RESUMEN

Patients' access to their psychotherapy records may be assumed to be well protected; however, the matter is intricately regulated. In fact, the statutes and rights pertaining to patient access to psychotherapy notes vary across states. Taken together, federal and state laws indirectly and inconsistently delineate lawful access-as well as clinical exceptions to providing access-to psychotherapy notes. Federal law defers to state laws when the latter afford individuals greater access to their notes. Both federal and individual state levels vary in providing for possible conditions under which access may be restricted. Right of access to psychotherapy notes is a matter of importance for all mental health clinicians in the United States. Awareness and integration of pertinent laws and regulations allow clinicians to manage such matters without a negative impact on their clinical care. Further consideration of how clinical practice interacts with other dimensions of health care administration (clinical, ethical, and legal) may serve to enhance the integrity of a clinician's work and the ability to adapt to difficult clinical circumstances with confidence.

RESUMEN

High rates of suicide continue to plague the modern world, with clinicians, researchers, and policymakers working urgently to ameliorate what has been recognized as a worldwide public health crisis. Under American Law, individuals- including health care providers, could generally not be held liable for causing the suicide of another person. This article presents a review of suicide law in the United States in the context of a recent civil case in which a physician with expertise in mental health was sued for the death of an ex-partner who committed suicide in his home. Historical events and landmark legal cases spanning the 15th century to now are examined and presented as a narrative review to inform society and mental health clinicians a-like towards interpreting the changing medical-legal landscape. As modern advances in science continue to discern the critical biopsychosocial factors that contribute to the act of suicide, there is an inevitably growing concern that suicide may no longer be an incomprehensible nor irrational event as has been assumed for centuries. Thus, it may be considered that individual with expertise and qualification to treat a group of individuals at higher risk of suicide (severe mental illness) may be subject to a different standard than the average individual. This article seeks to present a complex matter where no simple or broad-sweeping conclusions can yet be drawn, however remains a critically important matter for mental health clinicians.

Asunto(s)

Responsabilidad Legal , Suicidio , Humanos , Estados Unidos , Suicidio/legislación & jurisprudencia , Historia del Siglo XX , Historia del Siglo XIX , Historia del Siglo XVIII , Historia del Siglo XXI , Historia del Siglo XV

Asunto(s)

Internado y Residencia , Psiquiatría , Humanos , Retroalimentación , Psicoterapia/educación , Psiquiatría/educación

RESUMEN

The Psychiatric Consultation Service at Massachusetts General Hospital sees medical and surgical inpatients with comorbid psychiatric symptoms and conditions. During their twice-weekly rounds, Dr Stern and other members of the Consultation Service discuss diagnosis and management of hospitalized patients with complex medical or surgical problems who also demonstrate psychiatric symptoms or conditions. These discussions have given rise to rounds reports that will prove useful for clinicians practicing at the interface of medicine and psychiatry.

Asunto(s)

Trastornos Mentales , Trastornos Relacionados con Opioides , Psiquiatría , Hospitales Generales , Humanos , Pacientes Internos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Trastornos Mentales/terapia , Trastornos Relacionados con Opioides/epidemiología , Trastornos Relacionados con Opioides/terapia , Atención Dirigida al Paciente , Derivación y Consulta

Asunto(s)

Violencia de Pareja

Asunto(s)

Trastornos por Estrés Postraumático , Humanos

RESUMEN

For centuries, medicine and psychiatry mirrored society's equivocations regarding childhood trauma. Those conflicts have mostly resolved, with widespread agreement that children are commonly exposed to traumatic events that may lead to PTSD and other mental conditions. The psychiatric and legal arguments should no longer be about the reality of childhood trauma in general; instead, experts should focus on the methodology of translating a particular child's narrative truth of maltreatment into a historical account, so that the expert can be qualified to offer criminal or civil court testimony after examining the child. In this commentary, we explore the daunting forensic challenges of eliciting admissible evidence to confirm or dispute the allegations and of offering scientifically credible opinions about whether any present and future harm related to the trauma and PTSD was directly caused by the incident.

Asunto(s)

Testimonio de Experto , Psiquiatría Forense , Trastornos por Estrés Postraumático , Heridas y Lesiones , Niño , Preescolar , Humanos , Factores de Riesgo , Trastornos por Estrés Postraumático/etiología , Trastornos por Estrés Postraumático/psicología

RESUMEN

The treatment of sexually violent predators (SVPs) has been controversial since the implementation of sexual predator laws and statutes that seek to balance the civil rights of SVPs and the protection of potential victims. In this paper, we will present the case of an SVP who sought sexual enhancement surgery in order to perform intercourse with his wife. We will also discuss the conflicting legal and ethical issues affecting a decision to implement sexual enhancement therapy for SVPs in an effort to reconcile these divergent positions.

Asunto(s)

Genitales Masculinos/cirugía , Delitos Sexuales , Conducta Sexual , Procedimientos Quirúrgicos Urogenitales/ética , Adulto , Humanos , Masculino , Principios Morales , Trastornos Parafílicos , Violencia

Asunto(s)

Trastornos por Estrés Postraumático/psicología , Veteranos/psicología , Adulto , Campaña Afgana 2001- , Humanos , Guerra de Irak 2003-2011 , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/etiología , Estados Unidos/epidemiología , Guerra

RESUMEN

Facebook is the leading social networking website, with over 500 million users. Prior studies have shown an increasing number of housestaff accessing the site. While Facebook can be used to foster camaraderie, it can also create difficulties in the doctor-patient relationship, especially when boundaries are crossed. This study explored the prevalence of such boundary crossings and offers recommendations for training. An anonymous voluntary survey regarding Facebook use was distributed to current psychiatry residents through the American Psychiatric Association (APA) listserv. Of the 182 respondents, 95.7% had current Facebook profiles, and 9.7% had received friend requests from patients. In addition, 18.7% admitted to viewing patient profiles on Facebook. There is a substantial utilization of Facebook among psychiatric residents as compared with prior studies. Specific guidance regarding social media websites and the potential for ethical difficulties should be offered to trainees.

Asunto(s)

Internet/estadística & datos numéricos , Internado y Residencia , Relaciones Médico-Paciente/ética , Psiquiatría/normas , Red Social , Adulto , Actitud del Personal de Salud , Curriculum , Recolección de Datos , Femenino , Guías como Asunto , Humanos , Internet/ética , Masculino , Persona de Mediana Edad , Privacidad , Psiquiatría/educación

RESUMEN

The capital trial, by its nature, is fraught with emotionally disturbing elements that jurors must face when deciding the ultimate fate of a guilty defendant. A confluence of mitigating and aggravating factors influences a capital jury's decision to impose a sentence of death. The presence or absence of defendant remorse in these cases may make all the difference in whether a capital defendant's life is spared. This commentary examines the onerous emotional toll encountered by capital jurors in light of the findings of Corwin and colleagues regarding defendant remorse and juror's need for affect. The commentary also presents practical and ethics-related considerations that should be kept in mind when reflecting on their study.

Asunto(s)

Afecto , Concienciación , Pena de Muerte/legislación & jurisprudencia , Derecho Penal/legislación & jurisprudencia , Empatía , Testimonio de Experto/legislación & jurisprudencia , Culpa , Homicidio/legislación & jurisprudencia , Homicidio/psicología , Prisioneros/legislación & jurisprudencia , Prisioneros/psicología , Femenino , Humanos , Masculino

RESUMEN

As with the basic and clinical sciences, the field of medical ethics, in particular, that of psychiatric ethics, has grown and developed during the last four decades, the time when Dr. Eugene Brody edited the Journal of Nervous and Mental Disease. In this paper, the authors will consider a series of ethical problems that psychiatrists have identified in their clinical practice and suggest paths to resolution that may artfully balance conflicts in core moral beliefs.

Asunto(s)

Psiquiatría/ética , Ética en Investigación/educación , Humanos , Consentimiento Informado/ética , Psiquiatría/educación

Asunto(s)

Enfermedad de Alzheimer/psicología , Ética en Investigación , Consentimiento Informado/ética , Competencia Mental , Anciano , Enfermedad de Alzheimer/diagnóstico , Enfermedad de Alzheimer/terapia , Comprensión , Toma de Decisiones , Humanos , Tutores Legales/psicología

Asunto(s)

Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Psicoterapia/métodos , Adolescente , Niño , Femenino , Humanos , Lactante , Masculino , Trastornos Mentales/psicología , Relaciones Profesional-Paciente , Confianza

Asunto(s)

Testimonio de Experto/ética , Testimonio de Experto/normas , Psiquiatría Forense/ética , Psiquiatría Forense/normas , Guías como Asunto , Códigos de Ética , Humanos , Rol del Médico , Sociedades Médicas

RESUMEN

OBJECTIVE: The authors evaluated psychological responses to continuous terror. METHOD: Data were collected after 10 months of escalating hostilities against civilians in Israel. The study's participants were randomly selected adults living in two suburbs of Jerusalem, one frequently and directly exposed to acts of terrorism (N=167) and the other indirectly exposed (N=89). Participants provided information about exposure to terror-related incidents, disruption of daily living, symptoms of posttraumatic stress disorder (PTSD), and general distress (assessed with the Brief Symptom Inventory). RESULTS: Residents of the directly exposed community reported more frequent exposure to terror and deeper disruption of daily living. Notwithstanding, the directly and indirectly exposed groups reported comparable rates of PTSD and similar levels of symptoms: 26.95% of the directly exposed group and 21.35% of the indirectly exposed group met DSM-IV PTSD symptom criteria (criteria B through D), and about one-third of those with PTSD symptoms (35.7% in the directly exposed group and 31.5% in the indirectly exposed group) reported significant distress and dysfunction. Subjects who did not meet PTSD symptom criteria had very low levels of PTSD symptoms, and their Brief Symptom Inventory scores were within population norms. Exposure and disruption of daily living contributed to PTSD symptoms in the directly exposed group. Disruption of daily routines contributed to Brief Symptom Inventory scores in both groups. CONCLUSIONS: Continuous terror created similar distress in proximal and remote communities. Exposure to discrete events was not a necessary mediator of terror threat. A subgroup of those exposed developed serious symptoms, whereas others were surprisingly resilient. Disruption of daily routines was a major secondary stressor.

Asunto(s)

Recolección de Datos/estadística & datos numéricos , Judíos/psicología , Trastornos por Estrés Postraumático/epidemiología , Trastornos por Estrés Postraumático/psicología , Terrorismo/psicología , Actividades Cotidianas/psicología , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Israel/epidemiología , Judíos/estadística & datos numéricos , Acontecimientos que Cambian la Vida , Masculino , Inventario de Personalidad , Prevalencia , Escalas de Valoración Psiquiátrica , Calidad de Vida/psicología , Muestreo , Trastornos por Estrés Postraumático/diagnóstico , Estrés Psicológico/diagnóstico , Estrés Psicológico/epidemiología , Estrés Psicológico/psicología , Terrorismo/etnología , Terrorismo/estadística & datos numéricos , Violencia/psicología , Violencia/estadística & datos numéricos

Asunto(s)

Adaptación Psicológica , Niño Institucionalizado/psicología , Cuidados en el Hogar de Adopción/psicología , Desarrollo de la Personalidad , Trastornos por Estrés Postraumático/psicología , Adaptación Psicológica/fisiología , Adolescente , Hormona Adrenocorticotrópica/fisiología , Adulto , Anciano , Atrofia , Niño , Maltrato a los Niños/psicología , Abuso Sexual Infantil/psicología , Preescolar , Hormona Liberadora de Corticotropina/sangre , Mecanismos de Defensa , Dominancia Cerebral/fisiología , Femenino , Hipocampo/patología , Hipocampo/fisiopatología , Humanos , Sistema Hipotálamo-Hipofisario/fisiopatología , Lactante , Recién Nacido , Acontecimientos que Cambian la Vida , Masculino , Persona de Mediana Edad , Apego a Objetos , Sistema Hipófiso-Suprarrenal/fisiopatología , Aislamiento Social , Apoyo Social , Trastornos por Estrés Postraumático/diagnóstico , Trastornos por Estrés Postraumático/fisiopatología

Asunto(s)

Trastornos por Estrés Postraumático/terapia , Trastornos de Estrés Traumático Agudo/terapia , Adulto , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Femenino , Humanos , Acontecimientos que Cambian la Vida , Masculino , Planificación de Atención al Paciente/normas , Escalas de Valoración Psiquiátrica , Psiquiatría/métodos , Psiquiatría/normas , Psicoterapia , Psicotrópicos/uso terapéutico , Trastornos por Estrés Postraumático/diagnóstico , Trastornos de Estrés Traumático Agudo/diagnóstico

RESUMEN

Forensic psychiatrists and psychologists are often called on to provide opinions and render testimony in which minor head trauma accompanied by persistent somatic, cognitive, and/or emotional symptoms is alleged. The frequency of persistent symptoms following such minor head injury is generally low. The forensic clinician therefore must differentiate between subtle brain dysfunction, symptom amplification, psychogenic-based causes for the presence of cognitive and other deficits, or frank malingering. The purpose of this article is twofold: first, to review critical issues related to the assessment of malingering and symptom exaggeration in mild head injury cases; and second, to offer a practical model for the assessment of amplified neuropsychological and psychiatric deficits in civil litigants in cases of minor head trauma.

Asunto(s)

Traumatismos Craneocerebrales/fisiopatología , Decepción , Psiquiatría Forense/métodos , Pruebas Neuropsicológicas , Traumatismos Craneocerebrales/clasificación , Traumatismos Craneocerebrales/diagnóstico , Traumatismos Craneocerebrales/psicología , Manual Diagnóstico y Estadístico de los Trastornos Mentales , Testimonio de Experto/legislación & jurisprudencia , Femenino , Psiquiatría Forense/legislación & jurisprudencia , Humanos , Masculino , Persona de Mediana Edad , Síndrome , Estados Unidos

RESUMEN

Millions of children are affected by physical and sexual abuse, natural and technological disasters, transportation accidents, invasive medical procedures, exposure to community violence, violence in the home, assault, and terrorism. Unfortunately, the emotional impact of exposure to trauma on children is often unappreciated and therefore untreated, and yet the impact of exposures to disaster and violence is profound and long-lasting. This article first briefly discusses the epidemiology of trauma in children, and then reviews the psychiatric and neurodevelopmental impact of trauma on children as well as the effects of trauma on children's emotional development. Trauma in children can lead to the development of posttraumatic stress disorder as well as to a variety of other psychiatric disorders, including depression, generalized anxiety disorder, panic attacks, borderline personality disorder, and substance abuse in adult survivors of trauma. Research has found that early exposure to stress and trauma causes physical effects on neurodevelopment which may lead to changes in the individual's long-term response to stress and vulnerability to psychiatric disorders. Exposure to trauma also affects children's ability to regulate, identify, and express emotions, and may have a negative effect on the individual's core identity and ability to relate to others. The authors also discuss what has been learned, based on recent experiences such as the World Trade Center catastrophe, about the role of television viewing in increasing the effects of traumatic events. The last section of the article provides guidance concerning the identification and clinical treatment of children and adolescents who are having emotional problems as a result of exposure to trauma.