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

In recent decades, there has been an evolution in forensic psychiatry and psychology toward closer examination of the professionals' attitudes and intentions in their practice. We theorize that the progressive change reflects increased attention to the experiences of evaluators and evaluees in their social worlds. This cultural focus complements the traditional emphasis on biomedical elements, such as neuropsychiatric disorders. We suggest that sociocultural factors (such as poverty, trauma, and sexual orientation) and ethnocultural factors (such as those related to ethnic status, discrimination, and racialized application of risk assessment) have contributed substantially to these developments in forensic practice. We utilize past and current literature to illustrate the change and to frame it as a way of improving practice. This is a call for forensic practitioners to enhance their awareness of the impact of social and ethnocultural factors. We recommend further examination of these ideas by training programs and broader scholarly discussion in educational forums.

In their article, Aveson and colleagues postulate a model for understanding the neurocognitive underpinnings of competence to stand trial, and they present evidence to support that model for two specific facets: social intelligence and auditory verbal (episodic) memory. This commentary attempts to extend those findings by outlining specific interventions and assessment methods in the inpatient restoration setting that focus on strengthening these capacities and connecting them to the psycho legal context. It echoes the work of Aveson et al. that court is a transactional, social context heavily dependent on auditory processing and verbal comprehension and expression and suggests that restoration programs ought to incorporate interventions and assessment tools that address such faculties. Further refinement of our understanding of competence and its constituent components will enable us to better allocate scarce resources throughout the system, to tailor restoration programming to the needs of each individual defendant, and to aid defendants through restoration programming to develop the skills to take a more involved, collaborative role in the process.

There are approximately 500,000 children in the foster care system in the United States of America. With exposure to chronic and cumulative trauma, they constitute a population with an increased risk of developing mental health concerns and adverse outcomes in later life, including contact with the forensic system. Legislative frameworks that have been developed to facilitate improved outcomes are outlined, although these vary between states, and the focus is often on the parental relationship. Several studies have emphasized the importance of sibling relationships and that placing siblings in the same foster home is associated with higher rates of placement stability, reunification, adoption and guardianship, and fostering positive sibling relations. The multifaceted role of the clinician in promoting recovery from trauma, enhancing resiliency, and thoughtfully prescribing and advocating for familial relationships is discussed.

The main aim of this study was to ascertain whether a relationship existed between the modus operandi and motivation of homicide, clinical characteristics, and psychopathic traits in schizophrenia. Forty-seven male homicide perpetrators with schizophrenia were included in the study. We classified types of homicide perpetrated by the patients as predominantly impulsive (n = 27) or proactive (n = 20) in nature. We also evaluated the psychotic motivation accompanying the homicide. Forty-four (93.6%) of the homicides were psychotically motivated. The victim was a stranger in only 8.5 percent of the homicides. Use of firearms as a killing method was significantly higher in predominantly proactive homicides (30%) compared with impulsive homicides (3.7%). Infidelity delusions were more frequent in proactive homicides than in impulsive homicides. According to regression models, a predominantly proactive homicide was significantly associated with being married, older age at illness onset, killing with firearms, infidelity delusions and a high PCL-R affective facet score in univariate analyses. Multivariate analyses showed a significant association with infidelity delusions and a high PCL-R affective facet score. Our results confirm that certain predispositions, as well as contextual factors, may be associated with the violent subtype of homicidal behavior in perpetrators with schizophrenia.

The article by Zhang and colleagues in this issue of The Journal calls attention to an important but underrecognized problem facing today's seniors and their loved ones. The risk of digital financial exploitation, particularly in the wake of the COVID-19 pandemic, has risen considerably in recent years and continues to rise today. Zhang et al. provide a helpful analysis of assessment tools currently available to forensic psychiatrists for the evaluation of financial capacity. Although many of these tools were not originally intended to encompass technologically based transactions, the risks of fraud and scams associated with payment apps, social media, and electronic fund transfers are considerable and growing. Fraudsters frequently target vulnerable older adults, and victims have lost large sums through some of the more prevalent schemes. Several strategies can help to mitigate the risk of severe losses and to increase the likelihood that lost assets can be recovered. Proactive education through increased awareness will prove helpful, but given the growing sophistication of modern digital cons, such as romance scams, increased technological safeguards are warranted in the setting of reduced financial capacity. When losses do occur, there are some resources for recovery and for filing complaints against perpetrators.

Forensic psychiatrists have called for greater attention to cultural and racial topics in assessing examinees. While suggestions for new methods are welcome, they can ignore the extent of scientific progress if existing assessments are not accurately appraised. This article analyzes the arguments of two recent publications in The Journal that mischaracterize the cultural formulation approach. Contrary to the idea that forensic psychiatrists have received little guidance on assessing an examinee's racial identity, the article shows that forensic psychiatrists have contributed to scholarship on assessing racial identifications through cultural formulations that elicit how minoritized ethnoracial examinees interpret their illness experiences and legal involvements. The article also seeks to dispel misunderstandings about the Cultural Formulation Interview (CFI), which clinicians have used to complete person-centered cultural assessments, including in forensic settings. Conducting research, practice, and educational activities on the cultural formulation can be ways for forensic psychiatrists to combat systemic racism.