Michael A. Norko

The State of Contemporary Risk Assessment Research

The focus on assessing dangerousness in routine psychiatric practice developed when relatively little was known about factors related to violence, and the accuracy of predicting violence was distinctly below chance. Since the 1990s, however, significant research attention has been directed toward factors related to violence and mental illness, as well as toward factors related to the accuracy of risk assessment techniques. Sociodemographic and environmental variables have been identified as significant predictors of violence, as has the presence of substance abuse. However, the data on specific mental health variables are somewhat mixed. Many studies point to a modest increased risk of violence associated with major mental illness and psychosis, whereas other noteworthy studies have failed to confirm such findings. Studies of the accuracy of risk assessments indicate that both actuarial and clinical methodologies perform better than chance, although the former achieve greater statistical accuracy. Despite ongoing controversies, risk management strategies that encompass the strengths and limitations of our present knowledge are available to clinicians.

Prosecuting Assaultive Psychiatric Patients

For many reasons, inpatient psychiatric units are increasingly faced with treatment and management of violent individuals. This fosters a need to consider potential institutional responses to patient violence. This paper focuses on one response--prosecution of these persons. The existing literature on this topic is reviewed. In addition, the case history of a difficult but successful prosecution of an assaultive patient is presented. This case highlighted the development of guidelines, which are outlined herein, for determining the appropriateness of seeking legal action against patients. The paper concludes with an assessment of the benefits and risks associated with patient prosecution.

Assessing Insanity Acquittee Recidivism in Connecticut

For over 30 years now the movement and status of insanity acquittees in Connecticut has been supervised by the Psychiatric Security Review Board (PSRB). During this time, 365 acquittees have been committed to the jurisdiction of the PSRB, 177 individuals have achieved conditional release (CR) and 215 acquittees have been discharged from PSRB jurisdiction. This article examines revocation of CR by the PSRB, arrests of acquittees on CR, and provides the first report of arrests following discharge from the PSRBs jurisdiction. The literature on relevant aspects of recidivism is reviewed and compared with findings in Connecticut. There is little available literature about recidivism of insanity acquittees following release from supervision. In the present sample of individuals discharged from the PSRB, 16% were rearrested, a rate that compares favorably with other discharged populations of offenders. For discharged acquittees, community supervision on CR prior to discharge from the PSRB had a statistically significant effect on decreasing the risk of subsequent rearrest, as did both the length of stay in the hospital and the duration of commitment to the PSRB. This article presents descriptive information about revocations, arrests on CR, and arrests following discharge. These data are consistent with criminal justice studies demonstrating the value of community supervision in lowering recidivism. Copyright

Can Religion Protect Against Suicide

Abstract The vast majority of the worlds population is affiliated with a religious belief structure, and each of the major faith traditions (in its true form) is strongly opposed to suicide. Ample literature supports the protective effect of religious affiliation on suicide rates. Proposed mechanisms for this protective effect include enhanced social network and social integration, the degree of religious commitment, and the degree to which a particular religion disapproves of suicide. We review the sociological data for these effects and the general objections to suicide held by the faith traditions. We explore how clinicians may use such knowledge with individual patients, including routinely taking a religious/spiritual history. The clinician who is aware of the common themes among the faith traditions in opposition to suicide is better prepared to address religious/spiritual matters, as appropriate, in crisis situations. The clinician who understands the patients belief system is also better prepared to request consultation with religious professionals when indicated.

The forensic psychiatric report.

The construction of a written forensic report is a core component of forensic practice, demonstrating the evaluators skill in conducting the evaluation and in communicating relevant information to the legal audience in an effective manner. Although communication skills and quality of written documentation are important in clinical psychiatry generally, they form the sine qua non of successful forensic work, which consists in telling complex stories in a coherent and compelling fashion. High quality forensic reports require careful preparation from the earliest stages of work on a case. They generally follow an expected structure, which permits the evaluator to provide all the data necessary to form a carefully reasoned opinion that addresses the legal questions posed. Formats and content of reports vary according to the type of case and the circumstances of the evaluation and so require flexibility within customary frameworks. The style and quality of writing are critical to the crafting of forensic reports. The effects on legal decision-makers of various approaches to the presentation of information in reports has not been studied empirically, but guidance from experienced forensic psychiatrists is available. There is a small body of research on quality improvement in forensic writing, and further empiric study is warranted.

Duty to Warn and Dissociative Identity Disorder

How to treat a patient with a dissociative identity disorder and how to manage a threat made by one of the patients personalities. Virtual Mentor is a monthly bioethics journal published by the American Medical Association.