Zur Qualitätssicherung zivilrechtlicher Begutachtungen

Quality assurance in forensic psychiatry must take into account the different requirements for assessment in criminal, civil and social law. For civil law assessments the following measures are recommended: a reading list of articles reflecting the expert consensus, guidelines, a list of approved expert supervisors, an exemplary curriculum, modification of the present certificatation by the German Society for Psychiatry and Psychotherapy, Psychosomatic and Neurology (DGPPN) with more emphasis on civil law and a continuous process of education and recertification. Besides an interdisciplinary statement defining minimum requirements for civil law assessments, measures for continuous quality improvement should also be established in cooperation with representatives of the judicature.     

Certification in neurodevelopmental disabilities: the development of a new subspecialty and results of the initial examinations

The American Board of Psychiatry and Neurology, in collaboration with the American Board of Pediatrics, administered the first Subspecialty Certification Examination in Neurodevelopmental Disabilities to 190 candidates on April 3, 2001, and the second to 80 candidates on April 9, 2002. This report describes the history of the certifying examination including the process of its development and the results of the first and second examination administrations. The purpose of the Certification Examination in Neurodevelopmental Disabilities is to assess knowledge of qualified candidates in the subspecialty. A committee comprised of child neurologists and pediatricians developed this examination. Of the 190 pediatricians (n = 169) and child neurologists (n = 21) who completed the examination in 2001, 157 (83%) passed the examination. The second group of examinees included 68 pediatricians and 12 child neurologists, and the pass rate was 70%. The 213 candidates certified to date have received ten-year time-limited certificates that may be renewed by recertification process beginning in 2010. After the "grandfathering period," candidates for the examination must complete ACGME-approved training programs in the subspecialty.     

Das DGPPN-Zertifikat Forensische Psychiatrie

The introduction of the German Society for Psychiatry Psychotherapy and Mental Health (DGPPN) certificate for forensic psychiatry significantly contributed to improving the quality of forensic psychiatric expertises. The corresponding designations of state medical boards were created in 2004 and have now become established. Currently two methods of certification of forensic psychiatric training are possible which opens up the opportunity to further develop the certificate and to set standards for quality assurance. This article discusses in particular quality control measures, ways to respond to serious quality issues and the development process in terms of a continuing medical education. By establishing and enforcing such standards the DGPPN will achieve a key position.     

Standards nichtstrafrechtlicher psychiatrischer Begutachtung

The introduction of the certificate for forensic psychiatry of the German Association of Psychiatry, Psychotherapy, Psychosomatics (DGPPN) in 2000 was a significant contribution to raising awareness of the formal and substantive requirements for forensic psychiatric evaluations and to develop a systematic quality improvement in forensic psychiatric expert services. By the special dominance of the certification in the field of penal law assessment, this proved to be problematic for many predominantly non-penal experts. This led to a requirement to develop a qualification for the non-penal expert opinions. In particular the increasing specialization of the psychiatric disciplines and the diversity of the legal issues and framework require a continuing education in the field of non-penal psychiatric assessments. Substantive and formal requirements are discussed and a continuous process of quality improvement and assurance is outlined. Last but not least a plea is made for close interdisciplinary exchange with the jurisprudence and the courts in the context of quality circles.     

Board certification in health psychology

As professional practice in health psychology has matured, mechanisms for board certification through the American Board of Professional Psychology have been developed. This article describes the American Board of Health Psychology and its role in the credentialing of practitioners who demonstrate advanced competence in the science and practice of psychology related to health, including the prevention, treatment, and rehabilitation of illness.     

Specialization in Psychology and Health Care Reform

This article begins by contextualizing specialization and board certification of psychologists, with attention paid to relevant definitions and expectations of other health care professionals. A brief history of specialization and board certification in professional psychology is offered. The benefits of board certification through the American Board of Professional Psychology are highlighted. Consideration is then given to the primary reasons for psychologists working in academic health sciences centers to specialize in the current health care climate and to obtain board certification as a mark of such specialization.     

Does Evidence-Based Medicine Apply to Psychiatry?

Evidence-based psychiatry (EBP) has arisen through the application of evidence-based medicine (EBM) to psychiatry. However, there may be aspects of psychiatric disorders and treatments that do not conform well to the assumptions of EBM. This paper reviews the ongoing debate about evidence-based psychiatry and investigates the applicability, to psychiatry, of two basic methodological features of EBM: prognostic homogeneity of clinical trial groups and quantification of trial outcomes. This paper argues that EBM may not be the best way to pursue psychiatric knowledge given the particular features of psychiatric disorders and their treatments. As a result, psychiatry may have to develop its own standards for rigour and validity. This paper concludes that EBM has had a powerful influence on how psychiatry investigates and understands mental disorders. Psychiatry could influence EBM in return, reshaping it in ways that are more clinically useful and congruent with patients’ needs.     

Ambulante Behandlung von Sexualstraftätern

Treatment of sexual offenders is still a controversial issue for both forensic clinical practice and research. The methods to evaluate efficacy and effectiveness in the field of forensic psychiatry and psychotherapy show many distinctive characteristics. Especially outpatient treatment of sexual offenders takes place in a conflict of interest. This article aims to illustrate several potentials and difficulties in the field of sexual offender treatment using the example of the Hamburg Institute for Sex Research and Forensic Psychiatry at the University Medical Center Hamburg-Eppendorf (UKE).     

The Recovery of Religious and Spiritual Significance in American Psychiatry

This paper reviews a body of data that identifies underlying influences that have contributed to an evolving change in American Psychiatry toward a more positive and receptive stance toward religion and spirituality over the past three decades. This development, surprising in light of the remedicalization of psychiatry and its predominantly neuro-biological orientation, is attributed to five foundational ideas that have helped to leverage this change. These are significance of culture, creative power of ritual, psychic function of belief, neuro-biology of spirituality, and relevance of recovery narratives. The impact of these factors for psychiatric assessment and treatment is described, as well as the contribution of the Oskar Pfister legacy and award to the ongoing dialogue between religion and psychiatry. Adapted from the American Psychiatric Association's 2011 Oskar Pfister Lecture in Religion and Psychiatry.     

Beitrag der Neurowissenschaften zur forensischen Psychiatrie

Forensic psychiatry is a subspecialty dedicated to the interface between psychiatry and law. It uses paradigms and knowledge from general psychiatry for diagnostics, assessment, therapy and research under consideration of the special requirements of legal aspects and framework conditions; therefore, scientific development in forensic psychiatry is substantially dependent on scientific progress in psychiatry and thus nowadays also in neurosciences. Neurobiological hypotheses on the neuronal foundations of psychiatric diseases have been established, for example the dopamine hypothesis for schizophrenia, in a manner that led to important therapeutic advances in the treatment and long-term quality of life for affected persons. Analogous advances should not be withheld from forensic psychiatric patients, who are doubly affected by the disease and the accompanying limitations in their rights to freedom, which is why research in this field must be driven forwards. Clear advances in knowledge of the neurobiological foundations of forensic psychiatric illnesses have, for example, already been made in the field of pedophilia and psychopathy. Based on studies of investigation populations, such neuroscientific knowledge on the neurobiological principles of forensic psychiatric diseases, however, requires a carefully concerted communication with respect to dissemination in the media as well as in the interpretation of individual cases, for example in court. This is of great importance in order to prevent simplifying misconceptions and to avoid a subsequent loss of trust in the scientific process. Therefore, training of the new generation of forensic psychiatrists in the understanding and communication of scientific methods of modern forensic psychiatric neuroscience is of great importance for the societal impact and further advancement of the discipline.     

Gewalttaten psychisch Kranker

Only a minority of mentally ill persons become conspicuous due to acts of violence. Nevertheless, from time immemorial there has been a certain fear of the alleged unpredictability of the mentally ill, particularly of people who suffer from a psychosis. The creation of psychiatry as an independent medical discipline was designed from the very beginning to separate people deemed to be dangerous from society and to detain them in institutions in order to heal them, to make relevant improvements or to keep them indefinitely. The movement of dehospitalization since the 1970s, which in turn was a consequence of revolutionization of treatment options through modern neuroleptic and antidepressive drugs, led to a distinctive separation between general psychiatry and forensic psychiatry, institutionally (general psychiatric institutions with periods of hospitalization of a few weeks and psychiatric forensic committment lasting many years) as well as increasingly more in scientific discourses; however, a close cooperation is necessary for healthcare treatment, which meets the requirements of patients and also public security. In this respect general psychiatry must still undertake substantial safety reponsibilities, which it can learn from forensic psychiatry, whereas forensic committment must rapidly acquire the therapy experience of general psychiatry.     

INTERNISTS OF THE MIND OR PHYSICIANS OF THE SOUL: DOES PSYCHIATRY NEED A PUBLIC PHILOSOPHY?

Although psychiatry is interested in what both body and mind contribute to behavior, it sometimes emphasizes one more than the other. Since the early 1980s, American psychiatry has shifted its interest from mind and psyche to body and brain. Neuroscience and psychopharmacology are increasingly at the core of psychiatry. Some experts claim that psychiatry is no longer interested in problems in living and positive goals such as mental health, happiness, and morality but rather has narrowed its focus to mental disorders addressed with psychotropic drugs. In view of this trend, psychiatry needs to confront two questions in social philosophy. If it is no longer directly concerned with health and happiness, how does it relate to these positive goals? And how does it relate as a medical institution to religious institutions, schools, and other organizations that directly promote health, happiness, morality, and the purposes of life? It is not enough for psychiatry to renounce its moral role; its practices still shape cultural values. Psychiatry should take more responsibility for developing a public philosophy that addresses these issues.     

Board Certification in Psychology: Insights from Medicine and Hospital Psychology

For physicians board certification is an accepted tradition that research suggests improves services and outcomes. In contrast, relatively few psychologists pursue board certification suggesting ambivalence or limited contingencies reinforcing it. The authors report on medical school and hospital-based psychologists’ attitudes toward board certification and current certification status. About one-fifth (21.7%) of the sample were certified by the American Board of Professional Psychology, a greater proportion than psychologists generally: Highest rates were seen in neuropsychology (7.5%), clinical psychology (6.4%), clinical child and adolescent psychology (3.2%) and clinical health psychology (2.8%). Few (<2%) reported their hospitals required board certification. Half recognized benefits to the profession for psychologists pursuing board certification, yet 70% opposed requiring it for their hospital-based practice. Forces seeking to promote healthcare quality ultimately may increase expectations for board certification. If consumers, employers, hospitals and managed care organizations demand board certification for health professionals, greater numbers of psychologists would likely seek it.     

A Windows program to assist in preparing reports of emergency psychiatry nursing assessments

The Emergency Psychiatry Nursing Assessment Report Framework (EP Nurse) is designed to guide the nurse through the interview-and-reporting process, and to produce a report of the nursing evaluation in emergency psychiatry in 5–10 min. Input includes identifying information, presenting complaints, substance-use history, medical history and vitals, psychiatric medications, treatment history, history of mental illness, last hospitalization, family history of mental illness, nursing diagnosis, and nursing intervention. EP Nurse is intended to be used by licensed nurses familiar with nursing assessment in emergency psychiatry. It is suitable for adult patients.     

L’intelligence artificielle peut-elle aider à estimer le risque de récidive dans les comportements violents ?

In forensic psychiatry, magistrates raise the question of the existence of a risk of recidivism and dangerousness to psychiatric experts. Follow-up studies in forensic psychiatry showed that the psychiatric elements predictive of recidivism were mainly related to serious mental illnesses, toxic consumption, addictions, high levels of impulsivity, low insight, associated personality disorders, in particular antisocial personality disorders. There are also protective factors, in particular the observance of treatments. Given the complexity of psychiatric and criminological risk factors and protection, can artificial intelligence (AI) help psychiatrists and magistrates to improve the predictivity of recidivism?MethodsSystematic review of the literature on AI applications in the prediction of recidivism in forensic psychiatry, conducted according to PRISMA criteria, using the: “Artificial Intelligence”, “Recidivism”, “Personality Disorder”, “Impulsive” Behavior”, “Alcohol abuse”, “Drug Abuse”, “Schizophrenia”, “Bipolar disorder” on the PubMed, Science Direct, Clinical Trial and Google Scholar databases.ResultsThe vast majority of studies come from legal or computer reviews and very few from medical databases. The studies evaluating the AI in Forensic Psychiatry most often used Machine Learning based on sociodemographic, sociological and criminological data, notably the age of the first offense and the number of previous convictions. To date, there are very few studies evaluating psychiatric parameters, focusing on psychopathic personality disorders.Discussion/conclusionThe applications of the AI in Forensic Psychiatry are still very premature. However, some psychiatric criteria should be more prominent in this field, especially those from Webster's HCR-20 and Hare PCL-R scales. The challenge will also be to find relevant behavioral, psychological and psychiatric keywords to include in AI.     

Addictions Counseling Certification: An Emerging Counseling Specialty

This article summarizes the national standards for addictions counseling of 4 different professional groups or boards. The new addictions specialty certification standards that are being developed jointly by the National Board for Certified Counselors and the International Association of Addictions and Offender Counselors (a division of the American Counseling Association) are compared with the standards of 3 other groups.     

Psychiatry and Psychology in the Writings of L. Ron Hubbard

Objectives: Celebrity followers of the Church of Scientology have recently used their public forum to attack the modern practice of mental health. The practice of Scientology is rooted in the religious writings of its founder, L. Ron Hubbard. This paper will review the religious writings of L Ron Hubbard to understand Scientology’s position on mental health. Method: This paper reviews four of the major religious books written by L Ron Hubbard, in addition to a comprehensive overview of Scientology compiled by Scientology staff. Results: Hubbard’s theory of mind borrowed heavily from the earlier writings of Freud, until Hubbard’s psychological theory extended to include a spiritual existence that goes beyond the material world. The goal of Hubbard’s psychology and religion were to optimize the freedom of the individual, and he viewed psychiatry and psychology as inherently anti-spiritual and opposed to personal freedom and self-realization. Ultimately Hubbard presents a world view of potential nuclear world cataclysm, fueled by the geopolitical climate and mental health theories that dominated the mid 20th century. Conclusions: Hubbard’s writings mirrored the times in which he lived. His views that mental health practices are inherently anti-religious, freedom-inhibiting, and brain damaging do not reflect the modern-day practices of mental health. Dr. McCall is presently Professor and Chairman of the Department of Psychiatry and Behavioral Medicine at the Wake Forest University School of Medicine. He completed his medical degree and post-graduate psychiatric training at Duke University. He completed a Masters degree in Epidemiology from Wake Forest University. He is board certified in general psychiatry, geriatric psychiatry, and sleep disorders medicine. His research interests include depression, electroconvulsive therapy, quality of life, and insomnia. His research has been continuously funded by the National Institute of Mental Health since 1995, and he is author of more than 100 peer-reviewed journal articles. He is Editor of the Journal of ECT, Immediate-Past President of the Association for Convulsive Therapy, and a prior Director of the Board of the American Academy of Sleep Medicine.     

Approaching the religious patient in forensic psychiatry,with special focus on ethnic minority patients

ABSTRACT

Ethnic minority patients are overrepresented in Danish forensic psychiatry and knowledge is needed on how these patients are approached in relation to religious and cultural issues. The aim of this study was to investigate how psychiatrists in Danish forensic psychiatry approach religious ethnic minority patients. The study revealed positive approach towards religious ethnic minority patients. However, unless religion features as part of the illness, the tendency is to not incorporate the patients’ religiosity in treatment. The study finds that the hospital chaplain is regarded by the psychiatrists as an important part of the ward and expressed the desire for a more formal cooperation with religious specialists to be developed. Finally, the study finds that religious practices such as Ramadan, common prayer, and Islamic edicts on food and unlawful touch are areas where more knowledge is needed, especially in relation to anxiety, potential stress, and conflict situations.     

Psychiatry,psychoanalysis and sociology in the work of H.S. Sullivan

Abstract

Conci, M. Psychiatry, Psychoanalysis and Sociology in the Work of H.S. Sullivan. Int Forum Psychoanal 1997;6: 127–135. Stockholm, ISSN 0803-706X.

The author tries to illuminate H.S. Sullivan's complex professional identity. With E. Fromm he shared a basic humanistic orientation, and also the project of creating an interdisciplinary new science of man. This is the perspective he inherited from W.A. White, who tried to make psychoanalysis a major ingredient of psychiatry and social science. Sullivan's pioneer work with schizophrenic patients changed the prognosis of these patients, represented the basis of his interpersonal theory of psychiatry and of his collaboration with Chicago social science. Not only is the epistemological sophistication of his definition of psychiatrywhich includes the biological, intra- psychic, cultural and social dimensions-very relevant today, but so is the work he conducted, through the Washington School of Psychiatry (1936) and the journal Psychiatry (1938), with the aim of creating what he called a “psychiatry of peoples”, leading to world peace and greater social justice. In his view, psychoanalysis was more than a profession: it was a fundamental instrument of personal, cultural and social change.     

Resource Document on Access to Firearms by People with Mental Disorders

The American Psychiatric Association, (“APA”), with more than 36,000 members at present, is the Nation's leading organization of physicians who specialize in psychiatry. APA provides for education and advocacy and develops policy through Position Statements. It promotes enhanced knowledge of particular topics relevant to psychiatric practice and patient care through Resource Documents. Since 1993, the APA has developed various positions and resource materials related to firearms and mental illness, incorporating evolving themes as new issues emerge. This paper reflects the APA's 2014 Resource Document on “Access to Firearms by People with Mental Disorders.” This article is derived from work done on behalf of American Psychiatric Association and remains the property of APA. It has been altered only in response to the requirements of peer review. Copyright © 2015 American Psychiatric Association. Published with permission (original adopted by the American Psychiatric Association 2014).