The psychiatric expert witness.

The novice psychiatric expert witness undergoes intense scrutiny and enters an unfamiliar legal system. Caution must be taken to maintain professional integrity and avoid bias. Educating the court about matters pertaining to mental health is a critical function of the expert. Forming well-reasoned opinions that are communicated with clear language enhances this task. An expert who is both knowledgeable and well prepared will better serve the court, and is less likely to be intimidated by the adversarial process.

The detection of malingered psychosis.

The detection of malingered psychosis is sometimes quite difficult. The decision that an individual is malingering is made by assembling all of the clues from a thorough evaluation of a person's past and current functioning with corroboration from clinical records and other people. Identifying malingered psychosis will prevent unnecessary hospital admissions and is critical in forensic assessments. Indeed, clinicians bear considerable responsibility to assist society in differentiating true psychosis from malingered madness.

Legal issues in treating perpetrators and victims of violence.

Psychiatrists are faced increasingly with the difficult responsibility of evaluating perpetrators and victims of violence. The following guidelines will help the clinician avoid legal difficulty: 1. Become knowledgeable about your state statutes regarding civil commitment and duty to third parties. 2. Document thoroughly your risk assessment and the factors you considered in reaching your judgment. 3. Consider obtaining a second opinion in difficult cases. 4. Follow hospital policies regarding seclusion, restraints, and emergency medication of the patient. 5. Adhere to mandatory reporting requirements for victims of abuse.

Defrocking the fraud: the detection of malingering.

The purpose of this paper is to provide psychiatrists with practical advice on how to detect malingered mental illness. Various types of malingering are defined and the five major purposes of malingering are specified. The research literature on malingering is reviewed. Clinicians must be thoroughly grounded in the phenomenology of true mental disease to detect malingering. Detailed information about hallucinations is reviewed so that faked hallucinations that do not follow typical patterns can be more easily identified. Strategies for approaching persons suspected of malingering are suggested. Features of malingered mutism, mania, depression and mental retardation are described. The differential diagnosis of malingering, post-traumatic stress disorder, conversion disorder, and post-concussion syndromes after trauma is discussed. Clues to malingered psychoses and post-traumatic stress disorders are delineated. Finally, specific indicators of malingered insanity defenses are identified.

Proverb familiarity and the mental status examination.

Asking patients to interpret proverbs is a traditional method of assessing abstract thinking ability. Familiarity with a proverb increases the likelihood of interpreting it correctly. Differences in proverb familiarity among patients could lead clinicians to incorrectly conclude that a patient is thinking concretely, and thus to underestimate the patient's cognitive ability. Clinicians should be aware of this possibility when assessing patients from different racial and gender groups. The authors surveyed 229 Afro-American and 104 Caucasian high school students to determine their familiarity with 25 proverbs. Thirty-seven clinicians were also asked to rate their patients' familiarity with the same proverbs. The authors found no differences in proverb familiarity between the black and white students or the male and female students. Clinicians' beliefs about proverb familiarity in their patients were found to be inaccurate.

Child stealing by cesarean section: a psychiatric case report and review of the child stealing literature.

A highly unusual case of child stealing by cesarean section resulting in the death of the mother is presented. The judicial proceedings are summarized. The literature on the psychiatric status of perpetrators committing child stealing is presented. Two methods of psychiatrically categorizing these perpetrators are reviewed. The relevance of the literature to this and possible future cases is discussed.

Sexual attraction to corpses: a psychiatric review of necrophilia.

The authors review 122 cases (88 from the world literature and 34 unpublished cases) manifesting necrophilic acts or fantasies. They distinguish genuine necrophilia from pseudonecrophilia and classify true necrophilia into three types: necrophilic homicide, "regular" necrophilia, and necrophilic fantasy. Neither psychosis, mental retardation, nor sadism appears to be inherent in necrophilia. The most common motive for necrophilia is possession of an unresisting and unrejecting partner. Necrophiles often choose occupations that put them in contact with corpses. Some necrophiles who had occupational access to corpses committed homicide nevertheless. Psychodynamic themes, defense mechanisms, and treatment for this rare disorder are discussed.

Mutism, malingering, and competency to stand trial.

Mutism and mental illness have had a long-standing historical relationship with regard to the issue of competence to stand trial. This article reports a defendant who remained mute for 10 months and describes his use of the symptom of mutism in his malingering. Although mutism is frequently used by defendants for malingering, clinicians must have a high index of suspicion for the possibility. We recommend a comprehensive evaluation including neurologic workup, repeat interviews, observation of the defendant at unsuspected times for communicative speech with other inmates, study of handwriting sample, collateral nursing documentation, and, if necessary, Pentothal interviews to establish authenticity of mutism. The authors review the historical background and legal considerations of the relationship between mutism and malingering.

Posttraumatic stress disorder in murderers.

Three case histories of men who suffered posttraumatic stress disorders after committing homicides are presented. These men were relatively young and had chaotic childhoods and minimal criminal histories. Each had killed a woman with whom he had a significant but intensely turbulent emotional relationship. The killings all occurred during altered mental states that were unrelated to the use of drugs or alcohol. The clinical significance and some of the medicolegal implications of this phenomenon are discussed.

Perceptions of psychiatric testimony: a historical perspective on the hysterical invective.

This paper discusses the perceptions of psychiatric testimony by the public, lawyers, and psychiatrists. Five major criticisms are put into historical perspective: psychiatrists excuse sin; psychiatrists always disagree; psychiatrists give confusing, subjective, uninformed, jargon-ridden testimony; psychiatrists dictate the law; psychiatrists give conclusory opinions. Proposed solutions to these criticisms are analyzed.

A sexuality curriculum for gynecology residents.

PIP: A research project was conducted with the obstetrics and gynecology residents at University Hospitals of Cleveland in February 1976. The purpose was to provide residents with basic knowledge about female sexual problems, to assess the residents' skill and comfort in interviewing patients with sexual problems, to document the effects of supervision on interviewing skills, and to evolve a sexuality curriculum for residents in obstetrics and gynecology. 13 residents at various stages of training participated. The project's 5-1/2 hours were distributed over 2-1/2 weeks. 4 women were taught to respond as if they were patients with the following specific complaints: failure to develop sexual responsiveness, loss of responsiveness due to anger, loss of libido due to depression, and frustration becuase of an impotent husband. The sequence of activities was 1) required reading of a 2-page protocol for assessing a sexual complaint; 2) completion of a preinterview questionnaire which assessed comfort and skill measured on a 5-point scale, immediately followed by a 20-minute videotaped interview with the 1st patient; 3) reading of an article on female sexual dysfunction; 4) attendance at a 2-hour lecture on female sexual dysfunction and interviewing techniques; and 5) conduct of a 2nd, 3rd, and 4th interview over a 2-week period. Each interview was followed by a 45-minute session with the supervisor to view and discuss the videotape. As a group the residents' interviewing abilities failed to improve by the end of the program, as measured by total percentage of programmed content elicited; method of obtaining information, that is, direct or indirect questions; and style ratings. Recommendations are made concerning the educational needs of residents in obstetrics and gynecology.^ieng