From Reddit to manifestos: Forensic evaluation of incel online activity.

Forensic evaluators are increasingly called upon to review online collateral information, including social media posts, web forum posts, chat histories, and other sources such as manifestos. This information is especially vital when assessing members of a virtual community such as that of the involuntary celibate, or incel community. While this new wealth of information can add valuable context to the forensic assessment, it presents unique challenges for the evaluator including challenges with authenticity and interpretation. This article will present an approach to evaluations of such collateral, including a review of the relevant empirical research in this area and touch upon important areas to consider in the forensic evaluation of incel online activity.

Reproductive Decision-Making Capacity in Women With Psychiatric Illness: A Systematic Review.

BACKGROUND: Decision-making capacity can be affected by psychiatric illness. Women who have psychiatric illness who make decisions about their reproductive health may require evaluation of their decision-making capacity. OBJECTIVE: This article aims to characterize existing literature about capacity evaluations in women with psychiatric illness making reproductive decisions. METHODS: We conducted a systematic review searching PubMed, EMBASE, Ovid PsycINFO, and ClinicalTrials.gov databases through July 2020. Articles were evaluated for relevance to inclusion criteria, first by title and abstract screening then by reading the full text of articles. Our inclusion criteria were case reports and studies that involved women of childbearing age with psychiatric illness making obstetrical decisions for whom decision-making capacity was evaluated. We qualitatively analyzed our data by examining themes within the studies, such as the circumstances of the referral and characteristics of reproductive decision-making. We also collected information about the clinical circumstances, such as the clinical setting (e.g., inpatient or outpatient, in primarily psychiatric or obstetric care) and who made the determination of capacity. RESULTS: We identified 18 articles, which included 22 distinct patient cases and 27 distinct obstetrical decisions. Decisions about termination of pregnancy were most common, which were 10 of 27 decisions. Decisions about timing and mode of delivery accounted for 7 and 5 decisions, respectively. The most common psychiatric diagnosis reported was schizophrenia, which was present in 8 patients. Major depression and bipolar disorder were also frequently reported, present in 3 and 5 patients, respectively. CONCLUSION: Patients who make health care decisions must have decision-making capacity. A patient with psychiatric illness does not inherently lack capacity, and in fact, most patients with psychiatric illness have decision-making capacity. Psychiatric illness, however, can add complexity to obstetrical medical decision-making. Reasons for this complexity include the involvement of many stakeholders, the often time-sensitive nature of these decisions, and the potentially unpredictable course of psychiatric illness. Successful management of these cases involves multidisciplinary collaboration, the use of preventative ethics through advanced care planning, and identification of a guardian or surrogate decision-maker when a patient is determined to lack decision-making capacity or for a patient who has capacity through advanced care planning. PROSPERO REGISTRATION NUMBER: CRD42020143434.

Fatality Review and the Role of the Forensic Psychiatrist.

Multidisciplinary Fatality Review teams have operated for decades in the United States and across the developed world. Goals of these teams include examining individual deaths in the community to determine preventability and to make recommendations for future prevention. Fatality Review teams initially focused on child deaths but have expanded to include deaths from domestic violence, elder abuse, overdose, and maternal mortality. Case reviews include data from various agencies that have had contact with victims and perpetrators prior to the deaths. Cause of death and preventability are analyzed. Preventable deaths often include those with risk from mental illness or addiction. Recommendations made by Fatality Review teams have led to important changes for mental health services and prevention, including the Safe Haven laws for neonaticide prevention, suicide and homicide prevention, child murder prevention, firearm laws, and domestic violence screening. Fatality Review teams, which already include law enforcement and forensic pathologists, can benefit from collaboration with forensic psychiatrists because of their specialized knowledge about the intersection of mental illness and violence, should forensic psychiatrists have an opportunity to join them.

Physicians, the Spanish Inquisition, and Commonalities With Forensic Psychiatry.

The Spanish Inquisition was founded in 1478 by the Catholic monarchs and operated with the goal of controlling heresy in society. Religion was omnipresent, and Jewish conversos (Jews who had converted to Christianity) who continued to observe Jewish practices were many of the accused. In cases in which the defendant was thought to have mental illness, the Inquisition's physicians were to evaluate the person and provide reports and expert evidence. Those defendants who were found to have genuine mental illness were generally freed or transferred to specific hospitals for those with mental illness. Case examples elucidate the methods used by the Spanish Inquisition physicians to differentiate mental illness from malingering and heresy. Physicians also treated inmates and participated in evaluations regarding the appropriateness of torture. Understanding the events of the Spanish Inquisition and the role of physicians holds relevance for contemporary forensic psychiatry.

Comic Books, Dr. Wertham, and the Villains of Forensic Psychiatry.

Comic books have been part of popular culture since the 1930s. Social activists quickly became concerned about the risk that comic books posed for youth, including that their content was a cause of juvenile delinquency. Dr. Fredric Wertham, a forensic psychiatrist, led efforts to protect society's children from comic books, culminating in multiple publications, symposia, and testimony before a Senate subcommittee on juvenile delinquency in 1954. During the course of his activities, and quite possibly as a backlash, comics started to represent psychiatrists and particularly forensic psychiatrists as evil, clueless, and narcissistic characters (e.g., Dr. Hugo Strange went from being a mad scientist to a mad psychiatrist). Clinical forensic psychiatrists who were not necessarily evil were often portrayed as inept regarding rehabilitation. There are very few positive portrayals of forensic psychiatrists in the comic book universe, and when they do occur, they often have severe character flaws or a checkered history. These negative characterizations are woven into the fabric of contemporary comic book characters, whether represented in comic books or other media offshoots such as films and television.

Brief Report. A qualitative study of maternal mental health services in New Zealand: Perspectives of Maori and Pacific mothers and midwives.

OBJECTIVES: Suicide is the leading cause of maternal death in New Zealand particularly amongst Maori and Pacific. We explored current maternal mental health (MMH) screening practices and supports. METHODS: Qualitative research included interviews and focus groups with maternity carers and mothers of Maori and Pacific descent. Thematic analysis used a general inductive approach. RESULTS: Both mothers and carers reported that MMH screening is ad hoc and discussed multilevel barriers that hamper screening and access to supports. CONCLUSION: There are gaps in MMH services, and service improvements need to be targeted at patient, provider, and systems levels.

Maternal and Fetal Outcomes After Lamotrigine Use in Pregnancy: A Retrospective Analysis from an Urban Maternal Mental Health Centre in New Zealand.

INTRODUCTION: Pregnancy is a vulnerable period for recurrence of bipolar disorder. Discontinuation of mood stabilisers during pregnancy and the postpartum period can significantly increase the risk of recurrence of bipolar disorder. Lamotrigine is an anti-epileptic drug that has been approved for the maintenance treatment of bipolar disorder. Epilepsy literature has indicated that lamotrigine has a reassuring safety profile in pregnancy but there is little information on its effectiveness and safety in pregnant women with mental disorders. METHOD: We conducted a retrospective review of all pregnant women who presented to an urban maternal mental health centre in Auckland, New Zealand between 2012 and 2014 and were treated with antipsychotics and/or mood stabilisers. Pregnancy outcome, obstetric and perinatal complications, congenital malformations and maternal mental health in the postnatal period were considered. RESULTS: Here, we present the outcomes in the subset of six women who were treated with lamotrigine 100-400 mg/day for the entire pregnancy. Five were diagnosed with bipolar disorder and one with major depression. Three women received additional psychotropic medication during pregnancy. No women needed psychiatric hospitalisation. All babies were live birth after 36 weeks gestation. Two babies had low birth weight and required NICU admissions. Two women required lower segment caesarean section and the other 4 were induced. A trachea-esophageal fistula was noted in one baby. Four babies who were breastfed while their mothers received uninterrupted treatment with lamotrigine, experienced no complications. DISCUSSION: This naturalistic study indicates that lamotrigine can be an effective treatment option for maintenance of bipolar illness in women of childbearing age.

Late-life homicide-suicide: a national case series in New Zealand.

Homicide-suicide is a rare event, but it has a significant impact on the family and community of the perpetrator and victim(s). The phenomenon of late-life homicide-suicide has not been previously studied in New Zealand, and there is only limited data in the international literature. The aim of this study is to systematically review coroners' records of late-life homicide-suicides in New Zealand. After ethics approval was granted, the Coronial Services of New Zealand was approached to provide records of all closed cases with a suicide verdict (age 65+) over a five-year period (July 2007-December 2012). Of the 225 suicides, 4 cases of homicide-suicide were identified (an estimated incidence of 0.12 per 100,000 per persons year). All four perpetrators were men; three had been farmers. Their ages ranged from 65 to 82. One case occurred in the context of an underlying psychiatric illness (psychotic depression in bipolar disorder). Firearms were used in three cases. Two cases were categorized as spousal/consortial subtype, one case as filicide-suicide, and one case as siblicide-suicide. The prospect of major social upheaval in the form of losing their homes was present in all four cases. The findings of this case series were consistent with the limited existing literature on homicide-suicide. Age-related biopsychosocial issues were highlighted in this case series of late-life homicide-suicide. Additionally, evaluating firearm licences in high-risk groups may represent a prevention strategy.

Atypical antipsychotic use and outcomes in an urban maternal mental health service.

Objective Despite many women suffering from psychosis in their childbearing years, limited data exist about the use of atypical antipsychotic agents in pregnancy. Atypical antipsychotic agents are often used to treat bipolar disorder, instead of lithium or valproate because of the known teratogenicity of those agents. As well, atypical antipsychotics are often prescribed in anxiety disorders and depression. This study sought to describe pregnancy outcomes for women prescribed atypical antipsychotics during pregnancy. Methods This retrospective review included all cases treated by Auckland Maternal Mental Health services in which atypical antipsychotic agents were utilized during pregnancy over three years. Results Over the three years, 45 pregnant women were prescribed atypical antipsychotic agents, most commonly quetiapine or olanzapine. Two-fifths (40%) were diagnosed with bipolar disorder and almost one-third (31%) with a psychotic disorder. Two-thirds (64%) were prescribed multiple psychotropic medications during their pregnancy. Instrumental delivery rates were elevated at 38%. A minority (13%) of the women developed gestational diabetes mellitus. Although 7% of infants were born premature, all were born after 35 weeks. Two major malformations were noted, similar to baseline community rates. Conclusions This naturalistic study adds to the limited literature about treatment with atypical antipsychotic agents in pregnancy, though not adequately powered to detect small differences in malformations or obstetrical outcomes. It also highlights the myriad of indications for which pregnant women are prescribed atypical antipsychotics, and the multiple other risk factors seen in this population.

The Homicide-Suicide Phenomenon: Findings of Psychological Autopsies.

Homicide-suicide represents a single episode of violence which may decimate an entire family. This study aimed to further describe motives and context of these tragedies. Psychological autopsies were completed for 18 homicide-suicide cases in Dallas, Texas. This included postevent interviews with surviving family members and review of police and coroner records. Two-thirds of perpetrators had made either verbal or written threats prior to the homicide-suicide. A simplified typology describing victim-perpetrator relationship and motive type is suggested for future studies and clinical ease. Two-thirds of perpetrators fell into the category of Intimate-Possessive, most of whom were depressed men who were abusing substances and undergoing separation. Additional categories included Intimate-Ailing, Filial-Revenge, Familial-Psychotic, and Friend-Psychotic. Further, implications from this psychological autopsy study regarding risk assessment include use of collateral interviews regarding threats and past violence.

Delivering perinatal psychiatric services in the neonatal intensive care unit.

AIM: To describe characteristics of mothers who would likely benefit from on-site short-term psychiatric services while their infant is in the neonatal intensive care unit (NICU). METHODS: For 150 consecutive mothers who were referred for psychiatric evaluation and psychotherapeutic intervention in an innovative NICU mental health programme, baseline information was collected. Data regarding their referrals, diagnosis, treatments and infants were analysed. RESULTS: Most mothers were referred because of depression (43%), anxiety (44%) and/or difficulty coping with their infant's medical problems and hospitalization (60%). Mothers of VLBW infants were disproportionately more likely to be referred. A majority of mothers accepted the referral and were treated; most only required short-term psychotherapy. A minority resisted or refused psychiatric assessment; a quarter of these had more difficult interactions with staff or inappropriate behaviours. In these cases, the role of the psychiatrist was to work with staff to promote healthy interactions and to foster maternal-infant bonding. CONCLUSION: Overall, on-site psychiatric services have been accepted by a majority of referred NICU mothers, and most did not require long-term treatment. A considerable need exists for psychiatric services in the NICU to promote optimal parenting and interactions.

Commentary: postpartum psychosis, infanticide, and insanity--implications for forensic psychiatry.

Two dozen nations have infanticide laws that decrease the penalty for mothers who kill their children of up to one year of age. The United States does not have such a law, but mentally ill mothers may plead not guilty by reason of insanity. As in other crimes, in addition to the diagnosis of a mental disorder, other factors, such as knowledge of wrongfulness and motive, are critical to the assessment. Postpartum psychosis has been described for 2,000 years and modern science supports a genetic component to the risk. Yet, the Diagnostic and Statistical Manual of Mental Disorders does not include it as a diagnosis, leading to difficulty in testimony. In this article, we discuss postpartum psychosis, infanticide law, and research regarding mothers who kill, and we make recommendations to forensic psychiatrists.

Cómo prevenir el filicidio materno / Mothers who kill: perspectives on the act and its prevention

El tema del filicidio materno siempre provoca una fuerte respuesta emocional. Ya sea que genere sentimientos de simpatía o de rechazo, en la mayoría queda el interrogante de por qué las madres se ven impulsadas a matar a sus propios hijos y qué se puede hacer para evitar estos crímenes. Este artículo se centrará en las características de las madres que cometen actos filicidas. Consideraremos el papel de la madre en la historia del filicidio. En un intento por aclarar los rasgos comunes entre las madres filicidas, se revisará la literatura reciente. Además, compararemos la investigación sobre las madres que matan a sus hijos con aquella de sus análogos masculinos. Por último, ofreceremos sugerencias que ayuden a la prevención de actos filicidas futuros.

The topic of maternal filicide inevitably provokes a strong emotional response. Whether it engenders feelings ofsympathy or disgust, most people are left wondering whymothers may be driven to kill their own children and whatcan be done to prevent these crimes. This article will focuson characteristics of mothers who commit filicidal acts.Women’s role in the history of filicide will be considered.In an attempt to clarify traits common among filicidal mothers, the recent literature will be reviewed. Inaddition, research on mothers who kill their children will be compared to that of their male counterparts. Finally, suggestions will be offered to assist in the prevention offuture filicidal acts.

Child murder by mothers: patterns and prevention.

The tragedy of maternal filicide, or child murder by mothers, has occurred throughout history and throughout the world. This review of the research literature sought to identify common predictors in the general population as well as in correctional and psychiatric samples. Further research is needed to improve identification of children and mothers at risk. Infanticide laws are discussed. Suggestions for prevention are made based on the current literature and the authors' experiences.

Filicide-suicide: common factors in parents who kill their children and themselves.

The purpose of this phenomenological study was to identify commonly occurring factors in filicide-suicide offenders, to describe this phenomenon better, and ultimately to enhance prevention of child murder. Thirty families' files from a county coroner's office were reviewed for commonly occurring factors in cases of filicide-suicide. Parental motives for filicide-suicide included altruistic and acutely psychotic motives. Twice as many fathers as mothers committed filicide-suicide during the study period, and older children were more often victims than infants. Records indicated that parents frequently showed evidence of depression or psychosis and had prior mental health care. The data support the hypothesis that traditional risk factors for violence appear different from commonly occurring factors in filicide-suicide. This descriptive study represents a step toward understanding filicide-suicide risk.