Landy F. Sparr

The medical management of the paranoid patient

Patients who are medically ill and distrustful of their care-providers are unfortunately a fact of life for most physicians. Medical management of such patients can be a frustrating experience because their suspiciousness is usually heightened by the stress of medical illness. Most often the patients mistrust covers profound feelings of personal inadequacy and is a defense against feared passivity. Understanding of basic paranoid thought processes combined with knowledge of practical management techniques will lead to increased confidence and effectiveness when interacting with these difficult patients.

Combat-related PTSD in military court: a. diagnosis in search of a defense

As more veterans return from Iraq and Afghanistan, Posttraumatic Stress Disorder (PTSD) often returns with them. As a result, PTSD has quickly become the most prevalent mental disorder diagnosis among active duty United States (U.S.) military. Although numerous studies have not only validated PTSD but have chronicled its negative behavioral impact, it remains a controversial diagnosis. It is widely diagnosed by all types of mental health professionals for even minimal trauma, and DSM-IV PTSD criteria have wide overlap with other mood and anxiety disorders. This, however, has not stopped PTSD from being used in civilian courts in the U.S. as a mental disorder to establish grounds for mental status defenses, such as insanity, diminished capacity, and self-defense, or as a basis for sentencing mitigation. Not surprisingly, PTSD has recently found its way into military courts, where some defense attorneys are eager to draw upon its understandable and linear etiology to craft some type of mental incapacity defense for their clients. As in the civilian sphere, this has met with mixed success due to relevance considerations. A recent court-martial, U.S. v. Lawrence Hutchins III, has effectively combined all the elemental nuances of PTSD in military court.

The Organization and Regulation of Voluntary Faculty

A large number of psychiatrists have been, or are currently, unpaid, voluntary, or “clinical” faculty. In 1987-1988, in 127 medical schools, there were approximately 122,000 clinical faculty members, outnumbering regular faculty by approximately two to one. Yet, in contrast to primary faculty, administrative policies (e.g., appointment, reappointment, promotion) regarding clinical faculty are often ill-defined or absent entirely. We discovered in a survey of 8 departments of psychiatry that most departments do not have separate administrative guidelines or policies for these faculty. This article addresses specific mechanisms for determining clinical faculty membership and duties and suggests policies for appointment, reappointment, and promotion. The authors focus on administrative management strategies, such as the creation of a departmental Clinical Faculty Committee and the consideration of quality assurance issues.

The Gulf War and Mental Health: A Comprehensive Guide

This interesting book closely examines mental health services in the Persian Gulf War. Many of the chapter authors and editors were active participants and, as a result, give a knowledgeable, graphic, and comprehensive operational account. The book has three sections. The first, which details problems encountered in the process of organizing, preparing, deploying, and operating a credible mental health system during the Gulf War, takes up approximately 60% of the text. For the reader who is involved in the administration or organization of health services, particularly emergency response services, this book should have particular interest. The emphasis is on identifying and coping with organizational deficiencies. Those responsible for coordinating the Gulf War mental health system were presented with problems all too familiar. One author states that most division mental health sections arrived in Saudi Arabia deficient in experienced personnel, appropriate training, supplies, and equipment. Several authors mention the serendipity of