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PubMed1979

[Pathomorphosis of reactive psychoses].

Comparative clinicostatistical, epidemiological and catamnestic investigation was carried out in two groups of patients with reactive psychoses (a total of 982 subjects) recorded at medico-legal expert testimony in 1950--1960 (I group) and in 1961--1972 (II group). It was found that in the recent decade reactive psychoses are rarely transformed and course in the presence of less vitalistic affective disorders with a tendency to increasing hysterical symptoms; the relapses are not rather long and severe, and they lead to postreactive psychic changes less frequently. It is suggested that reactive psychoses are subject to essential pathomorphism which has clinical importance and optimistic prognosing.

Asthenia↗
PubMed1981

Informed consent and the family physician.

Informed consent, regardless of patient recall, is required in increasing detail. The family physician must obtain consent from every patient for every procedure except for a few clearly defined areas: "Emergency," "Waiver," "Therapeutic Privilege," "Immaterial Risks," and "Generally Known Risks." Because courts have adopted the "reasonable patient" standard of disclosure, suits can be won without expert testimony. The elements of informed consent require explaining the nature of the procedure, the consequences that will probably occur, the material risks that may occur, alternatives available, and problems in recuperation. Consent, like any contract, is a meeting of the minds and the physician has an obligation to himself to document that agreement.

Disclosure↗
PubMed1993

Liability issues for occupational health nurses: an overview.

Occupational health nurses need to be familiar with the Nurse Practice Act within their states. Most malpractice suits against nurses are based on negligence. The occupational health nurse should also be aware of potential liability for intentional torts, such as assault and battery, breach of patient confidentiality, and informed consent. The elements of a malpractice case are: a) the duty to conform to standard of care (which is usually established by expert testimony); b) breach of that duty, or the failure to conform to the standard of care; c) a causal connection between the breach of duty and the resulting injuries; and d) actual damages suffered by the patient-plaintiff.

Humans↗
PubMed1993

Mediators of septic shock: new approaches for interrupting the endogenous inflammatory cascade.

OBJECTIVES: To review the molecular pathogenesis of septic shock, with particular emphasis on the induction of cytokines by endotoxin. By understanding the mechanisms that result in the systemic inflammatory response, novel clinical interventions may be more effectively studied. DATA SOURCES: The English medical literature was reviewed, including human clinical trials, animal experiments, and in vitro studies elucidating cellular and molecular interactions. Expert testimony from the Roundtable Conference on Sepsis (Brussels, March 1992) was also used to synthesize emerging concepts and to ensure inclusion of ongoing investigations. STUDY SELECTION: Emphasis on controlled experimental studies which elucidated the molecular and cellular interactions during sepsis. DATA EXTRACTION: This study focused only on data that directly involved the induction and regulation of protein mediators of sepsis, especially tumor necrosis factor (TNF) and interleukin-1. Data concerning the role of TNF during health were extracted from the author's peer-reviewed data. DATA SYNTHESIS: Information concerning the many facets of the systemic inflammatory response was integrated into a chronological, clinically oriented model of cytokine induction during endotoxemia. CONCLUSIONS: The induction of inflammation during sepsis is a complex, but increasingly understood, biological cascade that is dependent on inter- and intracellular signaling. Novel biotherapies may improve patient outcome in sepsis by interrupting any or all points of signal transduction.

Animals↗
PubMed1995

The evolution and definition of the concept of 'automatism' in Canadian case law.

Legal and psychological perspectives are blended in a review of the evolution and definition of the legal concept of 'automatism'. Despite the oft-cited, succinct definitions such as those provided by Bowlby JA in R v Kasperek [1951] 101 CCC 375, and by Mr Justice Lacourciere (as he then was) in R v K [1971] 3 CCC (2d) 84 which emphasize a lack of consciousness, case law has shown a tendency to emphasize a lack of volitional control. It has also insisted that such a deficit be primarily brought about by an external factor over which the accused either had no control or, if they had control, of which effects they lacked knowledge. Two noticeable omissions are identified. One is a lack of a logical evaluation of expert testimony in terms of the complexity of the criminal acts that have been claimed to accompany an impoverished mental state. The other is the failure to recognize the mental chemistry of the presence of multiple conditions in the same person at the same time. An overriding concern has been protection of the public, and decisions in a number of cases can be regarded as attempts to ensure that this is achieved before permitting the unqualified acquittal that automatism would bring.

Automatism↗
PubMed1997

Sleepwalking disorder and mens rea: a review and case report. Maricopa County Superior Court.

This paper examines complications of sleepwalking disorder (DSM-IV 307.46), an arousal disorder or parasomnia, in relationship to mens rea, or culpable mental state necessary to a finding of criminal responsibility. The legal history of criminal intent and insanity is reviewed. A case of indecent exposure is discussed in a man with a history of closed head injuries and sleepwalking disorder who was found standing naked in the middle of a busy urban thoroughfare in the wee hours of the morning and arrested. On psychiatric evaluation, the defendant was found to have a long-standing sleepwalking disorder. At trial, scientific literature and psychiatric expert testimony concerning sleepwalking disorder was presented. The psychiatrist opined that the defendant was probably sleepwalking at the time of the alleged offense. No rebuttal testimony was offered by the prosecution. The jury found the man not guilty. The author surveys the legal history of sleepwalking disorder and compares this example with others in which uncontrolled behavior during sleep has resulted in harm to the patient or to others. Clinical and forensic implications of the disorder are reviewed. The parasomnias' impact on forensic practice should be systematically studied. Intervention strategies should be refined and implemented.

Criminal Law↗
PubMed1977

[Social and medical rehabilitation of patients subjected to surgery on account of aneurysms of the anterior connecting artery].

The report contains data concerning occupational and social rehabilitation of 46 patients operated on for aneurysma of the anterior communicative artery. It was established that the occupational prognosis depends upon the severity of the hemmorhage, character of surgical operation. Of significance are the conditions of work, time after the surgical operation. The authors mark that in 2/3 of the operated on patients the working capacity is being restored. A spontaneous restoration of diaturbed functions is slow and is not always sufficient. With this purpose it is expedient to repeat courses of a general tonic and special rehabilitative therapy. A favourable factor in the readaptation of patients is their early engagement in working activities. The authors give their recommendations for medical labour expert testimony for this category of patients.

Adolescent↗
PubMed1997

Political rape as persecution: a legal perspective.

The use of rape as a tool of persecution is not new, but recognition of the political rape of women as a violation of internationally protected human rights and as a basis for political asylum is. Over the last several years, a number of advances have been made, including human rights instruments that recognize the need to protect women from rape and other sexual abuse; guidelines from the United Nations High Commission for Refugees and several countries that acknowledge the political nature of rape and the difficulties experienced by women attempting to assert claims to asylum based on rape or other sexual abuse; and a number of important decisions by individual governments to provide protection to survivors of rape. Legal advancements for women in this area have depended largely on the assistance of medical and psychological experts who have been able to educate adjudicators and advocates on the effects of sexual harm, provide expert testimony in individual asylum cases, and provide critical treatment and support to survivors as they work their way through the process of obtaining legal protection.

Female↗
PubMed1997

Do juries listen to jury instructions?

The author reports the case in which he was sued for medical malpractice. A nonunanimous jury found in favor of the plaintiff. Interviews of two of the jurors revealed that the jury discounted the expert testimony on both sides, the evidence, and the jury instructions. The author, finding that the jury decided the case based upon it's perception of the physician's "bedside manner," concludes that juries expect psychiatrists to behave more like friendly family doctors than objective psychoanalysts.

Adult↗
PubMed2001

What judges and lawyers think about the testimony of mental health experts: a survey of the courts and bar.

The testimony of mental health experts is often important evidence considered by criminal courts in determining issues arising throughout the adjudicative process, but not all evidence provided by experts is equally valid or probative. Using a hypothetical insanity defense case, we compared the preferences of Virginia judges, prosecutors, and defense attorneys for different types of forensic mental health evidence, including descriptive and diagnostic testimony, testimony about relevant research and actuarial data, and ultimate issue testimony. In addition, we determined their preferences for different types of mental health professionals. Four key findings emerged. First, many participants preferred that psychiatrists, rather than psychologists or other mental health professionals, conduct forensic evaluations for the court. Second, while participants were interested in most types of mental health evidence, they were primarily interested in clinical diagnosis, followed by an analysis of whether the condition met the relevant legal threshold, and an ultimate opinion on the legal issue. Third, participants were less interested in research or actuarial evidence. Fourth, participants differed in their evidentiary preferences in ways that reflect their respective roles in the adversary system. The findings suggest that while courts and attorneys find traditional clinical testimony useful in criminal cases, they also favor ultimate issue testimony, and view research data or statistically based information as less helpful. Mental health professionals should consider how to educate the courts and bar about the dangers inherent in over-reliance on the conclusory legal testimony of mental health experts, the utility of scientific data as such information becomes more routinely introduced as evidence at trial, and the expertise available from various mental health professionals.

Analysis of Variance↗