A comparison of focused and standard cognitive therapy for panic disorder

A set of measures assessing abilities related to legal standards for competence in the adjudicative process were administered to mentally-disordered criminal defendants with diagnoses of schizophrenia, affective disorder, other psychiatric disorders, and to criminal defendants without diagnosed mental disorder. Mentally-disordered defendants were recruited from two groups: those who had been committed for restoration of competence and those who had been identified by jail personnel as mentally ill. Significant impairments in competence-related abilities were found for approximately half of the defendants with schizophrenia. Defendants with schizophrenia scored lower on measures of understanding, reasoning, and appreciation related to the adjudication process. The association between symptoms and competence-related abilities was explored within diagnostic groups. Conceptual disorganization was found to be inversely correlated with performance on all measures in both defendants with schizophrenia and those with affective disorders. For other psychotic symptoms, differing patterns of correlations were found in the two major diagnostic groups. The implications for policy designed to safeguard the rights of defendants to be tried while competent are discussed.     

Social psychology and plea bargaining: Applications, methodology, and theory.

Conducted 2 experiments with male undergraduates to investigate the plea bargaining process. Exp I (143 Ss) used a role-playing procedure to identify variables that affect the acceptance of a plea bargain. 18% of the Ss playing the role of innocent defendants accepted the plea bargain, whereas 83% of the guilty defendants accepted. Two other main effects revealed that defendants were more likely to accept a plea bargain when relatively many charges had been filed against them and/or when the severity of punishment upon conviction was great, although internal analyses revealed that these effects were present in guilty defendants only. Exp II (18 Ss) was conducted using involved participants to provide validation for the major result of Exp I. Ss were made to be innocent or guilty of having prior information about an exam. All were accused of having used prior information and were given an opportuinity to plea bargain rather than face an ethics committee. In accord with Exp I, guilty Ss accepted the plea bargain significantly more often than innocent students. Results are discussed in terms of information differences between innocent and guilty defendants and the availability heuristic. (21 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A comparison of clinical and structured interview diagnoses in a homeless mental health clinic

OBJECTIVE: This study compared psychiatric diagnoses ascertained by independent clinicians with structured research interviews of homeless psychiatric patients assessed in a mental health clinic and in the community. Problems of both overdiagnosis and underdiagnosis in structured research interviews compared to clinician assessment were predicted. METHOD: Over a period of a year, 97 patients referred to a mental health clinic for homeless people were assessed with the Diagnostic Interview Schedule (DIS) administered by a clinical social worker who then completed a full clinical psychiatric social work assessment. These same patients received a thorough and systematic clinical psychiatric evaluation by a psychiatrist or psychologist, both experienced with this population. These clinicians gathered data from multiple sources, often with extended observation over time. The DIS and clinician diagnoses were made blind to one another and then compared; the clinician was often made aware of some of the symptoms that the social worker had elicited, but not whether the elicited material was from the DIS or from the clinical assessment. Diagnoses of 33 clinic patients previously assessed by trained nonclinician DIS interviews in an epidemiologic study of the homeless population in the community were also compared to clinician diagnoses, and no information from these patients' survey DIS interviews was made available to the clinicians. RESULTS: Compared to clinician assessment, structured interviews underdiagnosed antisocial personality disorder (ASPD) and overdiagnosed major depression. Alcohol use disorder and schizophrenia showed only small discrepancies by assessment method. Drug use disorder revealed no bias according to method of ascertainment, but showed very discrepant kappa levels comparing DIS to clinician assessment in the two different comparison contexts. CONCLUSIONS: If structured research methods assessing the homeless population actually overestimate depression, underestimate ASPD, and misclassify drug abuse, then policies stemming from structured interview research recommendations may call for levels and types of services not optimally suited to the reality of this population's needs. Because mental illness and substance abuse are thought to be critical factors in the generation and perpetuation of homelessness, the issue of accurate diagnosis is tantamount to understanding and providing workable solutions to the problem of homelessness. Further research is needed to untangle potential confounders of the homeless situation to psychiatric diagnosis.     

A meta-analytic review of competency to stand trial research.

The present study is a meta-analysis of competency to stand trial research. One meta-analysis was previously conducted in this area, but the large number of empirical studies that have been conducted since and the introduction of new instruments and revision of old instruments warranted updating and expanding upon the previously conducted study via contemporary meta-analytic methods. We meta-analyzed 68 studies published between 1967 and 2008 that compared competent and incompetent defendants on a number of demographic, psychiatric, and criminological variables. Categorical and continuous variables commonly investigated in competency research were coded and aggregated to generate cumulative effect sizes in the form of odds ratios and Cohen's d statistics, and moderation was tested via meta-F and meta-regression analyses. The most robust findings were that defendants diagnosed with a Psychotic Disorder were approximately eight times more likely to be found incompetent than defendants without a Psychotic Disorder diagnosis and the likelihood of being found incompetent was approximately double for unemployed defendants as compared to employed defendants. The likelihood of being found incompetent was also double for defendants with a previous psychiatric hospitalization compared to those without a hospitalization history. Comparative data on 12 competency assessment instruments and three traditional instruments were also explored and the effect sizes associated with the competency measures were substantially larger (i.e., approximately one Cohen's d-point) than those for the traditional measures. Limitations of the primary research and the previous and present meta-analyses are presented and future directions in this area are outlined. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Denied pregnancy

OBJECTIVE: To review the literature on the topic of denied pregnancy and present a case study that illustrates some salient points. CLINICAL PICTURE: A 21-year-old woman was unaware of her pregnancy until she went into labour, at which time she went into a state of panic. She delivered a dead baby. TREATMENT: She was interviewed over the 5 days following delivery and referred for psychiatric assessment. She was discharged when cleared of serious psychiatric illness. OUTCOME: At follow-up she was well but haunted by recollections of the delivery. She was referred for further counselling. CONCLUSIONS: Denial of pregnancy is more common than realised. It is a heterogeneous condition associated with different coping styles and psychiatric diagnoses. Early testing for pregnancy is recommended in young women with nausea, weight gain and menstruation-like bleeding.     

Extraction of carboxylic acids as adducts with trioctylphosphine oxide

Simulated jurors were asked to render judgements in a case involving either a violent or a nonviolent armed robbery. The defendent either did or did not have a stated history or previous psychiatric hospitalization. The former mental patient received fewer guilty verdicts than did the nonhospitalized defendant in the nonviolent robbery condition, while no difference existed in the violent robbery condition. It was predicted that, relative to the nonhospitalized defendant, subjects would be more punitive when the former mental patient was judged guilty of the violent crime than when he was judged guilty of the nonviolent robbery. This prediction was confirmed only for male subjects. The data suggest that while males responded in terms of conventional stereotypes about the mentally ill, females did not. Results are discussed in terms of attribution of responsibility and fear reactions toward the mentally ill.     

On the decision to testify in one's own behalf: Effects of withheld evidence, defendant's sexual preferences, and juror dogmatism on juridic decisions.

360 undergraduates high or low in dogmatism served as members of 6-person juries that assessed the culpability of a homosexual or heterosexual defendant in a murder trial. Defendants either (a) invoked the 5th Amendment in response to specific crime-relevant interrogation, (b) invoked the 5th Amendment by opting not to take the witness stand, or (c) took the stand and provided substantive answers for all crime-relevant interrogation. Results indicate that defendants who invoked the 5th Amendment (either on the stand or by declining to take the stand) were judged more likely to be guilty and more deserving of conviction than their counterparts who took the stand and answered all questions. As anticipated, juror dogmatism interacted with the defendant's sexual preferences to affect juridic decisions. However, the form of these interactions were contrary to expectations: High dogmatic jurors were no more punitive toward homosexual than heterosexual defendants, whereas jurors low in dogmatism were actually more lenient toward homosexual than heterosexual defendants. An explanation for the leniency of nondogmatic jurors toward homosexual defendants is proposed, and some implications of this line of reasoning for future research are discussed. (20 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The competence of adolescents as trial defendants.

The significance of adolescents' capacities as defendants has increased as a consequence of new laws that promote the transfer of juveniles for trial in criminal court. Basic and applied developmental research is reviewed to examine evidence for adolescents' capacities to participate as defendants in their criminal court trials (defined in law as competence to stand trial). Research is reviewed in 4 areas: (a) adolescents' understanding of the legal process; (b) their appreciation of the significance of legal circumstances for their defense; (c) their ability to communicate information to counsel; and (d) their reasoning and judgment in making decisions as defendants. The results suggest a greater risk of impairments in trial competence abilities for adolescents than for adults. Possible ways to respond to adolescents who are less prepared to participate in trials are offered. Tentative recommendations are made for policy and law that would increase protections against trying adolescents in criminal court when their trial competence is impaired. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

An investigation of competency to participate in legal proceedings in Canada

OBJECTIVE: To assess fitness to stand trial, competency to plead guilty, and competency to understand Charter cautions to determine if the level of competency varies across these domains. METHODS: The Fitness Interview Test-Revised (FIT-R) and the Test of Charter Comprehension (ToCC) were administered to a group of individuals held on remand for fitness evaluations. Additionally, several questions from the FIT-R that address the ability to make a guilty plea were assessed separately and constituted an individual measure of competency to plead guilty (CoP). RESULTS: As predicted, the results indicated that the fact that an individual is competent at one juncture in the criminal proceedings does not mean that the individual necessarily is competent at all other stages of the proceedings. CONCLUSIONS: These findings suggest a need for a stage-specific approach to forensic competency assessments, requiring specialized instruments designed to assess the legal issues of competency at the various stages of legal proceedings.     

A Recent Court Experience.

Because of the recent interest in the testimony of the psychologist as an expert witness, I would like to share a recent court experience with APA members. A patient murdered his estranged wife during the time he was being evaluated for treatment at the Hamm Memorial Psychiatric Clinic, a privately endowed community clinic. He was seen once in May, 1955, by the psychiatric social worker and the psychiatrist; but he did not return until November of the same year, at which time he again saw the psychiatrist, who referred him to me for psychological evaluation. Eight days after I saw him, he shot and killed his wife. The entire psychiatric team was subpoenaed by the defense attorney to testify in the Ramsey County District Court as to the patient's mental condition prior to and at the time of the murder. In addition, the defense attorney requested that the psychiatrist, as well as myself, evaluate him in the jail as to his mental condition subsequent to the murder. The first professional member called to the witness stand was the psychiatric social worker, who was questioned rather briefly as to her impressions of the defendant at the time he was first referred. I was called to testify immediately afterwards and was subjected to questioning and cross-examination for a five-hour period. One hour was spent in qualifying me as an expert in terms of education, experience, academic appointments, and the like. The remainder of the time was devoted to an analysis of the psychological tests, as well as my clinical opinions as to the psychological condition of the patient. No attempt was made by the prosecuting attorney to harass me personally, although he would occasionally intersperse such comments as, "You are not a qualified psychiatrist, are you?" or, "You do not have an MD degree, is that right?" At the same time, he did not raise objections when the defense attorney asked for my diagnostic impression or opinion as to whether or not the patient knew right from wrong at the time of the shooting. Following my testimony, the psychiatrist was called to the witness chair and gave essentially the same picture based on his evaluation of the patient. The jury deliberated six hours and the defendant was found guilty of murder in the first degree which carries a mandatory sentence of life imprisonment. An informal polling of the jurors after the trial by the attorney for the defense revealed that the jury at no time questioned my expertness and fully accepted me as a professional member of the community. The majority agreed that the patient was psychotic but apparently did not feel he was insane. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinician Variation in Rates of Legal Sanity Opinions: Implications for Self-Monitoring.

How often do forensic psychologists find that a defendant meets criteria for legal sanity? Do clinicians vary in terms of how frequently they offer opinions supportive of insanity? If so, how might a conscientious clinician determine whether unusually high or low rates of insanity opinions reflect bias? The authors present the first available data regarding how individual clinicians vary in rates of insanity opinions, drawing from 59 clinicians who conducted 4,498 evaluations. Most clinicians found 5%-25% of defendants met criteria for legal insanity. However, some clinicians opined that no defendants met criteria for legal insanity, whereas others opined that as many as 50% of defendants did. The authors (a) provide suggestions to help practicing clinical-forensic psychologists monitor their patterns of psycho-legal opinions and (b) examine carefully whether unusual rates may reflect clinician bias. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Punished, dead or alive: Empirical perspectives on awarding punitive damages against deceased defendants.

Punitive damages are a tool for punishing defendants who engage in reckless and wanton behaviors that cause injury to others. As with criminal punishment, goals of punitive damages include retribution, specific deterrence, and general deterrence. Unlike criminal punishment, however, some courts allow punitive damages to follow the death of defendants. To explore this issue, we first conducted a legal analysis of appellate court decisions concerning punitive damages against deceased defendants. While the majority of courts suggest that punitive damages against deceased individuals are not appropriate, some argue that favorable policy implications of allowing punitive damages to follow the defendant's death merit their survivability. Next, we conducted a simulation study to investigate the effects of defendant injury severity, including death, on juror decisions in a punitive damages case. Consistent with some judicial reasoning, mock jurors' liability and damage awards were not influenced by a defendant's injury severity, but defendant death did influence participants' self-reported goals of their punitive damage awards. We conclude with a discussion of policy and research implications. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The effects of juror anonymity on jury verdicts

This study examined the effects of anonymity on jurors' verdicts and on jurors' feelings of accountability for their jury's verdicts. Twenty four-person anonymous juries and 20 four-person nonanonymous juries rendered individual and group verdicts for three student defendants charged with selling drugs on a school campus. When unanimous guilty verdicts were reached, juries imposed one of five punishments. Finally, jurors completed postdeliberation opinion and accountability questionnaires. As predicted, anonymous juries showed a higher rate of conviction (70%) than did nonanonymous juries (40%) when the evidence against the defendant was strong, supporting the hypothesis that anonymity would have a greater effect for situations in which there was relatively strong evidence of the defendant's guilt. Anonymous juries imposed the harshest punishment (expulsion) significantly more often than did nonanonymous juries. Contrary to predictions from differential self-awareness theory, anonymous juries did not report feeling less accountable than did nonanonymous juries. However, anonymous juries did see the process as significantly more fair than did identifiable juries.     

Assessing mental retardation in death penalty cases: Critical issues for psychology and psychological practice.

In 2002, the United States Supreme Court decided the Atkins case, which held that mentally retarded defendants could not be executed. The opinion gave no guidance on the definition of mental retardation, preferring to leave to individual states the task of determining not only the definition of mental retardation but also the assessment procedures to be used in making the diagnosis. This lack of guidance has resulted in many issues, including varying definitions of what constitutes mental retardation across states, use of different assessment procedures to make the determination that a person has mental retardation, and numerous psychometric concerns regarding the provision of psychological assessment services to the courts in capital cases that involve a defendant who may have mental retardation. This article examines these latter issues in detail from both psychological and legal perspectives and makes recommendations for practicing psychologists. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Determinations of participant and observer satisfaction with adversary and inquisitorial modes of adjudication.

To determine the reasons for previously reported greater satisfaction of defendants and observers with adversary vs single investigator inquisitorial procedures, 93 undergraduate males, who thought they were innocent, were tried under 1 of 4 procedures. 124 additional males and females served as observers. The procedures incorporated the 3 essential differences between the adversary and inquisitorial models: 2 attorneys rather than 1, attorney alignment with the defendant, and choice of attorney. All 3 factors were required to produce a significant increment in defendants' procedural satisfaction compared to the single investigator model. All 3 factors were also necessary to produce a significant increment in satisfaction with guilty verdicts. (Procedure did not affect evaluations of innocent verdicts.) Only number of attorneys produced a significant increase in observers' satisfaction with the procedure. Innocent verdicts produced more favorable procedure and verdict evaluations. Opportunity for evidence presentation is proposed as the mediator of adjudication evaluations. (29 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A multiregional study of nurses' beliefs and attitudes about work safety and patient assault

OBJECTIVE: The study attempted to increase understanding of nursing staff members' beliefs and concerns about work safety and patient assault. METHODS: A study conducted at a university-affiliated psychiatric facility in California in the late 1980s was replicated in five other psychiatric settings. Data were collected using the Attitudes Toward Patient Physical Assault Questionnaire, containing 31 statements designed to elicit nurses' beliefs about safety concerns, staff performance, and legal issues related to assaults. RESULTS: A total of 557 nursing staff members at the six sites responded to the questionnaire; 84 percent were female. The majority (76 percent) had been physically assaulted at least once, but 71 percent reported feeling safe in their work environment most of the time. Compared with female staff members, males tended to believe that assaults were to be expected, that assaulted staff have personality traits that make them vulnerable to assault, and that legal action against assaultive patients might jeopardize their jobs. Recently hired staff were more confident that their facilities did not admit unmanageable patients and that the environment was adequate to prevent assaults. Staff who had been assaulted more frequently tended to believe that assaults were to be expected. CONCLUSIONS: The study highlights a nationwide concern among nursing staff about safety. Ensuring a safe working environment requires better training, more adequate staffing, and a security plan to protect staff, patients, and others.     

Adjudicative competence: Evidence that impairment in “rational understanding” is taxonic.

In Dusky v. United States (1960), the U.S. Supreme Court articulated 3 abilities that determine a criminal defendant's competence to stand trial: He or she must be able to consult with counsel, have a factual understanding of the proceedings, and have a rational understanding of the proceedings. Although the legal determination of a defendant's competence involves a dichotomous judgment, the latent structures of the constructs that underlie the abilities articulated in Dusky are unknown. The current study focused on the rational understanding prong of the Dusky standard. We hypothesized that, whereas factual knowledge of the legal system and ability to assist counsel may fall on a continuum, plausible (i.e., rational) beliefs about legal proceedings may be dichotomous in nature. Taxometric analyses of the Appreciation scale of the MacArthur Competence Assessment Tool—Criminal Adjudication, with a sample of 721 defendants, provided support for a taxonic structure. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Timely delivery of biological therapy after cytoreductive nephrectomy in carefully selected patients with metastatic renal cell carcinoma

PURPOSE: We determine whether cytoreductive surgery delays or precludes the administration of systemic biological therapy in patients with previously untreated metastatic renal cell carcinoma. MATERIALS AND METHODS: We evaluated 79 patients 22 to 73 years old with untreated renal cell carcinoma for possible cytoreductive surgery before the administration of systemic biological therapy. Based on performance status, overall disease burden and subjective clinical assessment 13 patients were referred for initial systemic biological therapy and 66 underwent cytoreductive surgery as initial treatment. We evaluated patient ability to receive postoperative biological therapy, time to therapy, surgical complications and mortality. RESULTS: Cytoreductive surgery had a minimal impact on the administration of timely systemic biological therapy in these carefully selected patients. Of the 66 patients 54 (82%) received postoperative systemic biological therapy beginning a median of 40 days after nephrectomy. Two patients (3%) died postoperatively (within 30 days) and in 1 (1.5%) postoperative deterioration in performance status precluded the administration of systemic therapy. The other 9 patients did not have measurable residual disease postoperatively, did not need or refused systemic therapy, or were followed elsewhere. CONCLUSIONS: Systemic biological therapy can be administered in a timely manner (median 40 days) to the majority of patients (82% treated) after cytoreductive surgery. Surgery alone does not preclude the administration of systemic biological therapy in carefully selected patients.     

Involuntary medication, trial competence, and clinical dilemmas: Implications of Sell v. United States for psychological practice.

The recent U.S. Supreme Court decision in Sell v. United States (2003) raises a number of challenging issues for mental health professionals regarding the involuntary medication of individuals who are incompetent to stand trial. The authors examine the Sell decision, other relevant legal decisions, and research findings on coercion and procedural justice, and discuss the implications for mental health professionals involved in the treatment and assessment (both clinical and forensic) of defendants who may be affected by Sell. The authors conclude by proposing recommendations for mental health professionals working with defendants in Sell contexts. (PsycINFO Database Record (c) 2010 APA, all rights reserved)