Pub Date : 2020-01-01DOI: 10.1001/jamaoto.2019.3375
Justin S Golub, Adam M Brickman, Adam J Ciarleglio, Nicole Schupf, José A Luchsinger
<p><strong>Importance: </strong>Age-related hearing loss (HL) is a common and treatable condition that has been associated with cognitive impairment. The level of hearing at which this association begins has not been studied to date.</p><p><strong>Objective: </strong>To investigate whether the association between hearing and cognition is present among individuals traditionally classified as having normal hearing.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional study of 2 US epidemiologic studies (Hispanic Community Health Study [HCHS], 2008-2011, and National Health and Nutrition Examination Study [NHANES], 1999-2000, 2001-2002, and 2011-2012 cycles). The dates of analysis were November 2018 to August 2019. Multivariable generalized additive model (GAM) regression and linear regression were used to assess the association between HL (exposure) and cognition (outcome). Participants included 6451 individuals aged 50 years or older from the general Hispanic population (HCHS [n = 5190]) and the general civilian, noninstitutionalized US population (NHANES [n = 1261]).</p><p><strong>Exposures: </strong>Audiometric HL (4-frequency pure-tone average).</p><p><strong>Main outcomes and measures: </strong>Neurocognitive performance measured by the Digit Symbol Substitution Test (DSST) (score range, 0-113), Word Frequency Test (range, 0-49), Spanish-English Verbal Learning Test (SEVLT) 3 trials (range, 5-40), SEVLT recall (range, 0-15), and Six-Item Screener (range, 0-6); higher scores indicated better cognitive performance.</p><p><strong>Results: </strong>Among 6451 individuals, the mean (SD) age was 59.4 (6.1) years, and 3841 (59.5%) were women. The GAM regression showed a significant inverse association between hearing and cognition across the entire spectrum of hearing after adjusting for demographics and cardiovascular disease. In separate multivariable linear regressions stratified by the classic binary definition of HL, decreased hearing was independently associated with decreased cognition in adults with normal hearing (pure-tone average ≤25 dB) across all cognitive tests in the HCHS. For example in this group, a 10-dB decrease in hearing was associated with a clinically meaningful 1.97-point (95% CI, 1.18-2.75) decrease in score on the DSST. When using a stricter HL cut point (15 dB), an association was also present in NHANES. The associations between hearing and cognition were stronger or equivalent in individuals with normal hearing than among those with HL. For example, there was a 2.28-point (95% CI, 1.56-3.00) combined cohort DSST score decrease per 10-dB decrease among individuals with normal hearing vs a 0.97-point (95% CI, 0.20-1.75) decrease among those with HL, with a significant interaction term between continuous and binary hearing.</p><p><strong>Conclusions and relevance: </strong>An independent association was observed between cognition and subclinical HL. The association between hearing and cognition may be pre
{"title":"Association of Subclinical Hearing Loss With Cognitive Performance.","authors":"Justin S Golub, Adam M Brickman, Adam J Ciarleglio, Nicole Schupf, José A Luchsinger","doi":"10.1001/jamaoto.2019.3375","DOIUrl":"10.1001/jamaoto.2019.3375","url":null,"abstract":"<p><strong>Importance: </strong>Age-related hearing loss (HL) is a common and treatable condition that has been associated with cognitive impairment. The level of hearing at which this association begins has not been studied to date.</p><p><strong>Objective: </strong>To investigate whether the association between hearing and cognition is present among individuals traditionally classified as having normal hearing.</p><p><strong>Design, setting, and participants: </strong>Cross-sectional study of 2 US epidemiologic studies (Hispanic Community Health Study [HCHS], 2008-2011, and National Health and Nutrition Examination Study [NHANES], 1999-2000, 2001-2002, and 2011-2012 cycles). The dates of analysis were November 2018 to August 2019. Multivariable generalized additive model (GAM) regression and linear regression were used to assess the association between HL (exposure) and cognition (outcome). Participants included 6451 individuals aged 50 years or older from the general Hispanic population (HCHS [n = 5190]) and the general civilian, noninstitutionalized US population (NHANES [n = 1261]).</p><p><strong>Exposures: </strong>Audiometric HL (4-frequency pure-tone average).</p><p><strong>Main outcomes and measures: </strong>Neurocognitive performance measured by the Digit Symbol Substitution Test (DSST) (score range, 0-113), Word Frequency Test (range, 0-49), Spanish-English Verbal Learning Test (SEVLT) 3 trials (range, 5-40), SEVLT recall (range, 0-15), and Six-Item Screener (range, 0-6); higher scores indicated better cognitive performance.</p><p><strong>Results: </strong>Among 6451 individuals, the mean (SD) age was 59.4 (6.1) years, and 3841 (59.5%) were women. The GAM regression showed a significant inverse association between hearing and cognition across the entire spectrum of hearing after adjusting for demographics and cardiovascular disease. In separate multivariable linear regressions stratified by the classic binary definition of HL, decreased hearing was independently associated with decreased cognition in adults with normal hearing (pure-tone average ≤25 dB) across all cognitive tests in the HCHS. For example in this group, a 10-dB decrease in hearing was associated with a clinically meaningful 1.97-point (95% CI, 1.18-2.75) decrease in score on the DSST. When using a stricter HL cut point (15 dB), an association was also present in NHANES. The associations between hearing and cognition were stronger or equivalent in individuals with normal hearing than among those with HL. For example, there was a 2.28-point (95% CI, 1.56-3.00) combined cohort DSST score decrease per 10-dB decrease among individuals with normal hearing vs a 0.97-point (95% CI, 0.20-1.75) decrease among those with HL, with a significant interaction term between continuous and binary hearing.</p><p><strong>Conclusions and relevance: </strong>An independent association was observed between cognition and subclinical HL. The association between hearing and cognition may be pre","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"20 1","pages":"57-67"},"PeriodicalIF":7.8,"publicationDate":"2020-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6865840/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86920823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000210
M. Perlin
Therapeutic jurisprudence (TJ) provides a framework for psycholegal analysis that has had no difficulty in attracting adherents within the law and a broad range of health-oriented disciplines. Although psychiatry has proven perhaps predictably less willing to embrace TJ, the work of Robert L. Sadoff, M.D. provides a heartening exception. Dr. Sadoff's career stands for many enlightening principles—not least of which is the redemptive promise of TJ.
治疗法学为心理分析提供了一个框架，它毫不费力地吸引了法律界和各种面向健康的学科的追随者。尽管精神病学已被证明不太愿意接受TJ，但医学博士罗伯特·l·萨多夫(Robert L. Sadoff)的研究提供了一个令人振奋的例外。萨多夫博士的职业生涯代表了许多具有启发性的原则，其中最重要的是TJ的救赎承诺。
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Pub Date : 2012-06-01DOI: 10.1177/009318531204000207
K. Weiss
Dr. Robert Sadoff's teaching of honesty and integrity in forensic psychiatric work resonates both with current ethical principles and the ancient proscription against bearing false witness against one's fellow citizen. This article explores the misuse of psychiatric testimony in a 1928–1929 murder prosecution in Innsbruck, Austria. Amid clear undercurrents of Nazism, a Jewish youth found himself on trial for the murder of his father. Though there was no evidence that he was guilty, the expert testimony included distorted presentations of psychology and Freud's theory of the Oedipus complex. Freud and others protested the misuse of his work to convict the defendant, noting the difficulty in adapting psychoanalytic theory to legal settings. After 2 years in prison, the young man was set free, later becoming a world-renowned portrait photographer. Forensic professionals must continue to be vigilant in self-regulating the use of scientific information in legal settings.
{"title":"Bearing False Witness: Psychiatric Testimony in Nazi-Influenced Austria, 1928–1929","authors":"K. Weiss","doi":"10.1177/009318531204000207","DOIUrl":"https://doi.org/10.1177/009318531204000207","url":null,"abstract":"Dr. Robert Sadoff's teaching of honesty and integrity in forensic psychiatric work resonates both with current ethical principles and the ancient proscription against bearing false witness against one's fellow citizen. This article explores the misuse of psychiatric testimony in a 1928–1929 murder prosecution in Innsbruck, Austria. Amid clear undercurrents of Nazism, a Jewish youth found himself on trial for the murder of his father. Though there was no evidence that he was guilty, the expert testimony included distorted presentations of psychology and Freud's theory of the Oedipus complex. Freud and others protested the misuse of his work to convict the defendant, noting the difficulty in adapting psychoanalytic theory to legal settings. After 2 years in prison, the young man was set free, later becoming a world-renowned portrait photographer. Forensic professionals must continue to be vigilant in self-regulating the use of scientific information in legal settings.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"23 24 1","pages":"185 - 218"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88651022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000204
K. Weiss, R. Sadoff
Dr. Bernard L. Diamond (1973) published the first article in the first issue of the Journal of Psychiatry & Law. Entitled “The Psychiatrist as Advocate,” it was a follow-up to his famous editorial, “The Fallacy of the Impartial Expert” (Diamond, 1959). Given the impossibility of total impartiality, the expert witness can still be ethical, but then undertake a form of activism. After nearly 40 years, we continue to reassess our boundaries as expert witnesses. In this article, the author has asked Dr. Robert L. Sadoff to comment on Dr. Diamond's ideas in the context of contemporary ethics.
Bernard L. Diamond博士(1973)在《精神病学与法律杂志》的第一期上发表了第一篇文章。题为《作为辩护人的精神科医生》，是他著名社论《公正专家的谬误》(戴蒙德，1959)的后续。鉴于不可能完全公正，专家证人仍然可以是道德的，但随后采取一种形式的激进主义。在将近40年之后，我们继续重新评估我们作为专家证人的界限。在这篇文章中，作者请罗伯特·l·萨多夫博士在当代伦理学的背景下评论戴蒙德博士的观点。
{"title":"From the Journal of Psychiatry & Law Archives: Bernard L. Diamond. M.D. on “The Psychiatrist as Advocate”","authors":"K. Weiss, R. Sadoff","doi":"10.1177/009318531204000204","DOIUrl":"https://doi.org/10.1177/009318531204000204","url":null,"abstract":"Dr. Bernard L. Diamond (1973) published the first article in the first issue of the Journal of Psychiatry & Law. Entitled “The Psychiatrist as Advocate,” it was a follow-up to his famous editorial, “The Fallacy of the Impartial Expert” (Diamond, 1959). Given the impossibility of total impartiality, the expert witness can still be ethical, but then undertake a form of activism. After nearly 40 years, we continue to reassess our boundaries as expert witnesses. In this article, the author has asked Dr. Robert L. Sadoff to comment on Dr. Diamond's ideas in the context of contemporary ethics.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"12 1","pages":"121 - 133"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81254656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000209
Christopher W Racine, S. Billick
Capacity to consent to informed treatment decisions is an often overlooked, yet tremendously critical, aspect of modern medical practice. Despite its importance, research has shown that clinicians often fail to identify patients who lack capacity. Currently, other than a clinical psychiatric consultation and evaluation, there is no standardized method for determining whether a patient has capacity to make treatment decisions. Cognitive scales, such as the MMSE, may inform capacity evaluations but are neither sensitive nor specific. Accordingly, various clinical instruments have been developed to aid in the determination of capacity to consent to treatment. This is a review of several of these instruments. While there is no convincing evidence for the use of a particular scale, the CQ and ACE are easy to administer and can be efficiently utilized by clinicians to inform capacity assessment. While more time consuming to administer and score, the MacCAT-T also provides a comprehensive evaluation of key capacity domains.
{"title":"Assessment Instruments of Decision-Making Capacity","authors":"Christopher W Racine, S. Billick","doi":"10.1177/009318531204000209","DOIUrl":"https://doi.org/10.1177/009318531204000209","url":null,"abstract":"Capacity to consent to informed treatment decisions is an often overlooked, yet tremendously critical, aspect of modern medical practice. Despite its importance, research has shown that clinicians often fail to identify patients who lack capacity. Currently, other than a clinical psychiatric consultation and evaluation, there is no standardized method for determining whether a patient has capacity to make treatment decisions. Cognitive scales, such as the MMSE, may inform capacity evaluations but are neither sensitive nor specific. Accordingly, various clinical instruments have been developed to aid in the determination of capacity to consent to treatment. This is a review of several of these instruments. While there is no convincing evidence for the use of a particular scale, the CQ and ACE are easy to administer and can be efficiently utilized by clinicians to inform capacity assessment. While more time consuming to administer and score, the MacCAT-T also provides a comprehensive evaluation of key capacity domains.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"95 1","pages":"243 - 263"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81528308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000205
R. Slovenko
The history of the hospitalization of persons with mental disorders has progressed in distinct stages over the course of the past two centuries. From Philippe Pinel's introduction of moral treatment principles, through the advent of professional psychiatry as a result of Sigmund Freud's innovations, through the move toward deinstitutionalization enabled by the discovery of new psychiatric medications, the groundwork was laid for the fourth and most recent of what can be seen as “revolutions” in institutional mental health care: the focus of both law and medicine on the parameters of the state's commitment power. This article addresses the function of the criminal procedure model in the context of civil commitment, its practical effects, and opportunities for continued reform.
{"title":"Criminal Law Standards in Civil Commitment","authors":"R. Slovenko","doi":"10.1177/009318531204000205","DOIUrl":"https://doi.org/10.1177/009318531204000205","url":null,"abstract":"The history of the hospitalization of persons with mental disorders has progressed in distinct stages over the course of the past two centuries. From Philippe Pinel's introduction of moral treatment principles, through the advent of professional psychiatry as a result of Sigmund Freud's innovations, through the move toward deinstitutionalization enabled by the discovery of new psychiatric medications, the groundwork was laid for the fourth and most recent of what can be seen as “revolutions” in institutional mental health care: the focus of both law and medicine on the parameters of the state's commitment power. This article addresses the function of the criminal procedure model in the context of civil commitment, its practical effects, and opportunities for continued reform.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"232 1","pages":"135 - 166"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78809224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000208
Zachary D. Torry, K. Weiss
Noncompliance with medication therapy and mental health care is prevalent among the mentally ill. Its multifactorial dynamics can include aspects of the illness itself, such as anosognosia. Noncompliance with medication can increase risk of violent or other criminal behavior, but the law currently does not recognize it as a factor in determining culpability. The legal test of insanity that focuses on a “defect of reason from disease of the mind” presumes that the disease was not self-induced. Noncompliance with medication and voluntary intoxication can both be seen as self-induced incapacities, but their adjudication is often quite different. A psychotic condition may be the basis of an excuse, whereas simple intoxication is not. The distinction is not only the obvious one of acts of omission (medication noncompliance) and acts of commission (voluntary intoxication). There are other complicating factors, such as the knowledge of the effects of noncompliance, the mental state prior to the noncompliance, and the presence of any conditions that would excuse or justify it. These and other considerations render the assignment of criminal responsibility for the noncompliant psychiatric offender complex. A possible solution to this would be the application of therapeutic jurisprudence to the noncompliant mentally ill offender.
{"title":"Medication Noncompliance and Criminal Responsibility: Is the Insanity Defense Legitimate?","authors":"Zachary D. Torry, K. Weiss","doi":"10.1177/009318531204000208","DOIUrl":"https://doi.org/10.1177/009318531204000208","url":null,"abstract":"Noncompliance with medication therapy and mental health care is prevalent among the mentally ill. Its multifactorial dynamics can include aspects of the illness itself, such as anosognosia. Noncompliance with medication can increase risk of violent or other criminal behavior, but the law currently does not recognize it as a factor in determining culpability. The legal test of insanity that focuses on a “defect of reason from disease of the mind” presumes that the disease was not self-induced. Noncompliance with medication and voluntary intoxication can both be seen as self-induced incapacities, but their adjudication is often quite different. A psychotic condition may be the basis of an excuse, whereas simple intoxication is not. The distinction is not only the obvious one of acts of omission (medication noncompliance) and acts of commission (voluntary intoxication). There are other complicating factors, such as the knowledge of the effects of noncompliance, the mental state prior to the noncompliance, and the presence of any conditions that would excuse or justify it. These and other considerations render the assignment of criminal responsibility for the noncompliant psychiatric offender complex. A possible solution to this would be the application of therapeutic jurisprudence to the noncompliant mentally ill offender.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"53 1","pages":"219 - 242"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89792486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2012-06-01DOI: 10.1177/009318531204000203
F. Dattilio
This brief essay provides a snapshot of forensic psychiatrist Robert L. Sadoff and how his life has reflected the exemplification of honesty and integrity in the field of forensic science.
{"title":"On Honesty and Integrity in Forensic Science: A Snapshot of Robert L. Sadoff, M.D.","authors":"F. Dattilio","doi":"10.1177/009318531204000203","DOIUrl":"https://doi.org/10.1177/009318531204000203","url":null,"abstract":"This brief essay provides a snapshot of forensic psychiatrist Robert L. Sadoff and how his life has reflected the exemplification of honesty and integrity in the field of forensic science.","PeriodicalId":83131,"journal":{"name":"The Journal of psychiatry & law","volume":"54 1","pages":"117 - 120"},"PeriodicalIF":0.0,"publicationDate":"2012-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80302933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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