Mental Disorders, Personality Traits, and Grievance-Fueled Targeted Violence: The Evidence Base and Implications for Research and Practice.

This article aims to move away from intuitive appeals that link mental disorder with violence such as terrorism, mass murder, and other targeted violence. The article synthesizes the existing evidence base regarding the relationship between mental disorders and personality traits and (a) attitudinal affinities with violent causes, and (b) a number of violent behaviors (including mass murder and terrorism). The evidence base is mixed and the research focus changed across time: from simple and unempirical assertions of causation to an almost complete rejection of their presence to a finer grained and disaggregated understanding. Empirical research examining mental disorder in crime and violence highlights that the commission of such events is a complex synthesis of psychopathology, personal circumstance, and environment. The article concludes with several suggestions regarding future research and practice.

Targeted violence against law enforcement officers.

As highly visible representatives and guardians of society, law enforcement officers (LEOs) are very public figures. Injury or death in the line of duty, whether due to accidents or intentional acts of violence, is an occupational hazard for LEOs. Targeted assaults on police officers, referred to as ambushes in previous literature, are a particularly perplexing problem with significant implications for society at large. In the summer of 2016, the latest in a series of high-profile acts of violence aimed at police occurred, leading to increased examination of the acts themselves and their causes. This article examines recent trends in assaults on LEOs, focusing on predatory rather than reactive attacks, and applies a threat assessment model to a case of targeted violence against police. We use State of Washington v. Christopher Monfort (2015), a prosecution for arson, assault with intent to murder, and murder, as a case example, to examine how the threat assessment model, and the concepts of affective versus predatory violence help in understanding targeted violence against LEOs, assessing its risk, and managing it. Copyright © 2016 John Wiley & Sons, Ltd.

Psychiatric consultation in problem employee situations.

This article focuses on psychiatric consultation in "problem employee situations," a broad term that refers to any situation in which there is conflict between an employee and the employer or coworkers. It summarizes key principles and observations that are common to psychiatric consultations in the workplace and then offers case examples that are representative of such consultations and highlights those principles. Although the focus is on psychiatric consultation to employers, an employee may seek consultation himself or herself, especially when prospects for adversarial proceedings arise. The principles described here apply in both sets of circumstances.

Terrorism and the behavioral sciences.

Terrorism has existed for millennia and is a phenomenon well-known to many parts of the world. Americans were forced to recognize this phenomenon, and our vulnerability to it, by two sets of events in 2001: the attacks on New York City and Washington, DC, and the anthrax mailings that followed shortly thereafter. Psychiatry, psychology, and other behavioral and social sciences have been looked to for assistance in collecting and analyzing intelligence data, understanding terrorism, and developing strategies to combat terrorism. In addition to reviewing areas in which the behavioral sciences have made contributions in addressing this problem, this article discusses the developing roles for behavioral scientists in this field.

An approach to selected legal issues: confidentiality, mandatory reporting, abuse and neglect, informed consent, capacity decisions, boundary issues, and malpractice claims.

Medical practice occurs within a legal and regulatory context. This article covers several of the legal issues that frequently arise in the general medical setting. While this article provides an overview of approaches to informed consent, boundary issues, and malpractice claims, it is critical for clinicians to be familiar with the specific requirements and standards in the jurisdictions in which they practice. As a general rule, it is most important that physicians recognize that the best way to avoid legal problems is to be aware of legal requirements in the jurisdictions in which they practice, but to think clinically and not legally in the provision of consistent and sound clinical care to their patients.

Assessment of occupational impairment and disability from depression.

OBJECTIVE: Examination of the relationship of impairment to disability in the work psychiatry context and identification of practical strategies for occupational physicians to apply to screening, management, and appropriate referral. METHODS: Medical literature review. RESULTS: The determination and differentiation of impairment and disability is a complex psychiatric task which requires consideration of the type of employment, assessment of depression-related functional impairments that can create disability for a particular occupation, and individual factors. CONCLUSIONS: The authors propose a new and more consistent strategy for identifying impairment severity and its impact on employment, including simple procedures to screen for depression and guidelines to minimize role and boundary confusion.

Legal concerns in psychosomatic medicine.

In the practice of psychosomatic medicine, the psychiatric consultant is likely to be confronted with questions at the interface of psychiatry and law. These issues generally emerge around questions of confidentiality and exceptions to confidentiality, assessments of a patient's ability to consent to and refuse treatment, and concerns about malpractice liability. Overall, psychiatrists should approach the care of patients clinically, while understanding the applicable laws and regulations of the jurisdictions in which they practice. In addition, clinicians should be aware of the legal and risk management resources available to them should a complex situation arise. Finally, the psychiatric consultant should make use of consultation when complex issues emerge at the interface of psychiatry and law.

Commentary: Psychiatric advance directives as tools for enhancing treatment of the mentally ill.

In this issue of the Journal, Swanson et al. explore the demand for and utilization of psychiatric advance directives (PADs), and discuss some of the barriers to their greater acceptance. This author suggests that PADs may be more widely accepted and utilized if they are viewed as tools for maximizing individual autonomy, with an emphasis on optimizing rather than merely restricting care.

Community response to disaster: the role of the workplace.

Disasters, natural and man-made, have a considerable impact on communities. Most recently, disasters stemming from terrorist attacks have become a leading cause of concern. The importance of work in the lives of employees, coupled with the vulnerability of workplaces as potential targets of terrorist attacks, suggests that workplaces can and should play a role in planning for, and responding to, disasters. This article addresses the role of the workplace in disasters, with an emphasis on the psychological impact of such events, by drawing upon experience and literature related to workplace violence and to other traumatic events in the workplace.

Compensation for victims of trauma in the United States.

The awarding of damages in civil litigation is a basic element of the civil justice system in the United States. The system is not free of problems and controversy. Cases in which Posttraumatic Stress Disorder (PTSD) is the basis for a claim of damages pose specific problems in quantifying the harm done and attributing causation. This paper will provide an overview of the American civil litigation system and address some of the challenges confronted when PTSD and other emotional distress claims are made. In addition, it will discuss alternative methods for compensating victims of trauma that do not utilize the traditional civil litigation system.