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Biomedical subjects

R G Lande

Publications and source records attributed to R G Lande.

15 recordsLinked to original sources
PubMed1998

Disability law: problems and proposals.

BACKGROUND: Medically disabled persons have traditionally encountered obstacles when seeking and maintaining employment. Integration of the medically disabled worker is the goal of recent legislation that directs removal of physical barriers and protects disabled workers from discrimination. The major force driving this social policy is the Americans With Disabilities Act (ADA). METHODS: Current disability laws and related judicial opinions are reviewed. Primary attention is focused on the ADA. RESULTS: Legislation addressing employment discrimination has serious deficiencies. Medical support of this important social policy is hampered by vague statutory definitions and seemingly capricious judicial opinions. CONCLUSION: Disability laws require precise language identifying specific, qualifying medical conditions. The laws should require comprehensive medical assessment that objectively establishes a connection between a medical disorder and severe, sustained impairment. Some currently included conditions, such as personality disorders, should be considered for exclusion.

Disability Evaluation↗
PubMed1998

Forensic psychiatry in the United States military.

Members of the U.S. military and their families represent a unique subsection of the American culture. The U.S. Constitution, federal law, and military regulations establish guidance for the conduct of service members during peacetime and wartime. This same hierarchy of law and regulation sets forth the legal rights and directs the provision of medical care for service members and their families. The fact that the military population is concurrently subject to a body of military law, as well as to the broader guidelines of the civilian sector, creates distinct roles for the military forensic psychiatrist. An understanding of the medical and legal framework in which the military forensic psychiatrist operates will facilitate the interactions of the civilian expert witness with the military justice system. In this report, the legal issues most relevant to the practice of forensic psychiatry in the military are discussed. In addition, the roles and responsibilities for psychiatrists specifically trained in aspects of military medical and mental health law are identified.

Forensic Psychiatry↗
PubMed1997

Tardive dyskinesia in older out-patients: a follow-up study.

Tardive dyskinesia (TD) is a long-term potential adverse effect of neuroleptic treatment, and older age has been correlated with the development of TD. We conducted a chart review of current out-patients and examined annual Abnormal Inventory Movement Scale (AIMS) evaluations for the period 1987-1995 for 43 patients who started neuroleptic treatment after the age of 35 years. Patients (mean age 67 years) began neuroleptic treatment at a mean age of 46 years and were taking neuroleptics for 18 years on average. A total of 18 patients (42%) met the research criteria for TD, of whom all cases were mild except for three, which were moderate. Although TD was common, it rarely progressed in this naturalistic setting, suggesting that even for older patients maintenance neuroleptic treatment may be feasible for chronic psychosis.

Adult↗
PubMed1996

Factitious disorders and the 'professional patient'.

Factitious disorders are fabricated illnesses. Conceptually, these disorders lie in the gray zone between malingering and real diseases. Clinical awareness will prevent unnecessary diagnostic and therapeutic interventions. The author profiles those patients and symptoms that accompany factitious disorders as well as factitious disorders by proxy. In the case of the latter, child abuse may be uncovered as well. Although rare, factitious disorders will be present in a busy primary care practice. Clinical detection based on patient profiles can aide discovery. Early recognition and management may prevent a chronic and debilitating course from culminating into one in which the person becomes a "professional patient."

Adult↗
PubMed1993

The video violence debate.

Some researchers and theorists are convinced that graphic scenes of violence on television and in movies are inextricably linked to human aggression. Others insist that a link has not been conclusively established. This paper summarizes scientific studies that have informed these two perspectives. Although many instances of children and adults imitating video violence have been documented, no court has imposed liability for harm allegedly resulting from a video program, an indication that considerable doubt still exists about the role of video violence in stimulating human aggression. The author suggests that a small group of vulnerable viewers are probably more impressionable and therefore more likely to suffer deleterious effects from violent programming. He proposes that research on video violence be narrowed to identifying and describing the vulnerable viewer.

Adolescent↗
PubMed1993

Alcohol: the clinician's role in evaluating legal responsibility.

Alcohol-related misconduct poses a challenge for society, the legal system, and the medical profession. The debate is centered on alcohol abuse and the determination of responsibility for misbehavior. In assessing responsibility, the legal system often requests the expertise of the medical professional. The knowledgeable clinician can contribute to the just resolution of complex medico-legal cases. The best contribution considers medical facts in relation to the evolution of legal thinking. This article explores the historical, social, and legal approaches to alcohol-related misconduct. The article concludes with a discussion of a model clinical assessment.

Alcoholism↗
PubMed1992

Suicide and the military justice system.

The United States military is sensitive to suicide. There are military policies that direct the formation of active suicide prevention programs. The U.S. military emphasizes a humanitarian approach. Modern military law, however, may view suicidal behavior as deviant. The prosecution of this behavior, although theoretically possible, has never occurred until recently. The U.S. military has now convicted soldiers for attempted suicide and assisted suicide. This article reviews these recent court decisions and suggests revisions in the military law.

Adult↗
PubMed1992

Military psychiatry and the criminal law.

This article provides guidance in performing clinical psychiatric evaluations of the criminally accused. The interface between the law and psychiatry raises difficult dilemmas. Through a review of military regulations and relevant case law, suggestions are provided to enhance the clinician's control, quality, and value of contribution. The clinician's need for complete disclosure from the accused soldier, in order to ensure a thorough forensic assessment, may conflict with legal concerns. The accused and the military justice system must consider specific issues, such as confidentiality and compliance. This article discusses the practical ramifications and implications of these issues.

Confidentiality↗
PubMed1991

The military insanity defense.

This article describes the military insanity defense. The success of the litigated insanity defense is explored through the number of insanity acquittals over a 28-month period. A questionnaire distributed to all United States Army psychiatrists provided information on the number of forensic evaluations performed, the number of not criminally responsible (NCR) opinions made, and the disposition of noncontested NCR opinions. The questionnaire also tested the Army psychiatrists' knowledge about recent changes in the military insanity defense. This pilot study raises interesting questions about the military insanity defense that further research can address.

Forensic Psychiatry↗
PubMed1990

The perils of prediction.

Predicting dangerousness is performed by the mental health expert in a variety of settings. Within the medical model the issue is usually imminent dangerousness with the focus on intervention, diagnosis, and possibly treatment. The prediction of future dangerousness, however, is typically an administrative or legal function. The practitioner should be aware of the differences and the consequences of each opinion. This article examines the controversy of future dangerousness and argues for a more thorough evaluation and a frank disclosure of the inevitable limitations of forecasting.

Dangerous Behavior↗
PubMed1990

Disposition of insanity acquittees in the United States Military.

Recent amendments to the United States Code of Military Justice have essentially adopted the federal mental nonresponsibility rule or insanity defense. The prior standard, as outlined in the American Law Institute's Model Penal Code, has been abandoned. Notably absent is a system to address the disposition of the military insanity acquittee. This raises concerns regarding recidivism and the military's role in mitigating potential dangerousness. Relevant civilian and military law is reviewed, two cases described, and possible remedies proposed.

Adult↗
PubMed1989

Incest. Its causes and repercussions.

Throughout history, societies have circumscribed certain forms of intimacy in the family setting. Transgression has been punished by force of ecclesiastical rules and government statutes. However, no single definition of incest is widely accepted, as the degree of kinship in which marriage is allowed and the age of consent vary. Fueled in part by the current emphasis on child abuse prevention, the reporting of incest is increasing. The perpetrator in the majority of reported cases is a male adult, and most often the victim is a young girl. Other dyads do occur and are probably under-estimated in frequency. Disturbed family relationships generate a shift in individual responsibilities and expectations that can lead to incest. A lack of spousal sexual activity is a common preceding factor. The sequelae of this breach of family integrity are significant. Frequently, the family itself is destroyed; the destruction often begins before incest occurs. The victim faces a future characterized by emotional turmoil, diminished self-esteem, impaired interpersonal relationships, and impulsive acting-out behavior. Family and individual therapy, participation in support groups, and referral for chemical dependency treatment are essential if future problems in the lives of everyone involved are to be avoided.

Child↗
PubMed1989

Malingering.

Malingering adds to the cost of medicine. Unnecessary tests, exhaustive evaluations, and repeated referrals are part of the cost. In noneconomic terms, malingering erodes trust and confidence in the physician-patient relationship. This article explores means whereby the physician can detect the malingerer. Once the physician is convinced of the disingenuous nature of the symptoms, intervention is indicated. Suggestions for confronting the malingerer are reviewed.

Diagnosis, Differential↗
PubMed1989

The dangerous patient.

The dangerous patient requires proper management to ensure appropriate disposition and preclude injury. A safety-conscious public has propelled the issue into the courtroom, and a slowly evolving standard of care is emerging. In some states a legal duty to protect victims of violence exists. Understanding human aggression, the potentiating effects of the environment, and prior methods of coping, as well as assessing current behavioral controls and certain statistical correlates all aid management decisions. Stabilization of the dangerous patient begins with the interview and progresses to medication or restraints as the situation dictates. Once the acute crisis is resolved, attention is directed toward a more thorough review.

Adult↗