmates. Scarce criticism included minimal interactivity and a desire for more sessions. Although students perceived benefits, further research is required to determine its educational significance.

The increased visibility of the patients' rights movement in medicine in recent years has left the erroneous impression that patients and their physicians are on equal footing in the physician-patient relationship. The reality is that vulnerability of patients in this relationship leaves them at the mercy of health care professionals. This is most acute in psychiatry, where patients reveal aspects of their inner being to their psychiatrist, including strange beliefs they would never disclose to their closest friends and family members, whereas psychiatrists, in contrast, reveal close to nothing of themselves to patients. Additionally, distortions of reality can strip patients of social mores and basic humanity and sometimes cause them to commit crimes. American Academy of Psychiatry and the Law (AAPL) scholars have espoused the values of treating evaluees professionally and with compassion and respect while upholding their dignity and humanity. These worthy forensic psychiatric writings, however, have unfortunately not always transitioned into the clinical treatment of forensic patients. Reports of patient abuse by staff in psychiatric hospitals, including forensic psychiatric hospitals, remain rampant. Using real-life examples, I apply forensic psychiatric ethics to patient care and offer suggestions of practices and policies that would enhance treatment of patients and decrease the potential for patient abuse in psychiatric hospitals.

Bias can vitiate the quality and credibility of a mental health professional's forensic evaluations as well as scientific and scholarly contributions to the forensic process in forensic psychiatry publications. Our attention here is on this latter influence of bias, although the genres of bias identified here can as well occur in forensic practice and writings. Attention is given to multiple forms of bias in peer review: ad hominem, ideological, confirmatory, hindsight, the halo effect, gender, publication, conflict of (financial) interest, political, religious, nationality or country of origin, esthetic or linguistic, racial or ethnicity, and herding. No doubt much bias in peer review goes undetected and no absolute purification process exists. Nonetheless, as with almost any problem, the first step toward a remedy is recognition.

Stimulants are among the most widely used substances in the world after cannabis, with a rapid rise in methamphetamine use in the last 15 years. Methamphetamine has a high propensity to cause psychosis ranging from transient psychosis during acute intoxication to persisting psychosis with similarities to schizophrenia. Although the former condition may not abrogate criminal responsibility, the latter is recognized as a basis for an exculpatory mental state in a majority of jurisdictions across the United States. Methamphetamine use can therefore complicate criminal responsibility evaluations. We present the literature on methamphetamine-induced psychosis, underscoring the shortfalls in existing classificatory schemes for methamphetamine-associated psychosis that can complicate forensic mental health evaluators' opinions in criminal responsibility evaluations. We offer practical considerations for forensic mental health professionals performing criminal responsibility evaluations where methamphetamine use is a concern.

Malingering is defined as the intentional falsification or exaggeration of symptoms for secondary gain. The prevalence of malingering varies widely among different medicolegal contexts, emphasizing the need to identify additional predictive factors when considering the diagnosis. This study measured rates of malingering in a sample of 1,300 subjects from a forensic psychiatry practice located in Lexington, Kentucky. Among those who failed at least three symptom or performance validity scales, odds ratios for malingering were approximately twice as high in subjects with less than a college education (p = .011), those referred by the opposing counsel (p = .001), and those meeting criteria for a mental illness in three or more DSM-5 diagnostic categories (p = .015). Those evaluated for worker's compensation and head injury were more likely to malinger than other case types (p = .028). Men were found to malinger at a higher rate than women (p = .014), and no significant differences were observed based on race. These results indicate that education, gender, psychiatric history, case type, and referral type may be important factors to consider when assessing for malingering.

This article discusses the relevance of delusions for a finding of criminal insanity. The authors start from the recognition that the psychiatric notion of delusion is considered relevant to criminal insanity in most jurisdictions and therefore integrates psychiatric perspectives to define delusions. The key focus is on the differences regarding how and why delusions matter legally between the Anglo-American and the Norwegian approach to criminal insanity. The authors argue that Norwegian law provides a new point of entrance to clarify legal implications of delusions but also uncovers further challenges and targets for future research regarding how the law relies upon psychiatric constructs.

Hunger strikes are a common occurrence in carceral settings accompanied by serious health risks and intensive health care utilization. A 2017 study on hunger strikes within the New Jersey Department of Corrections found these events most often occurred in a disciplinary setting. We undertook this study after a new state law, the Isolated Confinement Restriction Act (ICRA), improved conditions of confinement in part by reducing the utilization, nature, and duration of disciplinary housing. We hypothesized that ICRA would reduce the frequency of hunger strikes. Although the frequency of strikes was unchanged, the mean hunger strike duration declined from 28.9 days to 9.7 days (p = .034). The typical strike was modestly briefer, with the median duration before ICRA being four days and after being three days. The rate of hunger strikes greater than three days declined (from 60.3% to 45.2%; p = .049). There was no difference in the rate of hunger striking in disciplinary housing before or after ICRA. Although hunger strikes remain a frequently used method of protest for incarcerated persons, reform to the conditions of confinement was associated with reducing the health-related dangers and associated health care costs of these phenomena and arguably was a factor in this reduction.